Preliminary Information
Multiple pieces of data are required to complete the staging process for lung carcinoma. Routine basic information sets the stage for obtaining other complex data. We initially assess T, N, M status and then finally stage group the patient.
Staging requires the following:
Additionally, note the following:
History
PhysicalHistory is absolutely necessary to assess whether there is any suggestion of metastasis. A detailed review of systems will help assess whether there is any symptom to warrant suspicion of presence of metastasis to distant sites or extension of tumor to mediastinal or chest wall structures.
Chest X-RayA complete physical exam should be done to assess whether there is evidence for any metastases. Supraclavicular area should be examined for nodes. Carefully palpate abdominal wall and rest of the body feeling for subcutaneous metastatic lesions. Hoarse voice would alert possible vocal cord paralysis.
CBCChest x-ray is useful to assess:
- Size of tumor
- Extension of tumor to surrounding structures
- Extent of collapse of lung, if any
- Presence of hilar and mediastinal nodes
SMA-20Thrombocytosis can be present as a nonspecific phenomenon. Presence of significant normochromic normocytic anemia, a presence of immature cells in peripheral smear, would raise suspicion for bone marrow metastasis.
BronchoscopyAbnormality in liver function tests would raise suspicion for liver metastasis. Calcium, phosphorus and alkaline phosphate abnormalities could suggest bony metastasis. One should be aware of the electrolyte and acid base abnormalities secondary to endocrine manifestation of tumor and distinguish it from metastatic disease.
BiopsyBronchoscopy is essential for:
Vocal cord paralysis would suggest invasion of recurrent laryngeal nerve in mediastinum. The lesion should be at least 2 cms. from carina to enable resection of lung with tumor free edge.
- Establishing the tissue diagnosis
- Assessing the proximity of the lesion to carina
- Vocal cord movement.
Histological diagnosis is essential to classify the tumor as NSCC or SCC.