Early-Stage Alveolar Cell Carcinoma with Hemoptysis: Successful Intervention Through Surgery and Radiation Therapy

When a 57-year-old woman presented with persistent cough, blood-tinged sputum, and fatigue, timely diagnosis and an integrated treatment approach led to a successful outcome. This case highlights the importance of early detection in rare lung cancers such as alveolar cell carcinoma—now more accurately referred to as adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma under modern classification systems. After thorough evaluation at Sun Yat-sen University Cancer Center in July 2019, she was diagnosed with stage I disease and treated with surgical resection followed by localized radiotherapy. With no signs of recurrence during follow-up and complete resolution of symptoms, this case underscores how prompt intervention can significantly improve prognosis and quality of life.

Patient Overview

Age & Gender: 57-year-old femaleDiagnosis: Early-stage pulmonary adenocarcinoma (formerly known as bronchioloalveolar carcinoma)Hospital: Sun Yat-sen University Cancer CenterTreatment Timeline: Initial hospitalization for 10 days, followed by 40 sessions of radiation therapy over several weeksTreatment Modalities: Lobectomy (surgical removal of a lung lobe), adjuvant radiotherapy, and supportive intravenous therapy including cefuroxime sodium (antibiotic), ambroxol hydrochloride (mucolytic agent), glucose, and saline infusionsOutcome: Full remission of symptoms, no evidence of tumor recurrence, improved respiratory function, and enhanced overall well-being

Initial Clinical Presentation

The patient sought medical attention due to a two-day history of worsening cough, sputum production, low-grade fever, and hemoptysis—coughing up blood-streaked phlegm. Notably, she had experienced intermittent cough and occasional blood in her sputum for over two years, along with progressive shortness of breath for the past six months. She denied night sweats, significant weight loss, or excessive white mucus production. On physical examination, coarse breath sounds were heard bilaterally, with crackles detected in the left lung field. Cardiac and abdominal exams showed no abnormalities.

Diagnostic Workup

A chest CT scan revealed multiple rounded nodular opacities scattered throughout the left lung. These findings raised concern for malignancy. Tumor marker testing showed elevated carcinoembryonic antigen (CEA) levels at 32.3 μg/L—well above the normal threshold—further supporting suspicion of lung cancer. Based on these results, the patient was admitted for comprehensive diagnostic evaluation and potential treatment planning.

Definitive Diagnosis and Staging

To confirm the nature of the lesion, a CT-guided percutaneous lung biopsy was performed. Histopathological analysis confirmed the presence of adenocarcinoma with lepidic growth pattern—consistent with what was historically termed alveolar cell carcinoma. Further staging included PET-CT, MRI, and bone scans, all of which showed no evidence of lymph node involvement, distant metastasis, or local tissue invasion. As a result, the cancer was classified as stage I, indicating localized disease amenable to curative intervention.

Surgical Intervention

After detailed discussions with the patient and her family about risks, benefits, and long-term outcomes, a decision was made to proceed with surgical resection. The patient underwent a lobectomy, during which the affected portion of the lung was completely removed with clear margins. The procedure was uneventful, and she recovered smoothly in the postoperative period.

Postoperative Care and Adjuvant Therapy

Following surgery, the patient received intravenous antibiotics (cefuroxime sodium) to prevent infection, ambroxol hydrochloride to aid in mucus clearance and reduce coughing, and standard fluid support with glucose and saline solutions. Her recovery progressed without complications. Ten days after admission, she met discharge criteria: stable vital signs, healing incision site, restored lung function, and absence of pre-treatment symptoms such as fever, hemoptysis, and dyspnea.

Radiation Therapy Phase

One month post-surgery, once adequate healing occurred, the patient began a course of targeted radiation therapy consisting of 40 fractions delivered to the tumor bed and surrounding high-risk areas. This adjuvant approach aimed to eliminate any residual microscopic disease and reduce the risk of local recurrence. Throughout the radiotherapy regimen, the patient demonstrated excellent tolerance with minimal side effects.

Treatment Outcomes and Follow-Up

At each follow-up visit, laboratory tests—including CEA levels—and imaging studies such as chest CT scans were conducted. All results remained within normal limits, showing no signs of tumor regrowth or new lesions. Clinically, the patient reported a dramatic improvement in energy levels, breathing capacity, and overall comfort. Her cough resolved entirely, and she regained her ability to perform daily activities without limitation.

Long-Term Monitoring Plan

Ongoing surveillance is critical even after successful treatment. The recommended monitoring schedule includes:

• Every 3 months for the first 2 years
• Every 6 months from year 3 to year 5
• Annual check-ups beyond 5 years

Lifestyle and Recovery Recommendations

To support sustained recovery and optimize health outcomes, the following lifestyle modifications were emphasized:

Nutritional Guidance

A balanced diet rich in high-quality proteins, calories, vitamins, and easily digestible foods is essential. Frequent small meals are encouraged, along with increased intake of fresh fruits and vegetables. Patients should avoid raw, spicy, greasy, or heavily processed foods that may impair digestion or irritate airways.

Skin Care During Radiotherapy

Radiation can cause skin irritation, redness, or breakdown in the treated area. Gentle cleansing, moisturizing, and protection from sun exposure are crucial. Any sign of ulceration or infection warrants immediate medical attention.

Mental and Emotional Wellbeing

Maintaining a positive mindset plays a key role in healing. Stress management techniques such as mindfulness, meditation, counseling, or participation in support groups can help patients cope with anxiety and build resilience.

Physical Activity and Rest

Light-to-moderate exercise such as walking, jogging, or tai chi is beneficial when approved by a healthcare provider. However, it's equally important to balance activity with sufficient rest and maintain a consistent sleep schedule to promote immune function and tissue repair.

Clinical Reflections on Early Detection

Alveolar cell carcinoma, though rare, often presents subtly and can be easily mistaken for chronic bronchitis or pneumonia. This case illustrates the value of vigilance—especially among middle-aged and older adults with risk factors like smoking history. Symptoms such as persistent cough, frothy sputum, blood-tinged phlegm, chest tightness, unexplained fatigue, or unintentional weight loss should never be ignored.

Proactive Screening Saves Lives

I consistently advise patients to seek prompt evaluation if respiratory symptoms persist beyond a few weeks. Simple yet effective tools like chest X-rays, sputum cytology, blood tumor markers (e.g., CEA), and advanced imaging can lead to earlier diagnoses. In select cases, image-guided biopsies provide definitive answers, enabling timely and potentially curative interventions.

With advances in diagnostics and personalized treatment strategies, early-stage lung cancers now offer much better prognoses than in the past. This patient's journey serves as a powerful reminder: awareness, early action, and multidisciplinary care can transform a life-threatening diagnosis into a story of recovery and hope.