Lung Cancer

The answer first

Lung cancer is managed as two different diseases that happen to share an organ, and every exam answer starts by saying which one you are dealing with ^[7]. Non-small-cell lung cancer (NSCLC — about 85% of cases) is a staging and biomarker disease: stage decides whether the intent is cure or control, and molecular testing decides which drug comes first in advanced disease ^{[14] [18]}. Small-cell lung cancer (SCLC — about 15%) is a tempo disease: it is systemic at diagnosis, exquisitely chemosensitive, and almost always relapses — so it has its own two-stage system (limited vs extensive), its own regimen, and its own rules ^[22].

Three working rules carry most DWE and DCE answers ^{[14] [26]}:

1. Tissue first, and enough of it. Diagnosis is histological, and in non-squamous NSCLC the biopsy must be large enough for molecular testing (EGFR, ALK, ROS1, KRAS, PD-L1 at minimum) — treatment in advanced disease now waits for those results ^[7].
2. Stage decides intent; biomarkers decide drugs. Surgery or stereotactic radiation for early disease, chemoradiotherapy plus durvalumab for unresectable stage III, and biomarker-directed therapy for stage IV — a sequence you should be able to recite as one sentence ^{[12] [18]}.
3. Palliation is not the alternative to treatment — it runs beside it. Early palliative care alongside active treatment in metastatic NSCLC improved quality of life and, remarkably, survival in the landmark Temel trial ^[26].

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References26ShowHide

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