Lung Cancer Staging

Abstract

Lung cancer incidence has dramatically risen in the past century. It is now the leading cause of cancer death in the world, both among men and women. Accurate staging is important because treatment options and prognosis differ significantly by stage. If there are no distant metastases, the status of mediastinal lymph nodes is the critical point to distinct between patients who will benefit from surgical therapy, neoadjuvant therapy or clinical treatment. Noninvasive imaging studies including chest computed tomography and positron emission tomography scanning should be performed in all patients who are potentially candidates to pulmonary resection. The findings of these noninvasive studies are critical, and the invasive mediastinal staging must be performed according to the medical examination and the results of noninvasive tests. In patients with extensive mediastinal infiltration by lung cancer, the disease is considered advanced and invasive staging is not needed. In patients with mediastinal lymph node enlargement seen at computed tomography, a sample tissue of these nodes is necessary. In these cases there are several methods to invasive staging the mediastinum, but mediastinoscopy is the gold standard. In patients with clinical T2 or with central tumors, invasive staging of the mediastinal nodes is necessary. Patients with a peripheral clinical T1 lung cancer do not usually need invasive confirmation of mediastinal nodes unless there is an abnormal standard uptake value in the nodes, found on positron emission tomography scanning. The staging of patients with left upper lobe tumors should include an assessment of the preaortic and aortopulmonary window lymph nodes. Pancoast tumors always need invasive mediastinal staging if they are considered for surgical resection.