The most appropriate treatment is resection. The transthoracic needle biopsy obtained in this patient was consistent with a diagnosis of adenocarcinoma of the lung. After non–small cell lung cancer (NSCLC) is diagnosed based on biopsy findings of a suspicious lung mass, staging studies are obtained to develop an appropriate treatment plan. Because the cancer may spread systemically, studies are also done to detect common sites of involvement, typically liver, bone, adrenal glands, or brain. Imaging studies include CT of the chest and abdomen plus a bone scan or PET/CT plus contrast-enhanced MRI of the brain. In this patient, the PET/CT showed only localized disease and his MRI of the brain did not show evidence of metastatic disease. If the mediastinum and distant sites are disease-free, surgical resection is considered feasible. The next steps are determining the extent of the surgical procedure to remove all known disease and deciding whether postoperative residual lung function will be adequate. Because most patients with lung cancer have damage to the lungs from tobacco use, pulmonary function studies should be obtained to evaluate total lung capacity, forced expiratory volumes, and DLCO. Values below a certain level may preclude surgery. In this patient with localized NSCLC who can tolerate surgery, complete resection should be attempted. The 5-year survival rate in patients diagnosed with resectable disease ranges from 30% to 75%. If surgery is not possible, radiation therapy is recommended as an alternative.
Airway stent placement can be performed in instances of airway obstruction, including those caused by endobronchial involvement of a primary lung cancer. However, this patient has no evidence of airway obstruction on chest imaging and is currently asymptomatic.
In more advanced NSCLC that includes mediastinal, hilar, or contralateral lymph node involvement, outcomes have not been shown to be improved with surgical resection; therefore, chemotherapy in combination with radiation therapy is considered first-line therapy. This patient has no evidence of advanced disease. Patients with distant metastasis are generally treated with chemotherapy alone, but this patient has no evidence of metastatic disease. Adjuvant chemotherapy could be considered in some patients with resectable disease.