Lung cancer: investigation and staging

In the modern lung cancer service the first visit to hospital will involve some detailed investigations as well as the clinical assessment. Ideally a computed tomography (CT) scan will be available as well as blood tests and spirometry. This provides the opportunity to plan the most effective next test (usually a biopsy) that will give a firm diagnosis, and may provide confirmation of stage and guide treatment options. Clinical assessment and spirometry will identify the need for further tests to assess fitness. Whilst the exact sequence of investigations may vary, patients undergoing radical treatment must always have a positron emission tomography (PET) scan and further imaging if metastases are suspected on clinical grounds. Histological confirmation of more advanced stage is required if there is any doubt.