Non-small cell lung cancer

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Теория 
Диагноз 
Лечение 
Последующее наблюдение 
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Последний просмотренный: 25 Aug 2026

Last updated: 07 May 2026

Non-small cell lung cancer is most common in older adult smokers and ex-smokers. Small tumors in the lung are often asymptomatic, so the majority of patients have either locally advanced or metastatic disease at diagnosis.

Most common presenting symptoms are cough, chest pain, hemoptysis, dyspnea, and weight loss.

A suspicious lung mass can be biopsied during bronchoscopy or using CT guidance. Staging studies (i.e., CT, PET, mediastinal sampling) are required to determine extent of local or regional disease and to evaluate for metastases.

Treatment depends on stage of disease, histologic subtype, molecular genotype, and patient comorbidities. Treatment modalities include surgery, radiation therapy, and chemotherapy, as well as molecular-targeted therapy for specific genotypes and immunotherapy.

Определение

Lung cancer comprises a group of malignant epithelial tumors arising from cells lining the lower respiratory tract. Lung cancer is divided into two histologic categories: non-small cell lung cancer (NSCLC) and small cell lung cancer. NSCLC accounts for more than 80% of all lung cancers.[1] There are three main types of NSCLC (adenocarcinoma, squamous cell carcinoma, and large cell carcinoma) and these are grouped into further subtypes.

Анамнез и осмотр

Ключевые диагностические факторы

cough
dyspnea
hemoptysis
chest and/or shoulder pain
weight loss

Полная информация

Другие диагностические факторы

older age
male sex
fatigue
pulmonary exam abnormalities
hoarseness
confusion
personality changes
nausea and vomiting
headache
dysphagia
bone pain and/or fractures
weakness, paresthesias, and/or pain in C8/T1 distribution
seizures
cervical or supraclavicular adenopathy
Horner syndrome
facial swelling
dilated neck or chest/abdominal wall veins
finger clubbing
hypertrophic pulmonary osteoarthropathy

Полная информация

Факторы риска

cigarette smoking
environmental tobacco exposure
chronic obstructive pulmonary disease (COPD)
family history
radon gas exposure
older age
asbestos exposure
male sex

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

chest x-ray
contrast-enhanced CT scan of lower neck, thorax, and upper abdomen

Полная информация

Исследования, проведение которых нужно рассмотреть

sputum cytology
bronchoscopy
biopsy
diagnostic thoracentesis and/or pleural biopsy
CT with contrast and/or fluorodeoxyglucose (FDG)-PET
sampling of the mediastinal lymph nodes: mediastinoscopy and endobronchial ultrasound (EBUS)
video-assisted thoracoscopic surgery (VATS)
thoracoscopy
MRI head
MRI of thoracic inlet
bone scan
pulmonary function tests (PFT)
CBC
LFTs
serum calcium
electrolytes and renal function
epidermal growth factor receptor (EGFR) mutation testing
anaplastic lymphoma kinase (ALK) testing
ROS proto-oncogene 1 (ROS1) testing
programmed death-ligand 1 (PD-L1) testing
B-Raf proto-oncogene (BRAF) testing
neurotrophin tyrosine receptor kinase (NTRK) fusion testing
mesenchymal-epithelial transition factor (MET) exon 14 (METex14) skipping mutations
rearranged during transfection (RET) gene mutations testing
KRAS proto-oncogene (KRAS) point mutations testing
ERBB2 (HER2) mutations testing
neuregulin 1 (NRG1) fusion testing
c-MET overexpression (≥50% immunohistochemistry [IHC] 3+) and EGFR wild-type (no EGFR mutation) testing

Полная информация

Алгоритм лечения

ПРОДОЛЖЕНИЕ

stage I and II

stage IIIA

stage IIIB and IIIC

stage III with tumors too extensive for combination chemoradiation therapy or stage IV and suitable for immunotherapy or targeted therapy

stage III with tumors too extensive for combination chemoradiation therapy or stage IV and unsuitable for immunotherapy or targeted therapy (ECOG performance 0-2)

stage III with tumors too extensive for combination chemoradiation therapy or stage IV and unsuitable for immunotherapy or targeted therapy (ECOG performance 3-4)

Составители

Авторы

Alex A. Adjei, MD, PhD, FACP

Chairman, Taussig Cancer Institute

M. Frank Rudy and Margaret Domiter Rudy Distinguished Chair in Translational Cancer Research

Cleveland Clinic

Cleveland

Раскрытие информации

AAA declares that he has no competing interests.

