Non-small cell lung cancer

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Última revisão: 24 Mar 2025

Última atualização: 15 Apr 2025

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.

Definição

Lung cancer comprises a group of malignant epithelial tumors arising from cells lining the lower respiratory tract. Lung cancer is divided into two 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.

História e exame físico

Principais fatores diagnósticos

cough
dyspnea
hemoptysis
chest and/or shoulder pain
weight loss

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

sputum cytology
bronchoscopy
biopsy
diagnostic thoracentesis and/or pleural biopsy
sampling of the mediastinal lymph nodes: mediastinoscopy and endobronchial ultrasound (EBUS)
video-assisted thoracoscopic surgery (VATS)
thoracoscopy
MRI or CT of brain
MRI of thoracic inlet
CT with contrast and/or fluorodeoxyglucose (FDG)-PET
bone scan
contrast-enhanced CT liver and adrenals
pulmonary function tests (PFT)
CBC
LFTs
serum calcium
electrolytes and renal function
electrocardiogram and echocardiogram
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

Detalhes completos

Algoritmo de tratamento

CONTÍNUA

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)

Colaboradores

Autores

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

Declarações

AAA declares that he has no competing interests.

Dr Fen Wang, MD

Peking University Shenzhen Hospital

Shenzhen

Guangdong

China

Declarações

FW declares that she has no competing interests.

Agradecimentos

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.

Declarações

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.

Revisores

Alan Neville, MD

Professor

Assistant Dean

Undergraduate Program

McMaster University

Hamilton

Ontario

Canada

Declarações

AN declares that he has no competing interests.

James Huang, MD

Assistant Attending Surgeon

Thoracic Service

Memorial Sloan Kettering Cancer Center

New York

Declarações

JH declares that he has no competing interests.

Siow Ming Lee, PhD, FRCP

Consultant Medical Oncologist

University College Hospital

London

Declarações

SML declares that he has no competing interests.

Diagnósticos diferenciais
- Small cell lung cancer
- Metastatic cancer
- Pneumonia/bronchitis
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Diretrizes
- 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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Folhetos informativos para os pacientes
Lung cancer (non-small-cell)
Lung cancer: questions to ask your doctor
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Non-small cell lung cancer

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

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)

Colaboradores

Autores

Alex A. Adjei, MD, PhD, FACP

Declarações

Dr Fen Wang, MD

Declarações

Agradecimentos

Declarações

Revisores

Alan Neville, MD

Declarações

James Huang, MD

Declarações

Siow Ming Lee, PhD, FRCP

Declarações

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice