Lung cancer: investigation and staging

The aim of achieving an accurate diagnosis and stage of lung cancer is to ensure that patients can be offered the most appropriate treatment. Investigations should yield the required level of diagnostic and staging information with least risk and discomfort for the patient. It is vital that this is in line with the patient's wishes and appropriate to their fitness as well as the potential treatment. To do this, contrast-enhanced computed tomography (CT) of the lower neck, chest and upper abdomen should be available for most patients at the first clinical assessment. At this time, performance status is recorded and blood tests and spirometry obtained. The most effective next test (usually a biopsy) can then be selected. Clear information should be given to the patient, who must have access to support from a lung cancer nurse specialist. Clinical assessment and spirometry identify the need for further tests to assess fitness. The exact sequence of investigations varies according to the clinical and CT findings, but pathological confirmation of findings of imaging is usually sought, providing samples that are adequate for sub-classification of tumours to facilitate targeted treatment.