Dr. David Carbone, Jill Feldman

Lung cancer is one of the most common forms of cancer. In this video, Dr. David Carbone and lung cancer patient advocate Jill Feldman discuss the important role of staging in helping to determine the proper treatment approach for lung cancer patients. Learn about diagnosis and biopsies, why staging is important, and how molecular profiling may ever change how doctors decide on a treatment plan in the future.

Staging is an important part of evaluating how to best treat lung cancer. And typically, once you know the diagnosis of lung cancer, you need to know where the cancer is. The tests that are used in lung cancer staging determination are:

  • CT scans, which are just X-rays that show shadows, but not the function of a spot.
  • PET scans, which rely on the fact that cancers take up more sugar than normal tissues. They give you a labeled sugar, let it circulate around your body, and then image where the sugar goes in relation to where the CT images show structures. This scan determines active spots of cancer that might not be picked up by the CT scan. Typically, a PET scan will be of your entire body showing any spots in the bones, the liver, and other places, which is very important to know in picking the best treatment.
  • Brain scans are often also part of the workup that’s called brain MRIs, typically. And brain MRIs are more sensitive at detecting brain metastases than PET scans. Even though PETs and CTs often include the brain. The MRI is the most sensitive and in especially advanced stages of cancer really should be part of the staging workup.

Does everybody have the same tests when they’re being staged?

Typically, these three tests: a CT scan, a PET scan, and a brain MRI, are part of every patient’s evaluation for staging. Other tests such as biopsying suspicious spots to determine whether they’re cancer or not are also part of determining the staging of lung cancer.

Why is lung cancer staging information important?

It’s very important to know where the cancer is in your body. There are sometimes when a spot in a bone, for example, will cause a weakness in the bone that can predispose to a fracture. And that injury can be prevented if you know that the spot is there. There are also specific treatments for bone metastases that will prevent or reduce the risk of problems from bone metastases.

Can my stage change during my cancer journey, or am I always the stage I was diagnosed with?

Most of the time people refer to staging as the stage when you were originally diagnosed. But it’s definitely true that, if you are diagnosed with stage 1 or 2 lung cancer, it can become metastatic This means the cancer has spread outside the lung to a part of the body where surgical resection or definitive radiation isn’t possible. But that’s technically referred to as recurrent or metastatic lung cancer and not stage four. Typically, a patient is the stage when they were diagnosed.