Principles of staging as applied to nonsmall cell lung cancer

PURPOSE OF REVIEW: To review the principles of staging cancer as applied to nonsmall cell lung cancer. RECENT FINDINGS: The current staging system is under review for update. It is timely to review the principles of staging cancer to see how the nonsmall cell lung cancer staging system can be improved. Staging systems should predict prognosis, and guide therapy and research. Based on newer data the next staging system will likely incorporate more categories for tumor size and metastatic disease. Nodal staging may need to distinguish between single station N2 disease and multiple N2 station involvement, as there is some evidence that those with bulky multiple station N2 disease do worse. Histology is increasingly used to guide therapy and there are data that it can affect prognosis. SUMMARY: How we stage patients with nonsmall cell lung cancer is about to change. The most important changes are to tumor size classification and classification of metastatic disease. Better standardization of measurements for tumor staging may further improve the utility of staging.