Optical and Functional Imaging in Lung Cancer

Lung cancer is the second most common cancer in men and women, and is the leading cause of cancer related death. In industrialized countries the mortality rate of lung cancer is higher than the mortality rate of breast, colorectal and prostate cancer combined 1. When lung cancer is diagnosed at an early stage patients are considered to have the best overall survival rate 2. Unfortunately, only a minority of patients is currently diagnosed at a curable stage of disease. The lack of specific symptoms at an early stage of the disease, the rapid growth of tumor cells and the metastatic behavior of lung tumors are the main reasons for a diagnosis at an advanced stage. Non-small-cell lung cancer (NSCLC) can be divided into three major histological subtypes: squamouscell carcinoma, adenocarcinoma, and large-cell carcinoma 3. Eighty-five percent of the lung cancer patients are diagnosed with NSCLC, and 75% of the patients are diagnosed with an incurable stage IIIB or IV disease 4, 5. Fifteen percent of the lung cancer patients have small-cell-lung cancer (SCLC) and the 5-year survival for them is even lower than for NSCLC 6. Whereas originally smoking is at the root of all types of lung cancer, the incidence of lung cancer in never smokers increases 7. Smoking is most strongly linked with SCLC and squamous-cell carcinoma 8, 9, although after the introduction of filter cigarets an increased incidence of adenocarcinomas was observed 10. This resulted in a change in ratio of adenocarcinomas-squamous cell carcinomas towards adenocarcinomas 8, 11. In some countries squamous cell carcinoma is still the most common histological type of lung cancer in male patients, e.g. France (41%) and United Kingdom (40%). In other countries adenocarcinoma is the most common type e.g. USA and Canada 12. In patients without a smoking history adenocarcinoma is most common 13-16. Despite new insights and improved medical treatments, lung cancer remains the type of cancer with the highest mortality. Additional studies are needed to improve detection of lung cancer in an early (pre)malignant stage to improve survival. Improved pretreatment staging of lung cancer is necessary to prevent under- or over treatment. Furthermore a better understanding of tumor behavior improves treatment modalities. In this introduction the histological subtypes of lung cancer, the microenvironment of lung cancer and systemic treatment modalities are described. Furthermore several imaging techniques to analyze the microenvironment of lung cancer tissue are discussed.

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