Staging cancer…it has nothing to do with the theater.
In short, staging is determining the extent of the lung cancer. Is the tumor invading into structures outside the lung such as the rib cage or the heart? Has the cancer spread through the lymphatic system to lymph nodes near but outside the lung? In the worst case, have cancer cells been distributed by the blood around the body to other organs such as the liver, brain or a bone? (i.e., is there metastatic disease?)
If there is no spread of the cancer to lymph nodes, there is no metastatic disease and the tumor is completely within the lung, an operation by a thoracic surgeon has an 80% chance of curing the patient. Unless the patient is not fit for a major operation, that is the appropriate treatment.
The presence of metastases means the patient will not be cured or even helped by an operation and one should not be performed. Lung cancer operations are associated with some pain afterwards and have risks. Subjecting someone to these without any chance of helping them is inappropriate.
The situation is less clear for patients with involvement of lymph nodes but no metastases. Some, depending on the extent and location of the involved nodes, can be effectively treated with a combination of chemotherapy and radiation followed by surgery. Experience has shown that others resemble patients with metastatic disease and are not candidates for surgery.
Accurate staging is obviously crucial. That is why a battery of tests including a variety of radiologic exams (x-rays and CAT, MRI and PET scans) and even surgical sampling of lymph nodes is used when necessary to enable the right decision for each individual patient. We want the best chance for cure but always remember the golden rule: do no harm.
