Follow up and surveillance of the patient with lung cancer: what do you do after surgery?

Of the new cases of lung cancer discovered each year, it has been estimated that 50-55% have localized disease and are thus candidates for potentially curative treatment. Some of these patients will refuse surgery or will have co-morbidities that preclude surgery. The remainder will undergo an attempted curative resection. A common clinical question arises in these patients: how should this patient be followed after surgery? Post-treatment surveillance is indicated to monitor for recurrence of the original tumor and for the development of a metachronous tumor. The appropriate protocol is controversial and current recommendations are primarily expert opinion or consensus-based and await further study. A suggested clinically reasonable and cost-effective surveillance approach would include a history, physical examination and an imaging study (either chest radiograph or CT) every 6 months for 2 years and then annually. Patients should be counselled on symptom recognition and advised to contact their physician should such symptoms appear.