lung ADENOCARCINOMA

A 64-year-old woman with no history of smoking presented with a three-month history of back pain and dry cough. Upon evaluation, it was discovered that she had a primary lung tumor in the right upper lobe, with bilateral mediastinal and ipsilateral supraclavicular nodal involvement, as well as metastases to both lungs, left adrenal gland, and multiple bony sites. Magnetic resonance imaging (MRI) confirmed the presence of multiple vertebral metastases with potential compression of the spinal cord at various levels.The patient received radiotherapy to the cervical and thoracic spine in five fractions, totaling 20 Gy. An ultrasound-guided biopsy of an involved right supraclavicular fossa node revealed adenocarcinoma positive for cytokeratin 7 (CK7), thyroid transcription factor-1 (TTF-1), Napsin A, and carcinoembryonic antigen (CEA), while being negative for cytokeratin 20 (CK20), caudal type homeobox 2 (CDX2), and gross cystic disease fluid protein-15 (GCDFP-15) by immunohistochemistry. These findings are consistent with a diagnosis of lung adenocarcinoma.

Questions 1. What is the stage of the patient’s disease? 2. What other investigations need to be undertaken prior to deciding on a treatment plan? 3. What is the significance of a history of never smoking in patients with lung cancer?