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cut is made in the skin at the front of the base of your neck and a tube passed through the cut into your chest. A light and a camera attached to the tube allow the doctor to closely look at the middle of your chest – the mediastinum – for any abnormal lymph nodes, as these are the first areas that the cancer may spread to. Samples of tissue and lymph nodes can be taken for further examination. Ask your doctor for details if you have any questions about these procedures Cyto(patho)logy Whereas histopathology is the laboratory examination of tissue or cells, cytology (or cytopathology) is the examination of cancerous cells spontaneously detached from the tumour. Common methods for obtaining samples for cytological examination include: • Bronchoscopy: Bronchial washings (in which a mild salt solution is washed over the surface of the airways) and the collection of secretions can be carried out during a bronchoscopy to look for the presence of cancerous cells. • Thoracentesis/pleural drainage: Pleural effusion is an abnormal collection of fluid between the thin layers of tissue (pleura) that line the lung and the wall of the chest cavity. This fluid can be taken from the pleural cavity by thoracentesis or pleural drainage and examined in the laboratory for the presence of cancerous cells. • Pericardiocentesis/pericardial drainage: Pericardial effusion is an abnormal collection of fluid between the heart and the sac that surrounds the heart (pericardium). This fluid can be taken from the pericardial cavity by pericardiocentesis or pericardial drainage and examined in the laboratory for the presence of cancerous cells. These techniques are carried out in the hospital, usually with the aid of ultrasound to help position the needle. You will be given a local anaesthetic and monitored closely for any complications afterwards. Because of the location of your lungs in your body, obtaining samples of cells/tissue can be difficult and it may be necessary to repeat some of these tests if results are found to be inconclusive. 17 ESMO Patients Guide How will my treatment be determined? After a diagnosis is confirmed, your cancer specialist will look at a number of factors to help plan your treatment. This includes information about yourself and about the cancer. Patient-related factors • Your age. • Your general health. • Your medical history. • Your smoking history. • Results of blood tests and scans. Cancer-related factors Treatment also depends on the type of lung cancer that you have (histopathology or cytopathology results), where it is in the lung (its location) and whether it has spread to other parts of the body (imaging results). Staging It is important for your doctor to know the stage of the cancer so that he/she can determine the best treatment approach Staging of the cancer is used to describe its size and position and whether it has spread from where it started. Cancer is staged using a number/letter system – described as Stages IA–IV. Generally, the lower the stage the better the prognosis. Staging considers: • How big the cancer is (tumour size; T). • Whether it has spread into the lymph nodes (N). • Whether it has metastasised (spread) to other areas within the lungs or to other parts of the body (M). Staging is usually carried out twice: after clinical and radiological examinations; and after surgery, in the case of surgically resected tumours. 18 Non-small-cell lung cancer The different stages of NSCLC are described in the table below. This may seem complicated but your doctor will be able to explain which parts of this table correspond to your cancer, and how the stage of your cancer impacts on treatment choice. STAGE IA (T1-N0-M0) • The tumour is no larger than 3 cm, is still inside the lung and has not spread to any of the nearby lymph nodes Early-stage NSCLC STAGE IB (T2a-N0-M0) • The tumour is 3–4 cm in size, is still inside the lung and has not spread to any of the nearby lymph nodes STAGE IIA (T2b-N0-M0) • The tumour is 4–5 cm in size, is still inside the lung and has not spread to any of the nearby lymph nodes STAGE IIB (T1/2-N1-M0 or T3-N0-M0) • The tumour is no larger than 5 cm, has spread to nearby lymph nodes but is not in any other part of the body; or • The tumour is 5–7 cm in size or there is
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