We have reviewed the histopathology of lung cancer patients seen over the past 13 years at RPMI. Assessment of this data indicates that adenocarcinoma is becoming progressively more prevalent as related to the other forms of lung cancer. Factors which in part may account for this increased prevalence are: 1) changes in criteria for reading histopathology of lung cancer, particularly since 1967; 2) the increased incidence of lung cancer among the female population who have a propensity for adenocarcinoma; and 3) occupational and environmental factors. In 1974 adenocarcinoma for the first time became the most prevalent type of lung cancer at RPMI. Whatever the reason, if our data are truly representative of a national trend, adenocarcinoma will soon become the most prevalent type of lung cancer in the United States. This fact may result in an increasing death rate since the present 18-month survival rate for adenocarcinoma is substantially less than for squamous cell carcinoma, which has in the past been the prevalent form of the disease. As the smoking habits of women more closely approximate those of men, we expect that the incidence and mortality of lung cancer will prove to be quite similar in both sexes.

Two hundred and twenty-eight patients who were treated for carcinoma of the lung were followed a n d their plasma CEA levels assessed at intervals during the course of the disease. In addition, plasma samples were taken from 487 healthy blood donors for comparison as a control. CEA assay is not selective or specific enough, at this time, to be used for screening purposes even though 68% of the patients who have lung cancer will have a n elevated concentration of CEA regardless of the histological cell type. In patients with plasma levels of CEA above 15 ng/ml the prognosis is uniformly poor. CEA in the authors' view does have value as a prognostic marker capable of suggesting the successful resection of a tumor and to a lesser degree confirming the clinical objective response to the radiotherapy or chemotherapy. It was found that the presence of CEA was not necessarily related to the volume of the tumor or the site of organ metastasis, but reflects the metabolic properties and characteristics of the individual tumor as it occurs in the patient.

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Carcinoembryonic antigen levels in 682 lung cancer patients have been studied in order to assess their value in the screening of high-risk populations, monitoring total surgical ablation and projecting the effectiveness of therapy. The initial values are shown to be related to the histology of the tumor and to the extent of the disease. All histologic types of lung cancer produce elevated CEA but adenocarcinoma characteristically produces higher values than small, large or squamous cell carcinomas. CEA has its most precise value in distinguishing at an early date cured patients subsequent to surgical resection from those patients who will eventually fail because of recurrent disease.Cancer 44:685-691, 1979.