Fen Wang, MD

Peking University Shenzhen Hospital

Shenzhen

Guangdong

China

Раскрытие информации

FW declares that she has no competing interests.

Выражение благодарностей

Professor Alex A. Adjei and Dr Fen Wang would like to gratefully acknowledge Professor David R. Baldwin, Dr Sanjay Popat, Dr Mick Peake, Dr Chris Kelsey, and Dr Lawrence Marks, previous contributors to this topic.

Раскрытие информации

DRB declares that he has no competing interests. SP has been paid and acted as a consultant to BMS, Eli Lilly, Roche, Takeda, AstraZeneca, Chugai, Novartis, Pfizer, MSD, EMD Serono, Guardant Health, AbbVie, Boehringer Ingelheim, and Tesaro; SP has received research grants from Pierre Fabre, Otsuka, and Boehringer Ingelheim; SP has received assistance for travel from Boehringer Ingelheim, MSD, and Pfizer. MP has received lecture fees from AstraZeneca Pharmaceuticals, Lilly Oncology Ltd, Pierre-Fabre, GSK Ltd, and Roche Pharmaceuticals Ltd; MP has also received educational grants to attend scientific conferences from Roche Pharmaceuticals Ltd and Boehringer Ingelheim Ltd. CK and LM declare that they have no competing interests.

Рецензенты

Alan Neville, MD

Professor

Assistant Dean

Undergraduate Program

McMaster University

Hamilton

Ontario

Canada

Раскрытие информации

AN declares that he has no competing interests.

James Huang, MD

Assistant Attending Surgeon

Thoracic Service

Memorial Sloan Kettering Cancer Center

New York

Раскрытие информации

JH declares that he has no competing interests.

Siow Ming Lee, PhD, FRCP

Consultant Medical Oncologist

University College Hospital

London

Раскрытие информации

SML declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: non-small cell lung cancer [internet publication].Полный текст

National Institute for Health and Care Excellence. Lung cancer: diagnosis and management. March 2024 [internet publication].Полный текст

European Society for Medical Oncology. Oncogene-mediated metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Jan 2023 [internet publication].Полный текст

Hendriks LEL, Cortiula F, Martins-Branco D, et al. Updated treatment recommendations for systemic treatment: from the ESMO non-oncogene-addicted metastatic NSCLC living guideline. Ann Oncol. 2025 Oct;36(10):1223-7.Полный текст

Puri S, Leighl NB, Ismaila N, et al. Therapy for stage IV non-small cell lung cancer with driver alterations: ASCO living guideline, 2026.3.0. J Clin Oncol. 2026 Mar;44(7):e15-55.Полный текст Аннотация

Reuss JE, Bazhenova L, Ismaila N, et al. Therapy for stage IV non-small cell lung cancer without driver alterations: ASCO living guideline, 2026.3.0. J Clin Oncol. 2026 Mar;44(7):e56-88.Полный текст Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия
- Small cell lung cancer
- Metastatic cancer
- Pneumonia/bronchitis
Больше Отличия
Рекомендации
- Therapy for stage IV non-small-cell lung cancer with driver alterations: ASCO living guideline
- Therapy for stage IV non-small-cell lung cancer without driver alterations: ASCO living guideline
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Использование этого контента попадает под действие нашего заявления об отказе от ответственности

Non-small cell lung cancer

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

stage I and II

stage IIIA

stage IIIB and IIIC

stage III with tumors too extensive for combination chemoradiation therapy or stage IV and suitable for immunotherapy or targeted therapy

stage III with tumors too extensive for combination chemoradiation therapy or stage IV and unsuitable for immunotherapy or targeted therapy (ECOG performance 0-2)

stage III with tumors too extensive for combination chemoradiation therapy or stage IV and unsuitable for immunotherapy or targeted therapy (ECOG performance 3-4)

Составители

Авторы

Alex A. Adjei, MD, PhD, FACP

Раскрытие информации

Fen Wang, MD

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Alan Neville, MD

Раскрытие информации

James Huang, MD

Раскрытие информации

Siow Ming Lee, PhD, FRCP

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Videos

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice