Abstract & Overview
Lung cancer has a devastating global impact, with diagnosis of more than 2 million new cases annually, and poor long-term survival. Recently, the landscape of lung cancer diagnosis, staging, and treatment has changed profoundly, with further developments on the horizon. It has become of increasing importance to comprehensively characterise lung tumour tissue. Minimally invasive diagnostic modalities, including standard bronchoscopy and radial probe endobronchial ultrasound (EBUS), enable adequate tissue sampling for tumour subtyping. Sophisticated electromagnetic navigation software and novel biopsy procedures have allowed for sampling of even very peripheral tumours, in the hands of experienced bronchoscopists. Linear EBUS is now widely used for simultaneous diagnosis and cancer staging, reducing time to treatment initiation and effectively replacing invasive mediastinoscopy. Liquid biopsy is an emerging noninvasive technology with potential for diagnosis, prediction of tumour response, and detection of resistance-related gene mutations. Significant advancements in our understanding of the immunologic and oncogenic processes involved with lung cancer biology have helped revolutionise management. Whilst chemotherapy remains a therapeutic cornerstone for many, evolving evidence supports a personalised approach, particularly in advanced disease. Specific inhibitors targeting driver mutations and key immunological pathways confer survival benefits in metastatic lung cancer, with emerging data in early stage disease. In this review, lung cancer histological subtypes are discussed, with a focus on non-small cell lung cancer, along with current and evolving approaches to diagnosis and staging. Therapeutic options in the era of precision medicine will also be considered within the context of targetable oncogenic driver mutations and the growing field of immuno-oncology.