小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 咳嗽
- 呼吸困难
- 咯血
- 胸痛和/或肩痛
- 体重减轻
其他诊断因素
- 男性
- 疲劳
- 肺部检查异常
- 声嘶
- 意识模糊
- 人格改变
- 恶心和呕吐
- 头痛
- 吞咽困难
- 骨痛和/或骨折
- 无力、C8/T1 分布区感觉异常和/或疼痛
- 癫痫发作
- 颈部或锁骨上淋巴结肿大
- Horner 综合征
- 面部肿胀
- 颈部或胸部/腹壁静脉曲张
- 杵状指
- 肥大性肺性骨关节病
危险因素
- 吸烟
- 暴露于烟草环境
- 慢性阻塞性肺疾病
- 家族史
- 氡气暴露
- 老年
- 石棉暴露
诊断性检查
首要检查
- 胸部 X 线检查
- 颈部下段、胸部和上腹部的对比增强 CT 检查
需考虑的检查
- 痰液细胞学检查
- 支气管镜检查
- 活检
- 具有诊断意义的胸腔穿刺术和/或胸膜活检
- 纵隔淋巴结取样：纵隔镜检查和支气管内超声（EBUS）
- 电视辅助胸腔镜手术 (VATS)
- 胸腔镜
- 脑部 MRI 或 CT
- 胸廓入口 MRI
- 正电子发射断层显像 (PET-CT)
- 骨扫描
- 肝脏和肾上腺对比增强 CT
- 肺功能试验 (PFT)
- 全血细胞计数 (FBC)
- 肝功能检查 (LFT)
- 血清钙
- 电解质和肾功能
- 心电图和超声心动图
- 表皮生长因子受体 (EGFR) 突变检测
- 间变性淋巴瘤激酶 (ALK) 检测
- ROS 原癌基因 1（ROS1）检测
- 程序性死亡-配体 1 (PD-L1) 检测
- B-Raf 原癌基因（BRAF）检测
- 神经营养因子受体络氨酸激酶（NTRK）基因融合检测
- c-间质-上皮转化因子（c-MET）14 号外显子（METex14）跳跃突变检测
- 转染重排（RET）基因突变检测
- KRAS 原癌基因（KRAS）点突变检测
- ERBB2（HER2）突变检测
治疗流程
I 期和 II 期
IIIA 期
IIIB 和 IIIC 期
III 期，肿瘤范围太广，无法行联合放化疗，或 IV 期，适合免疫疗法或靶向疗法
III 期，肿瘤范围太广，无法行联合放化疗，或 IV 期，不适合免疫疗法或靶向疗法（ECOG 体能状态为 0-2 级）
III 期，肿瘤范围太广，无法行联合放化疗，或 IV 期，不适合免疫疗法或靶向疗法（ECOG 评分为 3-4 分）
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 has acted as an uncompensated advisory board member for Swiss Rockets, Merck AG, and Zai Lab.
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.
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