- Superior vena cava syndrome: facial swelling, distended neck veins – oncologic emergency
- Malignant pleural effusion: dyspnea – requires thoracentesis and pleurodesis
- Brain metastases: headache, seizures, focal deficits – steroids and radiation
Non‑Small Cell Lung Cancer (Stage IV)
Must-Not-Miss / Red Flags
Patient Explanation
“You have a type of lung cancer that has spread beyond your lungs. We now have many targeted treatments and immunotherapies that can help control it and improve your quality of life.”
Board Fact
“PD‑L1 expression ≥50% predicts a strong response to pembrolizumab monotherapy in NSCLC without driver mutations.”
ICD-10
C34.90
Definition & Core Concept
Non‑small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for 85% of cases. Stage IV indicates metastatic disease to distant organs, with a 5‑year survival of <10%.
Epidemiology & Risk Factors
- Leading cause of cancer death worldwide
- Smoking is responsible for 80‑90% of cases
- Median survival for stage IV NSCLC: 8‑12 months with treatment, 4‑5 months untreated
Clinical Vignette
A 60‑year‑old former smoker presents with a 3‑month history of cough, weight loss, and right‑sided chest pain. CT shows a 4‑cm right upper lobe mass with bilateral pulmonary nodules and a liver lesion. Biopsy reveals adenocarcinoma; molecular testing shows EGFR exon 19 deletion.
Pearls & Pitfalls
- Always test for driver mutations (EGFR, ALK, ROS1, BRAF) before starting first‑line therapy – targeted agents are superior to chemotherapy in mutation‑positive patients.
- Immune‑related adverse events (colitis, pneumonitis, thyroiditis) can be life‑threatening and require prompt recognition.
Discharge & Follow-Up
Oncology follow‑up every 2‑3 months with imaging to assess response. Monitor for targeted therapy side effects (rash, diarrhea). Advance care planning and palliative care involvement.
Literature & Guidelines
NCCN 2024 NSCLC Guidelines. PMID: 38652100.