pulmonary disorders
Lung Carcinoma
Key Points
The main factor contributing to lung cancer is smoking. About 15% of all lung cancer patients have never smoked cigarettes and have suspected driver mutations. Lung cancer can be small cell lung carcinoma (SCLC) or non–small cell lung carcinoma (NSCLC). Several genetic driver mutations that are amenable to targeted drugs have been identified in NSCLC; newly diagnosed adenocarcinoma should be tested forEGFR,ALK,BRAF, andROS1mutations. Tumors should also have PD-L1 immunostaining. Manifestations can include cough, fever, hoarseness, pleural effusion, pneumonia, Pancoast tumor, paraneoplastic syndromes, superior vena cava syndrome, Horner syndrome, and metastases to the brain, liver, and bone. Suspect the diagnosis based on clinical information and imaging studies (eg, CT, PET-CT), and confirm it histologically (eg, by cytology of sputum or pleural fluid or core biopsy). Consider yearly screening with low-dose helical CT for people who currently smoke and those who formerly smoked who are ≥ 50 years and at high risk (> 20 pack-years of smoking, people who formerly smoked must have quit < 15 years ago); shared decision making should occur before imaging is pursued. Do testing, beginning with whole-body imaging, to stage cancer. Treat early-stage NSCLC with resection when pulmonary reserve is adequate, often followed by chemotherapy. Treat advanced stage SCLC and NSCLC with chemotherapy and/or immunotherapy. Genetic testing should be completed on adenocarcinoma to help define treatment regimens. 