Diagnosis and staging

Lung cancer may be diagnosed through:

• additional imaging (may include a PET-CT scan)
• bronchoscopy including endobronchial ultrasound-guided biopsy
• CT or ultrasound-guided biopsy or aspiration
• excisional biopsy or biopsy of a metastasis
• sputum cytology in rare cases.

Staging for lung cancer involves:

CT scans of the chest and upper abdomen (in all cases) and imaging (can be MRI) of the brain in some cases

• PET-CT scans where curative treatment is being considered
• assessment by a surgeon with thoracic/lung cancer expertise in cases where curative treatment is being considered.

Imaging and/or pathological confirmation of the most advanced site of disease may be required.

Molecular testing and biomarker testing can inform the most appropriate treatment for non-small cell lung cancer (NSCLC).

Genetic testing

Familial causes are rare in lung cancer and testing is not usually needed.

Treatment planning

The multidisciplinary team should discuss all newly diagnosed patients with lung cancer, usually before treatment begins.

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.

Communication

The lead clinician’s (1) responsibilities include:

• discussing a timeframe for diagnosis and treatment options with the patient and/or carer
• explaining the role of the multidisciplinary team in treatment planning and ongoing care
• encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
• providing appropriate information and referral to support services as required
• communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from multidisciplinary meetings (MDMs).

Checklist

Timeframe

Complete diagnostic tests within 2 weeks of the first specialist appointment.