Lung Cancer

Lung cancer, the leading cause of cancer-related mortality worldwide, is classified into two major histologic categories: nonsmall cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). Effective treatment strategies for patients with lung cancer require accurate clinical tumor, node, and metastasis (TNM) staging. The TNM-8 staging system is used to stage patients with lung cancer and imaging with CT, FDG-CT/PET and MR is an integral part of clinical staging. Chest CT is commonly used to stage patients with lung cancer and is performed to assess the primary tumor and detect intra- and extrathoracic metastases. While whole-body MRI can be used to stage patients, MRI is generally used as an adjunct to CT in evaluating patients whose CT findings are equivocal. FDG-CT/PET complements conventional CT assessment of lung cancer and is routinely used to improve the detection of nodal and extrathoracic metastases. Treatment options include surgical resection, chemotherapy, immunotherapy and radiation therapy. Surgical resection is the treatment of choice in patients with early stage NSCLC although stereotactic body radiation therapy alone is increasingly being used for curative intent. Resection can also be performed in patients with locally advanced disease without mediastinal nodal metastasis. Postoperative adjuvant chemotherapy is used in most patients with advanced NSCLC who undergo surgical resection. Chemotherapy and/or immunotherapy is the new standard to treat patients with distant metastasis who do not have driver mutations. Patients with driver mutations in key genes are treated initially with targeted agents. Concurrent chemoradiotherapy can be used to treat patients with locoregionally advanced NSCLC.