Disease Description (Causes and Symptoms)
- Definition and pathophysiology
- Non-small cell lung cancer (NSCLC): Classified by histologic type into adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and others; it is distinguished from small cell lung cancer. Clinical manifestations and treatment strategies vary according to the tumor’s location and histologic type. Lung cancer is often asymptomatic until the advanced stages, making early detection difficult.
- Major causes and risk factors
- Smoking (the greatest risk factor)
- Occupational exposure (asbestos, arsenic, etc.) and air pollution
- Individual factors: radiation exposure and certain genetic predispositions
- Characteristic pathology and sites of origin
- Adenocarcinoma: Commonly occurs in the peripheral lung (small bronchi and the distal parts of the lung) and has a relatively high incidence among nonsmokers and women.
- Squamous cell carcinoma: Frequently occurs in the central large bronchi and may cause symptoms of bronchial obstruction.
- Large cell carcinoma: Often occurs near the surface of the lung.
- Major symptoms
- Cough, hemoptysis (bloody sputum), chest pain, shortness of breath, weight loss, and fatigue
- Often asymptomatic in the early stages → frequent hospital visits after progression
- Complications and symptoms (rarely)
- Infection due to obstruction, pleural effusion, metastasis (to the brain, bones, liver, etc.), and paraneoplastic syndromes (e.g., hypercalcemia in squamous cell carcinoma)
Treatment Methods
- General principles of diagnosis
- Confirm the diagnosis through biopsy (bronchoscopy, percutaneous needle biopsy, sputum cytology, etc.), establish the stage (CT, PET-CT, brain MRI, bone scan, etc.), and then develop a treatment plan.
- Local treatment (early stages)
- Surgery: Lobectomy or limited resection (segmentectomy, wedge resection), bronchial resection, etc.; performed with the goal of cure. Pneumonectomy may also be necessary in some cases.
- Radiation therapy: Definitive radiation for patients who cannot undergo surgery (e.g., high-dose intensity-modulated radiation therapy), and adjuvant radiation therapy after surgery.
- Systemic treatment (advanced or metastatic disease)
- Chemotherapy: Platinum-based combination therapy is commonly used as the standard first-line treatment.
- Targeted therapy: For patients who test positive for genetic alterations such as EGFR, ALK, ROS1, BRAF, MET, or RET, mutation-matched targeted agents (e.g., EGFR-TKIs, ALK inhibitors, etc.) are applied first.
- Immunotherapy: PD-1/PD-L1 inhibitors (e.g., pembrolizumab, etc.) are used alone or in combination with anticancer drugs. The level of PD-L1 expression affects treatment decisions.
- The priority of targeted therapy or immunotherapy is determined according to the stage and the results of molecular target testing.
- Summary of recommendations by stage
- Stages 1–2: Surgery is first-line; adjuvant chemotherapy or radiation therapy may be considered
- Stage 3A: Surgery and adjuvant treatment (chemotherapy/radiation) if surgery is possible; concurrent chemoradiation or systemic therapy if surgery is not possible
- Stages 3B–4: Focus on systemic treatment (targeted therapy, immunotherapy, and chemotherapy) and symptom relief
- Supportive care and lifestyle management
- Smoking cessation, nutritional management, pulmonary rehabilitation (to maintain lung function), management of pain and shortness of breath, and infection prevention (consider influenza and pneumococcal vaccination)
- Treatment precautions/side effects
- Surgery: Decreased lung function, infection, bleeding, and risk of complications (increased risk in patients with cardiovascular disease)
- Radiation therapy: Radiation pneumonitis, esophagitis, etc.
- Chemotherapy: Bone marrow suppression (risk of infection), nausea and vomiting, neuropathy, etc.
- Targeted therapy: Drug-specific side effects such as skin rash and elevated liver enzymes
- Immunotherapy: Immune-related adverse events (systemic inflammation involving the skin, intestines, liver, endocrine organs, etc.) — early detection and treatment are necessary
Checklist Before an Outpatient Visit (Including Sample Questions)
- Items to prepare and confirm
- A list of currently taken medications (including prescription drugs, OTC drugs, and supplements) and a history of allergies
- Copies or digital files of previous tests and imaging (chest X-rays, CT, PET, biopsy findings, pathology reports, etc.)
- Records of when symptoms began and how they have changed (e.g., the date the cough started, frequency of hemoptysis, and whether shortness of breath has worsened)
- Smoking history (current smoking status, pack-year) and occupational history (exposure to asbestos or chemicals)
- Weight changes, fever, degree of fatigue, and exercise capacity (ECOG/performance status)
- Whether previous chemotherapy or radiation therapy was received and any history of side effects
- Preparation for the day of the outpatient visit
- Whether fasting is required if testing is needed (follow the instructions provided before bronchoscopy or a procedure)
- Wear clothing suitable for examinations; bringing a caregiver is recommended (in preparation for the possibility of a procedure or hospitalization)
- Sample questions (questions for the patient to prepare before seeing the doctor)
- “Can a treatment plan be established with the tests I currently have (images and pathology), without additional testing?”
- “My recent symptoms (e.g., hemoptysis and shortness of breath) have worsened. Is there an examination or treatment I should receive immediately?”
Examples of General Questions to Ask the Doctor
- What is the exact stage of this disease? What is the prognosis?
- Based on my biopsy results, are additional molecular target tests (EGFR, ALK, ROS1, PD-L1, etc.) needed?
- What is the recommended first-line treatment, and what effects and side effects can be expected?
- If surgery is possible, how long is the expected recovery period and how long until I can return to daily activities after surgery?
- If immunotherapy or targeted therapy is possible, what are the major complications of the medication and how will they be monitored?
Examples of Disease-Specific Questions
- Regarding molecular targets
- “Were tests performed for mutations in EGFR/ALK/ROS1/BRAF/MET/RET and for PD-L1 expression in the pathology examination? Please explain which targeted therapies are recommended according to the results.”
- Regarding treatment selection
- “For my stage, please explain specifically why surgery is the best option or which combination of chemotherapy, radiation therapy, and immunotherapy is recommended, as well as the expected differences in survival and quality of life.”