Diagnosis and treatment of early lung cancer: as it stands today

Treatment of "early" stage lung cancer should offer the patient the best chance for cure. Disease-free survival after surgical resection of lung carcinoma in situ has been reported as over 90%. For "microinvasive" lung cancer it may be similar. After resection of stage IA non-small cell lung cancer, survival at 5 years is approximately 60 to 70%. If endoscopic or bronchoscopic treatments of early stage lung cancer can offer similar disease-free survival with less perioperative mortality, morbidity, and cost, then they may be alternative front-line therapies. Regardless of therapeutic choice, the initial hurdle is developing a practical detection method for early stage disease. This article reviews early stage lung cancer detection by fluorescence bronchoscopy and potential treatment by the endoscopic techniques of photodynamic therapy, brachytherapy, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, electrocautery, and cryotherapy.