53 yr old presents with a 3 cm left upper lobe mass noted on CT scan of the chest. This was obtained after he presented with 2 months of cough and an abnormal chest x-ray. He has a 40 year history of smoking two packs of cigarettes a day. He denies other symptoms and has been in reasonable health aside from COPD.
CT guided biopsy reveals moderately differentiated adenocarcinoma. PET/CT scan of the body shows uptake in the ipsilateral mediastinal lymph nodes. These are confirmed to be pathologically involved by cancer by mediastinoscopy. He is staged as a IIIA lung cancer.