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- PET scanning can help to distinguish between benign and malignant solitary pulmonary nodules seen on chest x-ray. PET scanning may also be used in the assessment of nodal spread and metastatic disease.
- Imaging of other organs: if it is suspected that the cancer has spread to other organs, scans of the liver, brain or bone may be required.While imaging tests are helpful in raising the suspicion of lung cancer, diagnosis requires that cancer cells are seen under a microscope. There are a number of ways of obtaining samples of suspected cancer cells:
- Sputum cytology: cells from the sputum (spit) are examined for signs of malignancy (cancer).
- Bronchoscopy with washings, brushings and biopsy: a bronchoscopy is a camera tube placed through the throat into the airways of the lungs. Samples of the cells from the airways can be taken with washing, brushing, or biopsy.
- Fine needle aspiration biopsy through the skin may be used to investigate suspected lung tumours located on the outside of the lungs.
Prognosis of Lung Cancer (Large Cell Carcinoma of the Lung)
The prognosis (probable outcome) depends on the stage of the tumour. Cancer staging is a tool which allows prediction of patient outcomes, and helps decide on the best treatment options. It takes into account various features of a tumour in an individual patient, which can then be compared to other patients with similar tumour features.
Staging of large cell carcinoma of the lung is based on the TNM (Tumour, Node, Metastasis) system. ‘Tumour’ refers to tumour size, which is measured in centimetres. ‘Node’ refers to the presence of cancerous cells in regional lymph nodes. ‘Metastasis’ refers to the spread of cancer beyond regional lymph nodes to other organs of the body.
- Tumour size (T):
- Tx: Primary tumour not able to be assessed
- T0: No evidence of primary tumour, ie. cancer cells seen on sputum sampling or bronchial washing only
- Tis: Carcinoma in situ
- T1: Tumour 3 cm or less, surrounded by pleura, without evidence of invasion more proximal than the lobar bronchus.
- T2: Tumour with any of the following features:
- >3cm in greatest dimension
- Involves main bronchus, 2cm or more distal to the carina
- Invades visceral pleura
- Associated with atelectasis or obstructive pneumonitis, extending to the hilar region but not involving the entire lung.
- T3: Tumour of any size,
- directly invading the chest wall, diaphragm, mediastinal pleura or parietal pericardium; or tumour in the main bronchus; or
- in the main bronchus, less than 2cm distal to the carina, but without involvement of the carina; or
- with associated atelectasis or obstructive pneumonitis of the entire lung
- T4: Tumour of any size, invading the mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina; or with separate tumour nodules in one lobe, or with malignant pleural effusion
- Regional lymph nodes (N):
- NX: Regional lymph nodes not able to be assessed
- N0: No regional lymph node metastasis
- N1: Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
- N2: Metastasis in ipsilateral mediastinal and/or subcarinal lymph nodes
- N3: Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph nodes
- Distant Metastasis (M)
- MX: Distant metastasis not able to be assessed
- M0: No distant metastasis
- M1: Distant metastasis, including separate tumour nodule(s) in a different lobe (ipsi- or contralateral).
Using this classification, non-small cell lung cancers are grouped into stages as follows:
- Stage 0: TIS N0 M0
- Stage Ia: T1 N0 M0
- Stage Ib: T2 N0 M0
- Stage IIa: T1 N1 M0
- Stage IIb: T2 N1 M0, T3 N0 M0
- Stage IIIa: T1 N2 M0, T2 N2 M0, T3 N1 M0, T3 N2 M0
- Stage IIIb: any T N3 MO, T4 any N M0
- Stage IV: any T any N M1
Using this system, outcomes are best for patients with early stages of disease, with small tumours, no spread to lymph nodes, and no distant spread (metastasis) to other organs. Outcome