Overview
Stage IV lung adenocarcinoma is characterized by the presence of distant metastases, indicating advanced disease. Treatment strategies focus on systemic therapy to control disease spread and manage symptoms.Diagnosis
Diagnosis of lung adenocarcinoma is typically made via biopsy, often guided by imaging such as CT scans 1.
Physiologic evaluation for surgical candidacy includes cardiovascular evaluation and spirometry (FEV1, Dlco) 1.
Predicted postoperative (PPO) lung functions are calculated to assess surgical risk 1.
Low-technology exercise tests (stair climbing, shuttle walk) can be used as screening if PPO values are between 30% and 60% 1.
Cardiopulmonary exercise testing is indicated for PPO FEV1 or Dlco < 30% or unsatisfactory exercise test performance 1.
A peak oxygen consumption (V˙O2 peak) < 10 mL/kg/min or 35% predicted indicates high risk for resection 1.Management
Management of stage IV lung adenocarcinoma primarily involves systemic therapies 1.
Physiologic evaluation is crucial for patients being considered for resectional surgery, though this is less common in stage IV disease 1.Key Recommendations
Preoperative physiologic assessment for lung cancer patients considered for resection should begin with cardiovascular evaluation and spirometry (FEV1 and Dlco) 1. (Evidence: Expert opinion)
If % PPO FEV1 and % PPO Dlco are both > 60%, the patient is considered at low risk for anatomic lung resection, and no further tests are indicated 1. (Evidence: Expert opinion)
If % PPO FEV1 or % PPO Dlco are within 60% and 30% predicted, a low-technology exercise test should be performed as a screening test 1. (Evidence: Expert opinion)References
1 Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013. link