小结
定义
病史和体格检查
关键诊断因素
- cough
- dyspnea
- hemoptysis
- chest and/or shoulder pain
- weight loss
其他诊断因素
- 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
危险因素
- cigarette smoking
- environmental tobacco exposure
- chronic obstructive pulmonary disease (COPD)
- family history
- radon gas exposure
- older age
- asbestos exposure
诊断性检查
首要检查
- chest x-ray
- contrast-enhanced CT scan of lower neck, thorax, and upper abdomen
需考虑的检查
- 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
治疗流程
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)
撰稿人
作者
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
OH
利益声明
AAA declares that he has no competing interests.
Dr Fen Wang, MD
Peking University Shenzhen Hospital
Shenzhen
Guangdong
China
利益声明
FW declares that she has no competing interests.
鸣谢
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.
利益声明
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.
同行评议者
Alan Neville, MD
Professor
Assistant Dean
Undergraduate Program
McMaster University
Hamilton
Ontario
Canada
利益声明
AN declares that he has no competing interests.
James Huang, MD
Assistant Attending Surgeon
Thoracic Service
Memorial Sloan Kettering Cancer Center
New York
NY
利益声明
JH declares that he has no competing interests.
Siow Ming Lee, PhD, FRCP
Consultant Medical Oncologist
University College Hospital
London
UK
利益声明
SML declares that he has no competing interests.
参考文献
关键文献
National Institute for Health and Care Excellence. Lung cancer: diagnosis and management. March 2024 [internet publication].全文
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: non-small cell lung cancer [internet publication].全文
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].全文
Hendriks L E, Kerr K, Menis J, et al. on behalf of the ESMO Guidelines Committee. Non-oncogene-addicted metastatic non-small-cell lung cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Jan 2023;34(4):358-76.全文
Bazhenova L, Ismaila N, Abu Rous F, et al. Therapy for stage IV non-small cell lung cancer with driver alterations: ASCO living guideline, version 2024.2. J Clin Oncol. 2024 Dec 20;42(36):e72-86.全文 摘要
Jaiyesimi IA, Leighl NB, Ismaila N, et al. Therapy for stage IV non-small cell lung cancer without driver alterations: ASCO living guideline, version 2023.3. J Clin Oncol. 2024 Apr 10;42(11):e23-43.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Small cell lung cancer
- Metastatic cancer
- Pneumonia/bronchitis
更多 鉴别诊断Guidelines
- 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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