Lung cancer is divided into four stages Accurate clinical staging helps doctors to formulate scientific and reasonable treatment plans for lung cancer patients, so that those lung cancer patients who have distant metastases and should not undergo surgery can avoid the pain of open-heart surgery, and those lung cancer patients who originally do not have metastases can receive timely and scientific multidisciplinary comprehensive treatment based on surgical procedures. We classify lung cancer into stage I, II, III and IV, and stage I-III lung cancer is further divided into stage Ia, Ib, IIa, IIb, IIIa and IIIb, respectively. TNM staging The most commonly used clinical staging method for lung cancer is to adopt the internationally accepted TNM staging (T: represents primary tumor size, N: represents lymph node metastasis, M: represents distant metastasis): clinical staging examination of lung cancer includes chest CT scan and fiberoptic bronchoscopy, which are the most commonly used means as T staging of tumors. biopsy and CT-guided pulmonary aspiration biopsy are very necessary tools; TV thoracoscopy has unique advantages for the diagnosis of unexplained pleural effusion. Cranial MRI, abdominal ultrasound or CT and whole-body bone scan are the most common means to exclude extra-pulmonary metastases. Currently these clinical staging tests for lung cancer have been compiled as routine tests for clinical diagnosis and treatment of lung cancer by the Chinese Anti-Cancer Association and the Chinese Medical Association, and have entered the national and provincial and municipal medical insurance reimbursement catalogs. If your supervising doctor plans to arrange surgery directly without arranging these staging examinations, I suggest you transfer to a hospital immediately! Because if this doctor does not even standardize the staging examination before surgery, whether the surgery clears the mediastinal lymph nodes and the postoperative adjuvant treatment may not be standardized either! TV mediastinoscopy The TV mediastinoscopy carried out in recent years can accurately determine whether the mediastinal lymph nodes are metastatic or not. With the application of PET, PET-CT and SPECT, the development of TV mediastinoscopy and systematic mediastinal lymph node dissection routinely performed in lung cancer surgery, we also found that nearly 50% of mediastinal lymph node metastases reported in chest CT are false positives, and there is no metastasis at all. TV mediastinoscopy is routinely performed before lung cancer surgery abroad, but in China, it is only carried out in some large university lung cancer centers and a few cancer hospitals in thoracic surgery. New staging techniques In recent years, the clinical application of positron emission computed tomography (PET and PET-CT) examination, ultrasound endoscopy-guided esophagoscopic fine-needle aspiration biopsy (EUS-FNA), ultrasound endoscopy-guided bronchoscopic biopsy (EBUS-TBNA) and magnetic navigation technology has made the clinical staging of mediastinal lymph nodes before lung cancer treatment more accurate. In particular, positron emission computed tomography (PET and PET-CT) examinations can change the traditional clinical staging and make the treatment plan formulated by doctors more scientific and reasonable, which will benefit patients more. We hope that the national authorities will include them in the medical insurance reimbursement list as soon as possible! Traces of early stage lung cancer Early stage lung cancer often has no clinical symptoms because the lesions are small (about 1.5% of patients cannot find lesions on X-ray chest film or chest CT film) or the tumor is located in a place that does not affect the surrounding lung tissues much, about 6% of patients can have no clinical symptoms. Sometimes when lesions are found on X-ray chest film or positive sputum cytology, there are still no symptoms. The symptoms and signs of lung cancer vary with the site of mass occurrence, size and pathological type and certain biologically active substances produced by lung cancer, including hormones, antigens, enzymes, etc., as well as the degree of patient’s response to the cancer.