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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 NSCLC stage I and SCLC, respectively
  • Observation for complications of treatment is recommended for at least 3-6 months
  • Follow up with history, physical exam and chest computed tomography (CT) scan with or without contrast is advised every 6 months for 2-3 years; then history, physical exam and chest CT scan without contrast annually thereafter for patients with Stage I-II 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 and 3 years
  • For patients with Stage I-II NSCLC given primary treatment with radiotherapy, and patients diagnosed with Stage III or IV NSCLC, history, PE, and chest CT scan with or without contrast is advised every 3-6 months for 3 years; then history, PE and chest CT scan with or without contrast every 6 months for 2 years, then history and PE with low-dose chest CT scan without contrast annually
  •  For patients with advanced or metastatic disease, response to initial therapy should be assessed after 2 cycles using CT with or without contrast on previously identified tumor sites, then every 2-4 cycles or when clinically indicated
    • Assessment of response to subsequent therapy should be done every 6-12 weeks using CT with or without contrast on previously identified tumor sites
  • 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 further information
  • Immunizations (pneumococcal vaccine, influenza vaccine, Herpes zoster vaccine) may also be given

Follow-Up After Therapy for Patients with Small Cell Lung Cancer (SCLC)

  • Patients with limited disease are advised to follow up every 3 months for the 1st year or two, then every 6 months during the 3rd year, then annually after recovery
  • Patients with extensive disease are advised to follow up every 2 months during the 1st year, then every 3-4 months on years 2-3, then every 6 months on years 4-5, then annually
  • Response assessment using chest and abdominal CT scan with contrast depends on previous treatment given and stage of patient's disease:
    • Limited disease small cell lung cancer (LD SCLC) patients given adjuvant chemotherapy or chemoradiotherapy: Only after completion of treatments
    • LD SCLC patients given systemic therapy or chemoradiotherapy: After every 2 cycles of systemic therapy and at completion of treatments
    • Extensive disease small cell lung cancer (ED SCLC) patients given systemic therapy: After every 2-3 cycles of systemic therapy and at completion of therapy
  • Response assessment of ED SCLC patients with asymptomatic brain metastasis receiving systemic therapy prior to whole-brain radiotherapy should undergo brain magnetic resonance imaging (MRI) or CT scan with contrast every 2 cycles of chemotherapy and after completion of therapy
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