When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Non-small cell lung cancer

Ver PDF
  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão: 1 Dec 2025
Última atualização: 23 Dec 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • cough
  • dyspnea
  • hemoptysis
  • chest and/or shoulder pain
  • weight loss
Detalhes completos

Outros fatores diagnósticos

  • 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
Detalhes completos

Fatores de risco

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

OH

Declarações

AAA declares that he has no competing interests.

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

NY

Declarações

JH declares that he has no competing interests.

Siow Ming Lee, PhD, FRCP

Consultant Medical Oncologist

University College Hospital

London

UK

Declarações

SML declares that he has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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

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

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].Texto completo

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.Texto completo

Reuss JE, Kuruvilla S, Ismaila N, et al. Therapy for stage IV non-small cell lung cancer with driver alterations: ASCO living guideline, version 2025.1. J Clin Oncol. 2025 Aug 20;43(24):e31-44.Texto completo  Resumo

Owen DH, Halmos B, Puri S, et al. Therapy for stage IV non-small cell lung cancer without driver alterations: ASCO living guideline, version 2025.1. J Clin Oncol. 2025 Aug 20;43(24):e45-58.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

  • Diagnósticos diferenciais

    • Small cell lung cancer
    • Metastatic cancer
    • Pneumonia/bronchitis
    Mais Diagnósticos diferenciais

  • 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
    Mais Diretrizes

  • Folhetos informativos para os pacientes

    Lung cancer (non-small-cell)

    Lung cancer: questions to ask your doctor

    Mais Folhetos informativos para os pacientes

  • Videos

    Insertion of intercostal drain, Seldinger technique: animated demonstration

    Pleural aspiration animated demonstration

    Mais vídeos
  • padlock-lockedConectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal