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Staging in lung cancer is critical in terms of the course of the disease and the determination of the treatment method.
Staging in lung cancer
1. Small cell lung cancer, there are two stages localized and diffuse stage;
Localized phase; In small-cell lung cancer, the disease is limited to one side of the chest without spreading to the opposite lung or other organs.
Diffuse stage; In small-cell lung cancer, the disease has metastasized to organs other than the lung or the opposite lung.

Treatment is different in localized and diffuse stages of small-cell lung cancer, and we stage the using the following:

  • Brain CT or brain MRI
  • Upper abdomen CT
  • PET-CT

2. Since surgery is the most effective treatment in the early stages of non-small cell lung cancer, staging is critical.

Lung cancer is staged according to the TNM system.
T is used to define many features, such as tumor size, the relationship of the tumor with neighboring tissues and organs, and the bronchoscopic appearance of cancer.
N defines the presence or absence of metastases in the tumor's regional or distant lymph nodes.
M is associated with distant organ metastases, and there is no metastasis in M0 cases.

Staging with non-invasive methods in lung cancer (Imaging methods)

  • Computed Tomography
  • Brain MRI
  • USG
  • PET-CT: Detects metastasis. It can not detect brain metastasis. It should be kept in mind that PET uptake is weak or absent in some cancer types.

Non-invasive methods of staging in lung cancer

Minimal invazif

Minimally invasive methods

  • Bronchoscopy
  • EBUS ; Endobronchial ultrasonography
  • EUS: Endoscopic ultrasonography

Invasive methods

  • Bronchoscopy
  • Video-assisted mediastinoscopy
  • Thoracoscopy (VATS)
  • Mediastinotomy
  • Supraclavicular biopsy
  • Pleural fluid biopsy

Note: The main point to be considered here is that a biopsy should be performed in lymph nodes with PET-CT involvement or in places where there is a possibility of cancer. PET-CT positivity can also be detected in non-cancer diseases such as tuberculosis, other infectious diseases, and sarcoidosis, which are common in our country.Deciding without a biopsy may lead to the wrong treatment regimen. N2 (mediastinal lymph nodes), that is, it is necessary to biopsy large lymph nodes with PET involvement on the trachea. The least harmful method to the lymph nodes is chosen.
The first choice for the patient is endobronchial ultrasonography (EBUS) or Endoesophageal ultrasonography (EUS). Endobronchial ultrasonography is a safe and outpatient bronchoscopic method that does not require hospitalization. With this method, the probability of accurate lung cancer staging is over 85-90%. If there is no success, more invasive procedures such as video mediastinoscopy or thoracoscopy (VATS), surgical staging methods, are preferred. Surgical staging methods are performed under general anesthesia, and a vast number of sampling is done.