For a patient with a lung tumor that is radiographically consistent with early-stage NSCLC but pathology with characteristics overlapping with upper GI origin, what additional diagnostic procedures would you consider before treating?

In the absence of imaging findings in a patient with a risk profile consistent with early-stage NSCLC, I would probably just move forward with definitive management as NSCLC with either surgical resection or SBRT as appropriate. The only other thing I would consider is to make sure they are up to date on age and risk-appropriate colonoscopy screening although may miss an “upper GI” primary. If in need of a colonoscopy per guidelines, it wouldn’t be unreasonable to do an upper scope simultaneousl...

This could be pulmonary enteric adenocarcinoma (rare lung primary). It may be worth sending the path for outside review.

In addition to the above suggestions and negative PET, it would be prudent to consider more thoroughly assessing the pancreas/liver (diagnostic CT or MRI) and upper/lower endoscopy.