Sequential Staging

Clincal Diagnostic Staging

Surgical-Evaluative Staging

Surgical-evaluative staging utilizes all clinical-diagnostic data plus the findings at thoracotomy. The stage is derived from the surgeons impression at the time of thoracotomy, based on palpation and inspection of thoracic cavity. These impressions should be supplemented by biopsy and frozen section analysis of suspicious lymph nodes, pleural lesions, or unexpected parenchymal masses. Surgical staging serves to define the anatomic extent of resection necessary to remove all disease with sufficient clear margins.

Post Surgical Pathological Staging

Post surgical pathologic staging is based upon all of the preceding information plus the Pathologist's report after examination of the resected specimen and appropriately labeled lymph nodes. To be complete the surgeon must routinely remove all readily accessible nodal basins at the time of resection. This means removing mediastinal nodes from the paratracheal, subaortic, para-aortic, and subcarinal nodes. If this is not done, occult disease will be missed resulting in some patients being under staged and appropriate adjuvant therapy withheld in the postoperative period.

Retreatment

If SVC syndrome recurs following initial response to radiation, chemotherapy has to be tried. On the other hand, in patients with SCC, if chemotherapy was the initial treatment modality, radiation will be used for recurrence.

In case of death of a lung cancer patient, the extent of cancer, if any, found at autopsy may be recorded by the TNM system and an autopsy stage may be reported. This is important, since a comprehensive postmortem examination provides definitive information about the therapeutic efficacy of the treatment modalities patient received, and the sensitivity and specificity for various staging procedures.