Numerous screening studies performed on asymptomatic individuals, based on sputum cytology and chest radiography, have not shown any benefit, either in the increase of overall survival or in decreasing mortality rates from lung cancer. To date, no organization recommends screening for lung cancer in asymptomatic individuals.

In the natural evolution of cancer, which has been taking place over decades, clinical symptoms are the only indication of lung cancer until the disease takes its course. To passively wait, is to have a limited and very restricted perspective of oncological disease in general and of lung disease in particular.

The recent understanding of carcinogenesis, as a progressive and autonomous dysregulation in the response to cellular aggression, genetic control of cellular functions, oncogenes, suppressor genes and the multiple factors controlling cell growth, has led to a greater understanding of the disease and new ways of approaching it.

These recent advances in molecular biology and genetics, associated with a remarkable development of imaging techniques, such as computed axial tomography (CT Scan) and positron emission tomography (PET Scan), led to new approaches for an early diagnosis, the results of which are still under study.

The goal is the population at risk for lung cancer, asymptomatic individuals or individuals with symptoms unrelated to the disease who are exposed to carcinogenic agents. Identifying the genetic alterations that facilitate the deregulations of cells and somatic mutations together with new imaging technology capable of greater and precocious detection.

Smokers, men and women, over the age of 55 years, often with previous respiratory disorders, associated with risk occupations (such as handling asbestos, arsenic, chloromethyl, nickel) and/or previous neoplasia, and/or family history of lung cancer, are all considered to be at risk for lung cancer.

For an early diagnosis of lung cancer, it is also important to mention bronchoscopy.

It is the main evaluation screening technique for patients with suspected lung cancer. This exam is well tolerated and safe. It is performed on an outpatient basis, requiring only light oropharyngeal anaesthesia. This exam has replaced rigid bronchoscopy many years ago. It allows direct visualization and evaluation, not only of the trachea and main bronchi, but also of some fourth-generation bronchi. Contraindications are few, and it is considered a safe procedure with a complication rate of 0.12%. More than 70% of lung cancers are visible by bronchofibroscopy and of these the combination of bronchial aspiration and 3 to 5 bronchial biopsies will permit a diagnosis to be reached in more than 90% of cases. A bronchoscopy also plays an important role in cancer staging.

Staging a tumour means evaluating its extent and integrating it into a group where therapeutic options and prognostic perspectives are as uniform as possible.

As important as the anatomical staging, is the physiological staging, which seeks to assess the ability of each patient to tolerate the recommended therapy. Characterizing the patient’s general condition or performance status is of undeniable prognostic and therapeutic value.

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