The value of staging and estimating patient’s capacity for lung cancer therapy
Abstract
Background: Resection yields the best survival rate in non-small cell lung cancer, and also as an adjuvant therapy to chemotherapy and radiation in small-cell lung cancer. Therefore it is suitable to search for patients with technically and medically operable tumours. Therefore it is necessary to perform the correct staging and estimation of a patient’s capacity for the intended surgery. Knowledge of the capability and reliability of singular investigations and their proper sequencing enables clinical staging of the tumour. The selection of the best treatment modality is based on the last factor. The diagnostic procedure should be rational and short, and the selected treatment useful for recovery, prolongation of survival or at least the relief of symptoms.
Conclusions: Staging is based on TNM tumour classification. In the process and extent of staging it is necessary to carefully estimate and consider the patient’s capacity, particularly clinical condition, performance status, age, comorbidity and pulmonary function, and to assess tumour resectability by imaging (X-ray, CT, MRI, PET, US) and invasive investigations (bronchoscopy, cervical mediastinoscopy, parasternal mediastinotomy and [video]thoracoscopy). Before final selection of treatment, modality microscopic verification of the tumour is needed. Exploratory thoracotomy remains the ultimate possibility for verification and estimation of resectability. In addition to the imaging investigations mentioned, in searching for distant metastases the following are also useful: bone scanning, fine needle biopsy of palpable or reachable lesions of the lymph nodes, skin, bone marrow, body fluids and parenchymal organs. Laboratory tests of blood, urine and other bodily fluids may also indicate that the tumour has spread. It is necessary to take into account, that negative test results do not reliably exclude metastases.
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