Diagnosis of lung cancer and staging of the disease

M0 – no distant metastases M1 – distant metastases to a structure such as the scalene, cervical or contra

lateral hilar lymph nodes, brain, bones, liver or contra lateral lung It is essential to check that the patient has adequate respiratory reserve if surgery is contemplated and to check for symptoms that would make one suspect spread outside the lung, such as persistent bone pain; voice change; abdominal swelling; enlarged lymph nodes; enlarged liver; neurological features; or superior vena caval obstruction.