Lung cancer stage is crucial to treatment success. Correct lung cancer staging predicts optimal therapy and survival rate. High-resolution CT, mediastinoscopy, and endobronchial ultrasound determine early or late stage of lung cancer. Dr. Anton Titov, MD. Lung cancer treatment options depend on correct staging of the tumor. Lung cancer stage determination is a very important step after a patient is diagnosed with lung cancer. Dr. Anton Titov, MD. How do you stage patients with lung cancer? So standard of care in lung cancer staging is a contemporary CT scan. Dr. Michael Lanuti, MD. Most CT scans these days have high resolution. So we need good anatomic imaging. There's a target lesion and you understand that it could be lung cancer. Or lung cancer is proven by biopsy. The other staging tool that we use is a PET CT scan. And so PET CT also what would be considered standard. Brain imaging MRI is required if the tumor is big or central. Small tumors are in the periphery. Then we don't necessarily need brain MRI. And if we do brain imaging for staging, it would be brain MRI and not CT scan. Sometimes there is a biopsy-proven lung cancer, there's this notion of what we call "invasive mediastinal staging". So lung cancers tend to travel to lymph nodes in the region. Lung cancer can travel towards the airway, towards the trachea. And so there are lymph nodes that live around the trachea. And lung cancers tend to travel to them. That's one metastatic location that we need to rule out. Oftentimes those lymph nodes can be involved in lung cancer. Metastases in lung cancer changes the treatment plan. Dr. Michael Lanuti, MD. So there's something called invasive mediastinal staging, We use either an old tool that's called mediastinoscopy. We used to make an incision in the neck under general anesthesia. We would biopsy lymph nodes around the windpipe. This has moved now towards something called endobronchial ultrasound. Instead of making incisions in the neck, we go down the windpipe [trachea] with a camera. And we could sample the lymph nodes that are near the trachea. We can assess whether there's lymph node metastasis. Depending on how many of lymph nodes are positive, it would change the treatment plan. Ideally, stage 1 lung cancers have no lymph node involvement. Then surgery is the mainstay of treatment. Lymph node biopsy and staging is done before the major surgery. Dr. Michael Lanuti, MD. We have to decide on lung cancer surgery. Sometimes you do not find any cancer-positive lymph nodes, then you consider that a Stage 1 lung cancer. Surgery could be curative for these patients with stage 1 lung cancer. That's correct, that's correct. And if you find mediastinal lymph nodes involved in lung cancer, then you proceed to combination cancer therapy. Sometimes there's evidence of lymph node cancer involvement in this central region that you call “mediastinum". Then you need more than surgery. Dr. Michael Lanuti, MD. You typically would need chemotherapy, radiation. Surgery to remove lung cancer is considered a third modality for lung cancer cure. So the lung cancer patients are selected carefully if they have mediastinal lymph node involvement with cancer. Dr. Anton Titov, MD.