Current concepts in the staging of non-small cell lung cancer

When evaluating a patient diagnosed with non-small cell lung cancer (NSCLC), staging helps define the extent of disease. The main goals of staging are to assist in determining appropriate treatment options (surgery versus non-surgical) and in predicting prognosis. Based on the recommendation of the American Joint Committee for Cancer (AJCC), a TNM (tumor, node, and metastases) staging system is used for NSCLC. Clinical staging (cTNM) is determined using non-invasive techniques such as clinical assessment and radiologic testing. Pathologic staging (pTNM) is determined using invasive techniques such as bronchoscopy, mediastinoscopy, and video-assisted thoracoscopic surgery, or at the time of thoracotomy. Recently, new staging modalities such as positron emission tomography and intraoperative sentinel node mapping have been used with promising results. In the near future, these techniques, as well as molecular and serum tumor markers, will likely be used to more accurately determine the burden of disease and allow for more appropriate treatment.