Lung cancer has surpassed breast cancer in becoming the leading cause of cancer death in women. Adenocarcinoma accounts for 30-40% of lung cancers and is the most common histologic type. It is also the most common type of lung cancer in non-smokers (an estimated 10-15% of patients diagnosed with lung cancer are non-smokers). The most common sites of distant metastases are the brain, bones (most commonly vertebrae), liver, adrenals, and skin. The American Thoracic Society recommends measurement of a CBC, serum electrolytes, calcium, alkaline phosphatase, albumin, AST, ALT, total bilirubin, and creatinine in all patients with lung cancer. Abnormal LFTs should be followed up with a contrast-enhanced CT of the liver, and an elevated alkaline phosphatase or calcium level should be followed up with a bone or PET scan to detect metastases (there is conflicting evidence as to which imaging modality has greater sensitivity). With regard to monitoring response to therapy, one study reported that changes in FDG uptake on PET scan rather than changes in lesion size on CT more accurately correlates with response to therapy. Stage IV disease is primarily managed with chemotherapy or with palliative measures for symptomatic relief, and the five year survival rate is less than 5%.

Systematic screening for lung cancer is not currently recommended by any major medical organizations. The USPSTF concluded that there is currently insufficient evidence to argue for or against screening asymptomatic individuals for lung cancer with either chest x-ray, low dose computerized tomography, sputum cytology, or a combination of these tests. Studies evaluating the benefits of screening have shown increased detection of early stage lung cancer in asymptomatic individuals but have not shown a reduction in mortality. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial is an ongoing trial evaluating the use of a single posterior-anterior CXR, and the Early Lung Cancer Action Project is currently evaluating the use of low-dose spiral CT for screening.