ABSTRACT
It is logical that this chapter should fall between the preceding one on diagnosis and evaluation and those that follow on the treatment modalities for non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). At its most simplistic, ‘staging’ is the process by which the clinician examines and describes the local, regional, and distant extent of the cancer. This precise information is then used to determine the appropriate therapy for a patient diagnosed to have lung cancer. However, staging should not be thought of as a set of investigations that are performed between diagnosis and treatment. Many of the tests that are undertaken to establish the diagnosis, such as chest radiography, bronchoscopy, and pleural aspiration cytology, provide valuable information as to stage. Often the choice of test by which to establish the diagnosis will be made on the basis of the clinician’s assessment of the probable stage of the disease. In this context, obviously taking into account the financial cost and the potential morbidity of every procedure, it is desirable to undertake first the test that will prove the highest stage. For example, if a patient has a lung lesion and a probable adrenal metastasis, biopsy of the adrenal will, if positive, provide both a tissue diagnosis of cancer and the stage (M1).Tests undertaken to decide stage proceed in parallel with those required to establish the diagnosis and others to assess patient fitness for possible treatment options, often interweaving and providing information across these categories. Tests may have to be repeated if undertaken without sufficient foresight to look beyond the diagnosis and consider the consequential issues of treatment. Sometimes treatment may be recommended after staging and before a firm diagnosis. A surgeon may ‘stage’ a patient and recommend thoracotomy with only the strong clinical-radiographic suspicion of lung cancer and without pursuing the diagnosis to a cytologic or histologic conclusion. In such circumstances the surgeon will establish the diagnosis as the
first step at thoracotomy using rapid, ‘frozen section’ histology prior to proceeding with treatment by pulmonary resection.
