Signs of paraneoplastic syndromes should also be noted, because they provide a clue to the nature of the chest lesion. The presence of coexisting diseases should also be sought, especially other lung diseases and cardiovascular diseases, because they directly affect the planning and course of treatment. Chest X-Ray and CT Scan Radiographic studies play a central role in evaluating lung cancer. Although they are not diagnostic, these tests are important in establishing a diagnosis and directing further testing. Evaluating older chest x-rays on the same patient are as important as reviewing current films.
Older films allow comparisons to determine whether an abnormality is new, old, or has changed.
Lesions which have not changed in 2 or more years or show a benign calcification pattern are classified as benign. Without previous x-rays, all abnormalities must be considered new and require follow up. Chest CT scanning has improved significantly on chest x-ray. Chest CT scans should be obtained from the lung apices through the adrenals. It provides important anatomic staging information about the tumor.