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Non-small cell lung cancer
Diagnosis

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	- Introduction - Causes - Clinical picture - Diagnosis - Pathology - Staging - Treatment

Imaging

Chest x-ray

PA and lateral chest x-rays are indicated in a high-risk patient with new respiratory symptoms. Comparison with previous x-rays is frequently helpful. Suspicious findings include:

• Pleural effusion

• Synchronous pulmonary nodules

• Osseous metastases

• Widening of the  mediastinum (mediastinal lymph nodes)

Chest CT

A CT scan of the chest, including the liver and adrenal glands, is performed routinely to further define the primary tumor and to identify lymphatic or parenchymal metastases.

PET

Current data suggest that PET may be very helpful for the evaluation of lung masses, lymph nodes, and distant metastases. When a lung mass “lights up” on a PET scan, there is a 90%-95% chance that it is cancerous. Both the sensitivity and specificity of PET for detecting nodal metastases are approximately 60% (see mediastinoscopy).

Biopsy

Central lesions

• Collecting sputum cytologies for 3 consecutive days frequently provides a cytologic diagnosis for central lesions

• Bronchoscopy establishes a cytologic and/or histologic diagnosis in 80%-85% of cases. In addition, bronchoscopy may provide important staging information.

Peripheral lesions

• Resection is generally recommended for any suspicious peripheral mass.

• CT-guided needle biopsy may diagnose up to 90% of peripheral lung cancers but is usually reserved for patients who are not candidates for an operation due to distant metastatic disease or poor performance status.

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Mediastinoscopy

Indications

• To confirm the involvement of enlarged nodes on CT or PET

• Centrally located tumors

• T2-4 tumors

Thoracentesis and video-assisted thoracoscopic surgery (VATS)

Individuals who have pleural effusions should undergo thoracentesis. If thoracentesis does not show malignant cells then Video-assisted thoracoscopic surgery (VATS) may permit direct visualization of the pleural surface, enabling direct biopsy from pleural nodules, facilitating biopsy of ipsilateral mediastinal lymph nodes.

Serum tumor markers

Measurement of serum tumor-associated antigens has no current role in the staging of NSCLC.

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