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Câncer pulmonar de células não pequenas

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 17 Jul 2025
Last updated: 15 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • tosse
  • dispneia
  • hemoptise
  • dor torácica e/ou nos ombros
  • perda de peso
Full details

Other diagnostic factors

  • sexo masculino
  • fadiga
  • anormalidades observadas no exame pulmonar
  • rouquidão
  • confusão
  • alterações da personalidade
  • náuseas e vômitos
  • cefaleia
  • disfagia
  • dor óssea e/ou fraturas
  • fraqueza, parestesias e/ou dor na distribuição C8/T1
  • convulsões
  • adenopatia cervical ou supraclavicular
  • síndrome de Horner
  • edema facial
  • veias dilatadas no pescoço ou na parede torácica/abdominal
  • baqueteamento digital
  • osteoartropatia hipertrófica pulmonar
Full details

Risk factors

  • tabagismo
  • exposição ambiental ao tabaco
  • doença pulmonar obstrutiva crônica (DPOC)
  • história familiar
  • exposição ao gás radônio
  • idade avançada
  • exposição ao asbesto
Full details

Diagnostic investigations

1st investigations to order

  • radiografia torácica
  • tomografia computadorizada (TC) com contraste da região cervical inferior, tórax e abdome superior
Full details

Investigations to consider

  • citologia do escarro
  • broncoscopia
  • biópsia
  • toracocentese e/ou biópsia pleural diagnósticas
  • amostragem dos linfonodos mediastinais: mediastinoscopia e ultrassonografia endobrônquica (EBUS)
  • cirurgia toracoscópica videoassistida (CTVA)
  • toracoscopia
  • ressonância nuclear magnética (RNM) ou TC cranioencefálica
  • RNM do desfiladeiro torácico
  • TC com contraste e/ou PET com fluordesoxiglucose (FDG)
  • cintilografia óssea
  • TC com contraste do fígado e adrenais
  • testes de função pulmonar (TFP)
  • Hemograma completo
  • TFHs
  • cálcio sérico
  • eletrólitos e função renal
  • eletrocardiograma e ecocardiografia
  • teste de mutação do receptor do fator de crescimento epidérmico (EGFR)
  • teste da quinase do linfoma anaplásico (ALK)
  • Teste para proto-oncogene ROS (ROS1)
  • teste do ligante de morte celular programada 1 (PD-L1)
  • Teste para proto-oncogene B-Raf (BRAF)
  • Teste para fusão do receptor de tirosina quinase neurotrofina (NTRK)
  • Mutações descontínuas do fator de transição mesenquimal-epitelial (MET) exon 14 (METex14)
  • testes de mutações genéticas rearranjadas durante a transfecção (RET)
  • Teste de mutações pontuais do proto-oncogene KRAS (KRAS)
  • testes de mutação em ERBB2 (HER2)
Full details

Treatment algorithm

ONGOING

estádio I e II

estádio IIIA

estádio IIIB e IIIC

estádio III com tumores muito extensos para quimiorradioterapia combinada ou estádio IV e adequado para imunoterapia ou terapia direcionada

estádio III com tumores muito extensos para quimiorradioterapia combinada ou estádio IV e inadequados para imunoterapia ou terapia direcionada (capacidade funcional ECOG 0-2)

estádio III com tumores muito extensos para quimiorradioterapia combinada ou estádio IV e inadequados para imunoterapia ou terapia direcionada (capacidade funcional ECOG 3-4)

Contributors

Authors

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

Disclosures

AAA declares that he has no competing interests.

Dr Fen Wang, MD

Peking University Shenzhen Hospital

Shenzhen

Guangdong

China

Disclosures

FW declares that she has no competing interests

Acknowledgements

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.

Disclosures

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.

Peer reviewers

Alan Neville, MD

Professor

Assistant Dean

Undergraduate Program

McMaster University

Hamilton

Ontario

Canada

Disclosures

AN declares that he has no competing interests.

James Huang, MD

Assistant Attending Surgeon

Thoracic Service

Memorial Sloan Kettering Cancer Center

New York

NY

Disclosures

JH declares that he has no competing interests.

Siow Ming Lee, PhD, FRCP

Consultant Medical Oncologist

University College Hospital

London

UK

Disclosures

SML declares that he has no competing interests.

References

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.

Key articles

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

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

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].Full text

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.Full text

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.Full text  Abstract

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.Full text  Abstract

Reference articles

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

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