Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of pulmonary nodule/mass. History significant for persistent non-productive cough, mild dyspnea on exertion, and occasional pleuritic chest pain. No hemoptysis, constitutional symptoms (weight loss, night sweats), or history of recurrent pneumonia. Imaging reveals ground-glass opacity (GGO) with lepidic growth pattern, suggestive of adenocarcinoma.
Clinical Examination Findings
General: Patient appears in no acute distress. Respiratory: Lung auscultation reveals diminished breath sounds over the affected lobe, no wheezing or rhonchi. Percussion is resonant. Cardiovascular: Regular rate and rhythm, no murmurs, gallops, or rubs. Extremities: No digital clubbing or peripheral edema. Lymphatic: No palpable supraclavicular or cervical lymphadenopathy.
Treatment Protocol
Plan: Surgical resection (lobectomy or segmentectomy) with systematic lymph node dissection is the gold standard for lepidic predominant adenocarcinoma. Consider wedge resection for patients with limited pulmonary reserve. Adjuvant therapy to be determined based on final pathological staging, molecular profiling (EGFR, ALK, ROS1), and margin status. Smoking cessation counseling initiated.