【Major Points】

1. Lung cancer can be divided into small cell lung cancer and non-small cell lung cancer.
2. Patients with symptoms of long-term cough, short of breath, hemoptysis…etc., should seek medical attention of the department of Thoracic Medicine as soon as possible. 
3. Chest computed tomography, bronchoscopy, and biopsy can diagnose lung cancer.
4. The treatment of lung cancer includes surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.

What is lung cancer? 
Lung cancer refers to malignant tumors that develop in the lungs and bronchi. Based on the appearance of lung cancer cells under a microscope, it can be classified into "small cell carcinoma" and "non-small cell carcinoma," with non-small cell lung cancer being more common. (More information: Bronchoscopy)

1. Small cell lung cancer accounts for about 20% of all lung cancers (20 out of 100 patients), grows rapidly, and is prone to metastasis.
2. Non-small cell lung cancer makes up 80% (80 out of 100 patients), and is further divided into squamous cell carcinoma, adenocarcinoma, large cell carcinoma, etc., with adenocarcinoma being the most common. Cancer cells in this category grow and spread more slowly.
   

1. Small cell lung cancer is most closely related to smoking; for every 100 patients with the disease, 90 have a history of smoking.
2. The exact causes of non-small cell lung cancer are still unclear, but possible factors include:
   1. Chronic lung diseases: such as chronic bronchitis, chronic obstructive pulmonary disease, and tuberculosis.
   2. Long-term exposure to hazardous environments: such as air pollution, asbestos, and metals that can cause cell mutations (e.g., chromium, uranium).
   3. Family history: having two or more direct relatives with lung cancer increases the likelihood of developing the disease.
   4. Other factors: Oil fumes from high-temperature cooking or frying may be related to lung cancer.
      

1. A persistent cough that does not improve after a long time. 
2. Feelings of chest tightness or tingling when coughing or breathing deeply. 
3. The coughed up phlegm is bloodshot or bloody. 
4. Shortness of breath, or feeling short of breath. 
5. The voice is hoarse.
6. Unexplained loss of appetite and weight loss.

1. Chest X-ray: Monitor the lungs for abnormalities, but cannot detect tumors smaller than 1 cm.
2. Sputum cytology: A simple test where the patient coughs up sputum that is examined under a microscope to detect cancer cells.
3. Chest computed tomography: It can determine the size and location of lung tumors, and can monitor tumors smaller than 1 cm.
4. Bronchoscopy: The doctor can see tumors directly and perform a biopsy. Detection rate of lung cancer is 90%. (More information: Bronchoscopy)
5. Thoracic ultrasound biopsy or computed tomography-guided biopsy: sampling of tumors can be obtained, and could help determine the location of lung abnormalities. The detection rate is 96%.
   

1. Surgical treatment: Surgical resection is the main treatment for early stage lung cancer.(More information: Care of Patient with Lung Surgery(Video Assisted Thoracoscopic Surgery, VATS)
2. Radiation therapy: Directly irradiating lung or metastases tumors with high-dose radiation to relieve uncomfortable symptoms.
3. Chemotherapy: The use of chemical drugs to inhibit the growth of cancer cells, causing them to shrink. (More information: Care of Patient with Chemotherapy).
4. Targeted therapy: suitable for patients with non-small cell lung cancer, it is a drug developed for specific gene mutations, so patients must first go through genetic testing to determine if it applies. 
5. Immunotherapy: The immune effect is generated after injection of drugs to fight the growth of cancer cells.

1. Chemotherapy, Targeted Therapy, or Immunotherapy
   1. Fatigue: Get plenty of rest, limit daily activities, and schedule leisure activities. If working, try to schedule treatments near the end of the workday to allow for rest.
   2. Nail Infections (Fungal Nail Infections): Soak nails in warm water and wear open-toe shoes. If there are wounds, cover them and wear gloves while doing housework.
   3. Nausea and Vomiting: Eat small, frequent, and bland meals; chew food slowly, and rest in a sitting position for 30 minutes after meals.
   4. Diarrhea: Stay hydrated, avoid high-fiber and greasy foods, and use prescribed anti-diarrheal medication if symptoms are severe.
   5. Numbness in Hands and Feet: Avoid handling dangerous objects which are sharp, heavy or hot and prevent falls by wearing non-slip, well-fitting shoes.
2. Radiation Therapy
   1. Dry or Itchy Skin: Avoid hot baths, saunas, and steam rooms; use sunscreen outdoors and wear loose, soft clothing. Apply moisturizing lotion and consult a doctor for severe skin conditions.
   2. Radiation Esophagitis: May cause throat dryness, pain while swallowing, and a sensation of foreign body presence, which usually resolves after treatment. Eat small, soft, and liquid meals.
   3. Radiation Pneumonitis: Radiation can affect healthy lung tissue, causing persistent dry cough, increased shortness of breath, and mild fever. Seek medical evaluation if symptoms occur.

1. Ettinger, D. S., Wood, D. E., Aisner, D. L., Akerley, W., Bauman, J. R., Bharat, A., Bruno, D. S., Chang, J. Y., Chirieac, L. R., DeCamp, M., Dilling, T. J., Dowell, J., Durm, G. A., Gettinger, S., Grotz, T. E., Gubens, M. A., Hegde, A., Lackner, R. P., Lanuti, M., Lin, J., … & Hughes, M. (2023). NCCN guidelines® insights: Non-small cell lung cancer, version 2.2023: featured updates to the NCCN guidelines. Journal of the National Comprehensive Cancer Network, 21(4), 340-350. https://doi.org/10.6004/jnccn.2023.0020
2. Hwang, S. Y., Kim, J. Y., Lee, H. S., Lee, S., Kim, D., Kim, S., Hyun, J. H., Shin, J. I., Lee, K. H., Han, S. H., & Song. Y. G. (2022). Pulmonary tuberculosis and risk of lung cancer: A systematic review and meta-analysis. Journal of Clinical Medicine, 11(3), 765. https://doi.org/10.3390/jcm11030765
3. Kao, S. J., (2023). Current status and future prospect of treatment of advanced lung cancer. Taiwan Medical Journal, 66(8), 10-18. https://www.tma.tw/ltk/112660803.pdf