DIAGNOSIS AND STAGING OF LUNG CANCER

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The impact of lung cancer on the industrialized world is immense. Undeniably, the greatest risk factor is smoking and, because of increased numbers of women who smoke, lung cancer incidence has been on the rise in recent years. Lung cancer is now the leading cause of cancer death in both men and women in the United States.

This article discusses bronchogenic carcinoma with regard to the various modalities by which it can be diagnosed and the most appropriate clinical settings in which these modalities should be used. It also summarizes the most recent system for staging lung cancer, as well as discussing some adjunctive modalities for use in both diagnosis and staging. Neither treatment of lung cancer nor malignancy of the chest other than bronchogenic carcinoma is discussed here because they are beyond the intended scope of this article.

Section snippets

Screening

Although there are numerous recommendations from various organizations for screening and early detection of cancers such as breast, colorectal, and prostate, there are no such recommendations for lung cancer. Indeed, no organization recommends lung cancer screening of any sort at any time for asymptomatic patients. To date, there have been no data to support improved outcome by screening and some evidence to suggest that there is no beneficial effect.12, 15, 31 Because of the tremendous impact

Overview

Once lung cancer is diagnosed, it next becomes important to determine the extent of disease. Distant metastases are found in nearly 40% of patients with newly diagnosed lung cancer.5 The presence of local extension and invasion, as well as the presence of metastatic disease, has important treatment implications for patients with lung cancer. Careful attention, therefore, should be paid to the recommended staging processes outlined subsequently. Obviously, some, or even all, of the recommended

CONCLUSION

Lung cancer can present in a myriad of ways and the goal of prompt diagnosis and staging requires the clinician to be able to knowledgeably choose from a variety of tools available for such purpose. Review of some of these tools and general strategies with regard to staging have been provided. Many new technologies are becoming available and much evaluation remains to be done before their proper roles become well defined. Little has changed with regard to staging of SCLC in recent years. The

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    Address reprint requests to Gerard Silvestri, MD, 96 Jonathan Lucas Street, Suite 812, Charleston, SC 29425, e-mail: [email protected]

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    Division of Pulmonary and Critical Care Medicine, Allergy, and Clinical Immunology, Medical University of South Carolina, Charleston, South Carolina

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