For certain patients, specific scans of these organs are performed if the doctor is concerned about tumor spread. This procedure is performed under general anesthesia through a small incision just above the breast bone. The surgeon biopsies multiple lymph nodes to determine whether or not spread has occurred. Third, the patient's functional status is evaluated. Of particular concern is how short of breath they become with exercise.
Functional status helps determine how much lung can be removed safely.
Additional studies are done that specifically measure lung function. Once the studies have determined whether spread has occured to lymph nodes or other organs, the patient is typcially assigned to a clinical stage of disease. If the tumor has spread outside of the chest to an organ such as the liver or adrenal glands, then surgery is generally not performed, instead chmotherapy or radiation, or a combination is used. For most other patients, surgery is the primary treatment. In small-cell lung cancer, chemotherapy with or without radiation is the primary treatment.