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Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer

Authors
Karl W Thomas, MD
Michael K Gould, MD, MS
Section Editor
David E Midthun, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Lung cancer is the leading cause of cancer deaths worldwide in both men and women [1]. Non-small cell lung cancer (NSCLC) accounts for the majority (approximately 85 percent) of lung cancers with the remainder as mostly small cell lung cancer (SCLC). Most patients present for diagnostic evaluation because of symptoms suspicious for lung cancer or an incidental finding on chest imaging. The goal of the initial evaluation is to obtain sufficient clinical and radiologic information to guide diagnostic tissue biopsy, staging, and treatment.

This review will provide a general overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer. Typically, the approach for those with suspected NSCLC is the same for those with suspected SCLC, although most of the data is derived from patients with suspected NSCLC. Thus, throughout the text of this topic the term NSCLC is frequently cited. The approach to a patient and modalities used for tissue biopsy and treatment of patients with NSCLC are reviewed elsewhere. (See "Selection of modality for diagnosis and staging of patients with suspected non-small cell lung cancer" and "Procedures for tissue biopsy in patients with suspected non-small cell lung cancer" and "Management of stage I and stage II non-small cell lung cancer" and "Management of stage III non-small cell lung cancer" and "Overview of the treatment of advanced non-small cell lung cancer" and "Personalized, genotype-directed therapy for advanced non-small cell lung cancer".)

GENERAL GOALS AND TIMING OF EVALUATION

For each patient with suspected lung cancer the overall goal is a timely diagnosis and accurate staging so appropriate therapy can be administered. The general approach should be tailored to the individual values and preferences of the patient, the clinical presentation, as well as the technical expertise at the practicing institution. Our approach to the initial evaluation and radiologic staging of patients with suspected lung cancer is concordant with the guidelines issued by the American College of Chest Physicians (ACCP) and the National Comprehensive Cancer Network (NCCN) [2-4]. The role of multidisciplinary teams in the timely evaluation of patients with suspected lung cancer is discussed in detail separately. (See "Selection of modality for diagnosis and staging of patients with suspected non-small cell lung cancer", section on 'Role of multidisciplinary teams'.)

Goals — The major goals of the initial evaluation of a patient with suspected lung cancer are to assess the following (figure 1):

Clinical extent and stage of disease

                           

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