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LUNG CANCER
Lung cancer is having a malignant tumor in the lungs especially in the cells lining air passages.
Primary tumor-related signs and symptoms are cough, dyspnea, hemoptysis, and chest discomfort.
Signs and symptoms due to intrathoracic spread may involve the nerves (hoarseness, dyspnea, muscle wasting of upper limb, Horner's syndrome), chest wall and pleura (chest pain, dyspnea) and vascular structures (facial swelling, dilated neck veins, cardiac tamponade) & viscera (dsyphagia).
The signs and symptoms due to metastatic spread are bone pain with or without pleuritic pain, neurologic symptoms, limb weakness, unsteady gait, cervical lymphadenopathy, and skin nodules.

Follow Up

 Follow-Up After Therapy for patients with Non-Small Cell Lung Cancer (NSCLC)

  • Studies have shown 6.5% annual recurrence rate of non-small cell lung cancer (NSCLC) stage I & small cell lung cancer (SCLC), respectively
  • Observation for complications of treatment is recommended for at least 3-6 months
  • Follow up with history, physical exam & chest CT scan with or without contrast is advised every 6 months for 2-3 years; then history, physical exam & chest CT scan without contrast annually thereafter for patients with Stage II-III NSCLC given primary treatment including surgery with or without chemotherapy
    • High-resolution CT scan is recommended 4 years after surgical resection of stages IA to IIIA NSCLC, followed by low dose computed tomography (LDCT) every year starting in the 5th year
    • Peak incidence of recurrence is between 2 & 3 years
  • For patients with Stage I-II NSCLC given primary treatment with radiotherapy, & patients diagnosed with Stage III or IV NSCLC, history, PE, & chest CT scan with or without contrast is advised every 3-6 months for 3 years; then history, PE & chest CT scan with or without contrast every 6 months for 2 years, then history & PE with low-dose chest CT scan without contrast annually
  • Biomarkers (eg ALK fusion oncogene, ROS1 gene rearrangements, BRAF V600E mutations, EGFR mutations, PD-1 ligand) may be utilized to predict treatment outcome or disease prognosis
  • Patients who smoke should be advised to quit
    • Please see Smoking Cessation Disease Management Chart for more details
  • Immunizations (pneumococcal vaccine, influenza vaccine) may also be given

Follow-Up After Therapy for patients with Small Cell Lung Cancer (NSCLC)

  • Patients are advised to follow-up every 3-4 months during 1-2 years, then every 6 months 3-5 years, then annually after recovery
  • Follow-up history, PE, & chest, liver & adrenal gland CT scan with contrast depends on previous treatment given & stage of patient's disease:
    • Limited disease small cell lung cancer (LD SCLC) patients given adjuvant chemotherapy or chemoradiotherapy - only after completion of treatments
    • Limited disease small cell lung cancer (LD SCLC) patients given systemic therapy or chemoradiotherapy - after every 2 cycles of systemic therapy & at completion of treatments
    • Extensive disease small cell lung cancer (ED SCLC) patients given systemic therapy - after every 2-3 cycles of systemic therapy & at completion of therapy
  • Extensive disease small cell lung cancer (ED SCLC) patients with asymptomatic brain metastasis receiving systemic therapy prior to whole-brain radiotherapy should undergo brain magnetic resonance imaging (MRI) or computed tomography (CT) scan with contrast every 2 cycles of chemotherapy & after completion of therapy
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