324.2 🩺 國考版

324.2.1 高頻考點

324.2.1.1 Etiology

  • Smoking #1 (80-85%)
  • Radon #2
  • Asbestos + multiplicative with smoking
  • Air pollution PM2.5
  • Occupational
  • Genetic

324.2.1.2 Pathology

  • NSCLC 85%: adenocarcinoma (most common), squamous, large cell
  • SCLC 15%: smokers, central, fast-growing, neuroendocrine

324.2.1.3 LDCT Screening (USPSTF 2021)

  • Age 50-80
  • ≥ 20 pack-years
  • Current smoker or quit < 15 years
  • Annual LDCT

324.2.1.4 NLST + NELSON Trials

  • NLST: 20% mortality reduction with LDCT
  • NELSON: 24-33% reduction (men/women)

324.2.1.5 NSCLC Molecular Testing

  • EGFR (50% Asian adenocarcinoma; osimertinib)
  • ALK (alectinib, brigatinib, lorlatinib)
  • ROS1 (crizotinib, entrectinib)
  • KRAS G12C (sotorasib, adagrasib)
  • MET exon 14 (capmatinib, tepotinib)
  • HER2 (trastuzumab deruxtecan)
  • BRAF V600E (dabrafenib + trametinib)
  • NTRK fusion (larotrectinib, entrectinib)
  • RET fusion (selpercatinib, pralsetinib)
  • PD-L1 (immunotherapy)

324.2.1.6 Paraneoplastic Syndromes

  • SCLC: SIADH, Cushing (ACTH), LEMS, limbic encephalitis
  • Squamous: hypercalcemia (PTHrP)
  • Adenocarcinoma: hypertrophic osteoarthropathy, clubbing
  • Trousseau: hypercoagulability

324.2.1.7 Pancoast Syndrome

  • Apical tumor
  • Shoulder + arm pain (C8/T1/T2)
  • Horner syndrome
  • Hand weakness/atrophy

324.2.1.8 TNM Staging Key Concepts

  • T: size + invasion
  • N: regional LN involvement
  • M: distant mets
  • 8th TNM (2017) AJCC/UICC

324.2.1.9 Staging Modalities

  • CT chest/abd + PET-CT + brain MRI
  • Mediastinal: EBUS-TBNA preferred
  • Bone scan if symptoms

324.2.2 易混淆比范

Feature NSCLC SCLC
% 85% 15%
Smoking Variable Strong (>99%)
Location Peripheral (adeno) or central (squamous) Central
Growth Slower Fast
Molecular Driver mutations + IHC TP53, RB1 universal
IHC TTF-1, napsin (adeno); p40 (squamous) Chromogranin, syn, CD56
Paraneoplastic Squamous → PTHrP; Adeno → HOA SIADH, ACTH, LEMS
Treatment Targeted + IO Chemo + IO + RT

324.2.3 Special Topics

324.2.3.1 EGFR Mutation in Asian Women Non-Smokers

  • Prevalence 50% (vs 10-15% Caucasian)
  • Often adenocarcinoma
  • Targeted therapy effective

324.2.3.2 Lung Cancer in Never-Smokers

  • 15% of all lung cancers
  • Adenocarcinoma typical
  • Often female, Asian
  • EGFR, ALK, ROS1 driver mutations common

324.2.3.3 Pulmonary Nodule Workup (Ch326)

  • Solitary pulmonary nodule (SPN) < 3 cm
  • Fleischner Society guidelines
  • LDCT, PET-CT, biopsy as appropriate