Oncology
Non-Small Cell Lung Cancer
비소세포폐암
Most common lung cancer, including adenocarcinoma, squamous, and large cell
- How common
- 85% of lung cancers (top cancer killer in Korea)
- Typical age
- Ages 60–70
What is it?
Carcinogens (chiefly tobacco) accumulate driver mutations (EGFR/KRAS/ALK) that transform bronchial epithelium.
Commonly affected: Lung (peripheral adenoCa / central SCC), mediastinal nodes
How it develops
- Carcinogen exposureTobacco smoke, radon, asbestos cause DNA damage
- Driver mutationEGFR (50% Asian adenoCa), KRAS, ALK fusion, TP53 accumulate
- Local invasion/angiogenesisVEGF drives tumor vasculature, invasion of bronchus/pleura
- Lymphatic & distant metastasisMediastinal nodes → brain, bone, liver, adrenals
Symptoms
- Chronic cough>8 weeks, change in pattern
- HemoptysisBlood-streaked sputum or frank hemoptysis
- Weight loss>5% involuntary loss in 6 months
- Pancoast syndromeApical tumor: Horner + shoulder pain
- Chest pain/dyspneaPleural invasion or mass effect
How it is examined
- Chest auscultationFocal wheeze, decreased breath sounds (effusion)
- Lymph node examSupraclavicular/cervical adenopathy
- PS/weight assessmentECOG performance status, nutritional state
Imaging
Chest X-ray detects nodule, mass, effusion, atelectasis.
- Pulmonary nodule/mass
- Pleural effusion
- Hilar adenopathy
Chest CT + PET-CT for TNM staging; brain MRI for CNS metastasis.
- Spiculated mass
- FDG-avid PET
- Brain metastases
Non-surgical care
- Staging (TNM, IASLC 8th)CT, PET-CT, brain MRI, EBUS-TBNA for mediastinum
- Molecular markersEGFR, ALK, ROS1, KRAS, BRAF, PD-L1 (TPS%) testing
- Targeted therapyEGFR: osimertinib, ALK: alectinib, KRAS G12C: sotorasib
- Immunotherapy (PD-L1≥50%)Pembrolizumab monotherapy first-line, or chemo-IO combo
- ChemotherapyPlatinum doublet: cisplatin/carbo + pemetrexed (non-squamous) or paclitaxel
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Stage I–II, selected IIIA (resectable), adequate pulmonary function
Procedures that may be discussed
- Lobectomy + mediastinal LN dissection (standard)
- Sublobar resection (small peripheral)
- Pneumonectomy (central)
- VATS/robotic approach
- SBRT (medically inoperable)
Outlook
5-yr survival: stage I 70–90%, II 50%, III 15–35%, IV <10%. IO/targeted therapy improves stage IV.