Diagnostic work-up and stage classification of lung cancer

Lung cancer is the most frequent form of cancer leading to death worldwide. The prognosis is still poor and progress in developing therapeutic approaches is slow: 20 years ago the 5-year survival rate was 11% and today it is at the most 15%. The main risk factor is inhalation of cigarette smoke that entails a clear dose-effect relationship. The importance of passive smoking has in the meantime also become clear. Since early symptoms of the tumor are extremely rare, an advanced tumor stage can as a rule be assumed when the patient presents with symptoms at the hospital or physician's office. The classic solitary pulmonary nodule at the early stage is usually detected by chance. In addition to bronchoscopy aimed at histological verification of the process, the most important examinations include thoracic computed tomography, abdominal sonography, and bone scintigraphy, if necessary in conjunction with further imaging procedures. The tumor is classified based on these findings and then appropriate treatment is initiated. Lung cancer is the most frequent malignant tumor in men worldwide. In the USA the disease incidence for both sexes takes second place and in Germany third place for women among malignant tumor diseases. Despite continued efforts to achieve improvements in diagnostic and therapeutic options, the 5-year survival rate for patients with bronchial cancer increased only slightly in the past 25 years and is currently a mean of 15% across all stages. Every year the incidence of the tumor increases by 0.5% and is greater than the incidence of colorectal cancer, breast cancer, and cervical cancer together. In the Western world this tumor remains with a constant tendency the most frequent cause of cancer death in men, but also increasingly more often in women. Developing countries are also reporting rising mortality rates. © Springer Medizin Verlag 2006.