Educated Patient® Lung Cancer Summit Staging Presentation: June 25, 2022

Lung cancer staging is an important part of a patient’s cancer journey as it determines prognosis and helps to guide treatment decisions, according to an expert.

“Lung cancer is a deadly cancer,” said Dr. Farhard Mazdisnian in an interview with CURE®. “With all the advances that we’ve had in the treatment of lung cancer, even with later stages of lung cancer, patients can have a very good quality of life and survival. So, it’s really important to know what your options are and how to manage these things.”

Mazdisnian, chief of the Division of Pulmonary and Critical Care Medicine at City of Hope in Duarte, California, discussed the different types of techniques used to stage lung cancer further at the CURE® Educated Patient® Lung Cancer Summit.

Patients who are diagnosed with early-stage lung cancer, stages 1 to 2, can usually be treated with surgery, whereas those diagnosed with late-stage disease, stages 3 to 4, may be treated with medical therapies.

There are a few options to stage lung cancer that are both invasive and non-invasive. Currently the “gold standard” for diagnosis and staging is surgery, Mazdisnian noted; however there is an added risk of surgical complications and undergoing general anesthesia.

Imaging is another option, which includes CT scans that can determine size, location and if the disease has spread to the lymph nodes or liver; however, there is only a 55% chance this option can diagnose the cancer. PET scans are also included in imaging, which can be more accurate in diagnosis that CT scans; however there is a 15% false-positive rate with these.

There is also an option for trans-thoracic guided lung biopsy, in which a needle is passed through the skin under image guidance to get tissue. This has “relatively good accuracy,” he said, however there is a risk that the lung may collapse depending on the lesion size and location.

A new staging technique is liquid biopsy, where a patient’s blood is tested to detect cancer cells and is usually used in addition to standard tissue biopsy. This strategy provides a lot of information in terms of prognosis, genetic mutations for precise treatment, effective monitoring and early diagnosis. It is only right in diagnosing stage 1 disease 50% of the time but it is right in diagnosing stages 3 and 4 disease 100% of the time. And the false-negative rate is about 20% to 30%.

And the final staging technique Mazdisnian discussed is robotic bronchoscopy. Prior to the procedure, a CT scan is done to give a “map” or direction to the lesion. It has a good diagnosis rate, depending on the expert who is conducting the procedure, and if they are familiar with the technique he said, and the risks are low compared to other staging mechanisms.

“We are able to go to places where we would never go before with a regular bronchoscope,” he noted about this mechanism. “It has revolutionized the early diagnosis of lung cancer.”

“All of these are very exciting … it allows us to diagnose cancers in early stage, we can get adequate tissues to help (oncologists) tailor their treatment better to the cancer,” Mazdisnian concluded in his presentation.

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