Lung cancer staging now and in the future

Abstract

For a long time lung cancer was associated with a fatalistic approach by healthcare professionals. In recent years, advances in imaging, improved diagnostic techniques and more effective treatment modalities are reasons for optimism. Accurate lung cancer staging is vitally important because treatment options and prognosis differ significantly by stage. The staging algorithm should include a contrast computed tomography (CT) of the chest and the upper abdomen including adrenals, positron emission tomography/CT for staging the mediastinum and to rule out extrathoracic metastasis in patients considered for surgical resection, endosonography-guided needle sampling procedure replacing mediastinoscopy for near complete mediastinal staging, and brain imaging as clinically indicated. Applicability of evidence-based guidelines for staging of lung cancer depends on the available expertise and level of resources and is directly impacted by financial issues. Considering the diversity of healthcare infrastructure and economic performance of Asian countries, optimal and costeffective use of staging methods appropriate to the available resources is prudent.The pulmonologist plays a central role in the multidisciplinary approach to lung cancer diagnosis, staging and management. Regional respiratory societies such as the Asian Pacific Society of Respirology should work with national respiratory societies to strive for uniform standards of care. For developing countries, a minimum set of care standards should be formulated.Cost-effective delivery of optimal care for lung cancer patients, including staging within the various healthcare systems, should be encouraged and most importantly,tobacco control implementation should receive an absolute priority status in all countries in Asia.

Withaferin a synergistically enhances the effects of paclitaxel against lung cancer.

“…However, patients with stages III-V are considered to have advanced lung cancer and thus have the worst clinical outcome [20]. The dismal survival for patients with advanced lung cancer is mainly because of the regional and distant metastases.…”

“…Among these patients, the primary tumor is already spread beyond the lung tissue into lymph nodes (stage III) and sometimes with distant metastases (stage IV). Very frequently, advanced lung cancer patients also have undetected systemic micrometastases that can result in tumor relapse [13,18,22]. Therefore, the main clinical goal of treatment in advanced lung cancer is palliation of symptoms and to prolong the life of patients.…”

“…Many clinical reports indicate that the stages IA, IB, IIA, IIB are considered early stage lung cancer [20,21] where the primary tumors are sufficiently localized and therefore are considered curable.…”

“…World Health Organization (WHO) utilizes and recommends the Tumor-NodeMetastasis (TNM) staging system of lung cancer based on the size of the primary tumor(T), regional lymph nodes (N), and (M) distant metastases [19,20]. Using this system, a combination of TNM descriptors is used to group lung tumors into seven stages that reflect expected survival outcomes [11].…”

Age-related host factors regulate lung cancer progression.

“…Proper staging is of the utmost importance for the determination of the appropriate treatment regimen. For example, surgical resection is beneficial for patients with stages 1-2, while those with stages 3-4 rarely benefit from surgery [24]. Other treatment options include chemotherapy alone or in combination with radiation.…”