Disease Description (Causes and Symptoms)
- Definition and pathophysiology
- Non-small cell lung cancer (NSCLC) is a major classification of lung cancer. Representative types include lung adenocarcinoma (adenocarcinoma), squamous cell carcinoma, and large cell carcinoma. It grows relatively more slowly than small cell lung cancer but has a high potential for systemic metastasis after local invasion. The main sites of metastasis are the brain, bones, liver, and adrenal glands.
- Causes and risk factors
- Smoking (the greatest risk factor), occupational exposure to carcinogens (such as asbestos and arsenic), air pollution, family history, and certain genetic predispositions. Adenocarcinoma commonly develops in the peripheral lung and tends to occur increasingly in women and nonsmokers.
- Main symptoms
- Cough (persistent), hemoptysis, chest pain, shortness of breath, weight loss, and fatigue. It is often asymptomatic in the early stages, so the disease is frequently advanced at diagnosis.
Treatment Methods
- Diagnostic principles
- Confirmation is made through imaging (chest X-ray → chest CT), sputum tests, bronchoscopy, and percutaneous needle aspiration or biopsy. In patients with advanced disease, additional tests such as PET-CT, brain MRI, and bone scans are performed for staging and treatment planning. Molecular genetic tests (e.g., EGFR, ALK, ROS1, BRAF, etc.) and PD-L1 testing are recommended on biopsy specimens (according to clinical guidelines).
- Standard treatment (stage-based summary)
- Stages I–II (early stage): Surgical resection is the primary treatment (lung resection). Adjuvant chemotherapy after surgery may be needed, depending on the stage and pathological findings.
- Stage IIIA: If surgery is indicated, surgery plus adjuvant radiation therapy/chemotherapy may be considered. For some stage III cases, concurrent chemoradiotherapy is standard (when resection is not possible).
- Stages IIIB–IV (advanced/metastatic): Systemic treatment (chemotherapy), targeted therapy (when molecular targets are present), and immunotherapy (immune checkpoint inhibitors, PD-1/PD-L1 inhibitors) as monotherapy or combination therapy. Local treatment (radiation therapy or palliative surgery) may be used for symptomatic lesions.
- Newer and adjuvant treatment options
- Molecular targeted therapy: Targeted agents are used when specific gene mutations, such as EGFR, ALK, ROS1, or BRAF, are positive.
- Immunotherapy: Administered alone or in combination, depending on PD-L1 expression or specific indications.
- Procedures/surgery
- Lung resection (wedge resection, lobectomy, pneumonectomy) and lymph node dissection. Depending on the patient’s general condition and the lesion’s location, radiation therapy may include external-beam radiation or stereotactic radiosurgery (SRS).
- Lifestyle management and precautions
- Smoking cessation is important for both prevention and treatment. Prevention of respiratory infections during treatment (vaccination recommended: seasonal influenza and pneumococcal vaccines), nutritional management, and pulmonary rehabilitation (breathing exercises) are recommended. Monitoring for adverse effects of chemotherapy and immunotherapy, including bone marrow suppression, pulmonary toxicity, liver and kidney toxicity, and immune-related adverse effects, is necessary.
Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)
- Items to bring
- A list of medications currently being taken (including prescriptions), recent test results (CT, chest X-ray, blood test results, etc.), previous pathology reports (biopsy and molecular test results), allergy and chronic disease information, and a record of symptom changes (when they began, frequency, and aggravating factors).
- Useful information to record in advance
- Whether hemoptysis is present and when it occurs, the severity of shortness of breath (changes during daily activities), weight changes, systemic symptoms such as fever and night sweats, and smoking history (past and current amount smoked).
- Examples of questions the doctor may ask during an outpatient visit (patients may find it helpful to prepare in advance)
- When did the symptoms begin, and how have they progressed?
- Do you usually smoke (how many pack-years)? Have you had any workplace exposure?
- What medications are you currently taking (including supplements), and do you have a history of allergies?
- Do you have the results of any previous tests or treatments (e.g., chest CT, bronchoscopy, or biopsy)?
General Examples of Questions to Ask the Doctor
- What is the exact stage of this disease? Am I a candidate for surgery?
- What treatment options do you recommend for me, and what benefits and expected adverse effects can I expect?
- Have molecular target gene tests or an immune marker test (PD-L1) been performed? Will the treatment change based on the results?
- What is the schedule for follow-up tests (monitoring) during or after treatment?
Examples of Disease-Specific Questions
- Which molecular genes (e.g., EGFR, ALK, ROS1, BRAF, etc.) were tested in my biopsy? Are there targeted therapies that can be used based on the results?
- What is my PD-L1 test value? How likely is immunotherapy to help with my treatment?
(Note: The information above is general medical information. Please consult your treating physician to determine your individual diagnosis and treatment.)