Why lung cancer staging is important

  Lung cancer is firstly classified into two major pathological types, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), according to the size of the cells under light microscopy. Since this classification method is easy to operate, and it has been proved in clinical practice that this classification method and treatment principles are closely related, it has been used and widely accepted. After the diagnosis of lung cancer is confirmed, the principles of comprehensive lung cancer treatment are formulated after multidisciplinary discussion based on the TNM staging of lung cancer according to the three aspects of tumor size (tumor, T), lymph node metastasis (node, N) and the presence of distant metastasis (metastasis, M) established by WHO. Due to the different cell biological behaviors of NSCLC and SCLC, their characteristics of lymph node and bloodstream metastasis are different, and they are very different in terms of treatment.  Only radical resection of NSCLC can give patients the best possible chance of long-term survival or even cure, yet only 25% of patients have the opportunity for radical surgery at the time of initial diagnosis. In most cases, patients are diagnosed with poor general condition, severe disease, locally advanced lung cancer that is difficult to resect, or distant metastases, resulting in loss of surgical opportunity. Generally speaking, if NSCLC lung cancer lesions are small, confined to the lung, have not metastasized distantly, the patient’s general condition is good, and the cardiopulmonary function can tolerate radical surgery, local treatment should be the main treatment, and surgery should be the main treatment. Radiotherapy, etc. With the development of science and technology, new technologies are also widely used in the treatment of lung cancer. Patients who cannot tolerate or do not want to undergo surgery can also receive minimally invasive lung cancer treatment, such as minimally invasive lung cancer surgery, radiofrequency ablation, microwave ablation or argon helium knife cryotherapy, which can also achieve a certain degree of cure.  For SCLC, it is found that SCLC is characterized by early lymph node metastasis and distant hematogenous dissemination, about 2/3 of cases have hematogenous metastasis at the time of initial diagnosis, and among the remaining 1/3, most of them have extensive metastasis in lymph nodes. Therefore, surgery is not the main treatment step for SCLC, and chemotherapy is used instead. Clinical studies have confirmed that staging SCLC by limited disease (LD) and extensive disease (ED) is more suitable for clinical selection of treatment options; LD stage means that there is a possibility of cure and radical chemotherapy and radiotherapy to the primary site and lymph node drainage area should be given, while ED stage means that the possibility of cure is greatly reduced. Palliative chemotherapy is given in most cases, supplemented with palliative radiotherapy only in the presence of brain metastases or acute tumor conditions such as superior vena cava compression syndrome, spinal cord compression syndrome or bone metastases with severe bone pain and risk of fracture in weight-bearing critical areas. Except for the section on SCLC staging, the rest of this section refers to lung cancer as NSCLC by default. For patients who can be operated, the treatment mode includes various combinations of surgery-follow-up observation, surgery-adjuvant chemotherapy and/or radiotherapy, neoadjuvant chemotherapy and/or radiotherapy-surgery-adjuvant chemotherapy and/or radiotherapy, etc. The correct TNM staging is an important guide for the clinical treatment plan of NSCLC patients. The correct TNM staging is an important guideline for the selection of clinical treatment plan for NSCLC patients and is a particularly critical step. Therefore, the ideal treatment model for lung cancer patients is: before any non-emergency surgical treatment, a comprehensive examination such as non-invasive examination (including medical history, physical examination, liver and kidney function and biochemical and tumor marker tests, and imaging examination) should be completed, and histopathological diagnosis should be obtained with the help of fibrinoscopy, percutaneous lung aspiration or thoracoscopy. The feasibility of surgical resection is initially judged by the surgeon, and if necessary, minimally invasive staging tools (such as mediastinoscopy and thoracoscopy) are given to further achieve accurate clinical staging.  When postoperative patients need to change hospital treatment or change to oncology department for the next treatment, they should make copies of surgical medical records, especially including discharge records, surgical records and pathology reports, so that medical oncologists can accurately judge the pathological stage and arrange postoperative adjuvant chemotherapy and/or radiotherapy, or directly enter into regular follow-up period.