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2We found that adenocarcinoma is now the most common histological subtype of primary lung cancer diagnosed in the Western Cape and that almost 90% of all patients with non-small cell lung cancer have advanced local or metastatic disease at the time of diagnosis. ‘Lung cancer’ denotes cancer arising in the airways and pulmonary parenchyma. Its histopathological designation is based on the World Health Organization classification system, with 4 cell types responsible for most deaths: adenocarcinoma (including bronchoalveolar carcinoma), squamous cell carcinoma, large cell (undifferentiated) carcinoma and small cell carcinoma. 3 Carcinoid tumours and other rare cell types complete the list of cell types. An interesting phenomenon in the developed world over the last two decades has been the relative increase in the diagnosis of adenocarcinoma which has replaced squamous cell carcinoma as the most frequent histological subtype. 4 Many explanations for this well-documented phenomenon have been suggested. There are few current South African data regarding the relative incidence of the various cell types. The latest National Cancer Registry (NCR) report is from 2001, and contains no data on the relative incidence of the lung cancer cell types. 5 Moreover, published and unpublished data from the 1980s suggested that more than 50 - 60% of all lung cancers were squamous cell carcinomas. 6

Adenocarcinoma the most common cell type in patients presenting with primary lung cancer in the Western Cape province