pretreatment staging for patients with lung cancer

All patients: 1) complete history & physical examination a) determination of performance status & weight loss b) ear, nose & throat examination 2) complete blood count 3) serum chemistries: chem 7, Ca⁺², phosphorous, LFTs 4) electrocardiogram 5) skin test for tuberculosis 6) chest X-ray 7) computed tomography (CT) of brain, thorax, abdomen 8) radionuclide bone scan if CT suggests metastatic lesions 9) X-rays of suspicious bone lesions 10) barium swallow if esophageal symptoms are present 11) pulmonary function studies including arterial blood gas (ABG) of signs or symptoms of respiratory insufficiency are present 12) biopsy of accessible lesions a) no tissue diagnosis has been made b) treatment of staging dependent upon whether or not accessible lesion is malignant Non-small cell carcinoma 1) fiberoptic bronchoscopy with washing, brushings & biopsy of suspicious areas 2) coagulation studies 3) diagnostic & therapeutic thoracentesis if pleural effusion is present 4) transthoracic fine needle biopsy of peripheral lesions if material from fiberoptic bronchoscopy is non diagnostic

References

Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 556