Latimer Kelly M
US Naval Hospital Sigonella Italy, PSC 836 Box 2670, FPO, AE 09636.
FP Essent. 2018 Jan;464:23-26.
In the absence of screening, most patients with lung cancer are not diagnosed until later stages, when the prognosis is poor. The most common symptoms are cough and dyspnea, but the most specific symptom is hemoptysis. Digital clubbing, though rare, is highly predictive of lung cancer. Symptoms can be caused by the local tumor, intrathoracic spread, distant metastases, or paraneoplastic syndromes. Clinicians should suspect lung cancer in symptomatic patients with risk factors. The initial study should be chest x-ray, but if results are negative and suspicion remains, the clinician should obtain a computed tomography scan with contrast. The diagnostic evaluation for suspected lung cancer includes tissue diagnosis, staging, and determination of functional capacity, which are completed simultaneously. Tissue samples should be obtained using the least invasive method possible. Management is based on the individual tumor histology, molecular testing results, staging, and performance status. The management plan is determined by a multidisciplinary team consisting of a pulmonology subspecialist, medical oncology subspecialist, radiation oncology subspecialist, and thoracic surgeon. The family physician should remain involved with the patient to ensure that patient priorities are supported and, if necessary, to arrange for end-of-life care.
在没有筛查的情况下，大多数肺癌患者直到晚期才被诊断出来，而此时预后很差。最常见的症状是咳嗽和呼吸困难，但最具特异性的症状是咯血。杵状指虽然罕见，但对肺癌具有高度预测性。症状可能由局部肿瘤、胸腔内扩散、远处转移或副肿瘤综合征引起。临床医生应对有危险因素且出现症状的患者怀疑肺癌。初步检查应是胸部X光，但如果结果为阴性且仍有怀疑，临床医生应进行增强计算机断层扫描。对疑似肺癌的诊断评估包括组织诊断、分期以及功能状态的确定，这些应同时完成。应尽可能采用侵入性最小的方法获取组织样本。治疗基于个体肿瘤组织学、分子检测结果、分期和身体状况。治疗方案由一个多学科团队决定，该团队由肺科专科医生、医学肿瘤学专科医生、放射肿瘤学专科医生和胸外科医生组成。家庭医生应持续关注患者，以确保患者的需求得到支持，如有必要，安排临终关怀。
