324 Ch 323. Lung Cancer — Epidemiology, Screening, Pathology, Diagnosis, and Staging

肺癌 全球 cancer mortality #1 (~ 1.8 million deaths/yr)；smoking 為 #1 cause (80-85% in US)，radon 第二大原因，asbestos + air pollution + occupational + genetic + chronic lung disease 也是因素；2010s-2020s lung adenocarcinoma in non-smokers (especially Asian women) 上升 — EGFR mutation 高比例；分 NSCLC (~ 85%) 與 SCLC (~ 15%)；NSCLC 又分 adenocarcinoma (most common), squamous, large cell；LDCT screening (USPSTF 2021 + NLST)：age 50-80 + ≥ 20 pack-years + current smoker or quit < 15 yr → annual LDCT；台灣 2022 LDCT screening：50-74 yo (男) / 45-74 (女)，重度吸菸或家族史 — 自費或政府補助；diagnosis：tissue biopsy + immunohistochemistry + comprehensive molecular profiling (EGFR、ALK、ROS1、KRAS G12C、MET exon 14、HER2、BRAF V600E、NTRK、RET、PD-L1、TMB)；staging：8th TNM AJCC/UICC (2017)，PET-CT + EBUS-TBNA mediastinal + brain MRI (esp NSCLC)；liquid biopsy (ctDNA) for non-invasive monitoring；MRD (molecular residual disease) 為 2024 新興 paradigm。