54-Year-Old Man Successfully Manages Bronchioloalveolar Carcinoma with Surgery and Targeted Therapy

When a 54-year-old male patient began experiencing persistent dry cough, wheezing, and progressively worsening shortness of breath, he sought medical attention at our facility. After thorough diagnostic evaluations—including chest CT, bronchoscopy, tumor marker tests, and biopsy—he was clinically diagnosed with bronchioloalveolar carcinoma (BAC), a subtype of lung adenocarcinoma. Following a comprehensive treatment plan involving surgical resection and targeted therapy, his condition has remained stable with no signs of disease progression during follow-up.

Patient Overview

Age & Gender: 54-year-old maleDiagnosis: Bronchioloalveolar Carcinoma (Non-Small Cell Lung Cancer Subtype)Hospital: Sun Yat-sen University Cancer CenterDate of Initial Consultation: August 2020Treatment Approach: Right middle and lower lobectomy followed by adjuvant targeted therapy with GefitinibTreatment Duration: 10-day hospitalization, ongoing oral medication, and regular monitoringOutcome: Stable disease, no recurrence or metastasis observed

Initial Clinical Evaluation

The patient presented with a recent onset of irritating dry cough, audible wheezing, and gradually increasing dyspnea on exertion. These respiratory symptoms prompted him to seek specialized care for a definitive diagnosis. A high-resolution chest CT scan revealed a suspicious mass in the right lower lobe measuring approximately 6 cm in diameter. The lesion exhibited irregular margins and internal branching air bronchograms, with signs of rigid bronchial walls—imaging features highly suggestive of malignancy.

Fiberoptic bronchoscopy showed mucosal irregularity in the B6a+c segment of the right lower lobe, although the basal segments appeared normal. Tumor marker analysis detected elevated levels of carcinoembryonic antigen (CEA), further supporting a potential neoplastic process. Based on clinical presentation and radiological findings, we admitted the patient for tissue confirmation and multidisciplinary management planning.

Diagnostic Confirmation and Treatment Plan

To confirm the nature of the pulmonary lesion, a percutaneous CT-guided lung biopsy was performed. Histopathological examination confirmed the diagnosis of bronchioloalveolar carcinoma—a rare variant of adenocarcinoma that grows along alveolar walls without destroying the underlying architecture.

Staging and Surgical Intervention

A full-body PET-CT scan was conducted to assess for distant metastases. Fortunately, no evidence of nodal involvement or systemic spread was found, indicating an early-stage localized tumor. With curative intent, we recommended surgical removal of the affected lung segments.

The patient underwent a right middle and lower lobectomy under general anesthesia. Intraoperative frozen section analysis confirmed the malignant nature of the lesion, guiding complete resection margins. Postoperatively, he recovered well in the surgical ward with intravenous cefuroxime sodium administered for infection prophylaxis.

Personalized Targeted Therapy

Molecular profiling of the resected tumor tissue revealed an EGFR exon 19 deletion mutation—an important biomarker predictive of response to tyrosine kinase inhibitors (TKIs). As a result, the patient was started on daily oral gefitinib, a first-generation EGFR inhibitor known for its efficacy in EGFR-mutant non-small cell lung cancer (NSCLC).

This sequential approach—surgery followed by genotype-directed targeted therapy—represents a modern standard of care for eligible patients with early-stage, molecularly defined lung cancers.

Treatment Outcomes and Follow-Up

The surgery was completed without complications, and the patient's postoperative recovery was uneventful. He reported feeling significantly better within days of the procedure, particularly noting improved breathing and resolution of coughing episodes.

After a 10-day hospital stay, he was discharged in stable condition with clear instructions for long-term management. Serial imaging studies—including periodic chest and abdominal CT scans—have shown no evidence of local recurrence or distant metastasis over multiple years of follow-up.

His consistent adherence to oral gefitinib and scheduled clinic visits has played a crucial role in maintaining disease control. Regular surveillance remains essential to detect any potential relapse at the earliest opportunity.

Key Recommendations for Patients in Recovery

While successful treatment brings relief, long-term wellness requires sustained effort. I emphasized several critical lifestyle and health-monitoring practices before the patient's discharge:

• Maintain a balanced routine: Avoid late nights and excessive physical strain; prioritize rest and moderate activity.
• Nutrition matters: Focus on light, easily digestible meals rich in vitamins. Increase intake of fresh fruits and vegetables while avoiding spicy, oily, or processed foods.
• Eliminate carcinogens: Strictly abstain from smoking and alcohol consumption—both are major risk factors for lung cancer progression.
• Commit to follow-up: Attend all scheduled appointments for imaging and blood work to monitor treatment response and catch any changes early.

Clinical Insights: Why Early Detection Makes a Difference

Bronchioloalveolar carcinoma, though now classified under the broader category of lung adenocarcinoma in current WHO guidelines, is notable for its indolent growth pattern and relatively favorable prognosis when caught early. Unlike more aggressive forms of lung cancer, BAC often progresses slowly and may remain localized for extended periods.

This case underscores the importance of timely symptom recognition and access to advanced diagnostics. Because this patient sought help during the early symptomatic phase, we were able to intervene before metastatic spread occurred. Curative surgery combined with biomarker-driven targeted therapy offers real hope for long-term survival in such cases.

Moreover, the integration of genetic testing into routine oncology practice allows clinicians to tailor treatments precisely to individual tumor profiles—maximizing effectiveness while minimizing unnecessary toxicity.

Final Thoughts

This patient's journey reflects both medical progress and personal resilience. Thanks to early diagnosis, precise pathology, and personalized treatment strategies, he continues to live an active, fulfilling life with controlled disease. His story serves as a powerful reminder: proactive healthcare, informed decision-making, and patient-doctor collaboration can transform even a cancer diagnosis into a manageable chronic condition.