The importance of treating lung cancer at the earliest stage possible has been increasingly recognised. With the resurgence of interest in lung cancer screening, the use of less invasive staging and treatment procedures has gained momentum. Technical advances have propelled the use of bronchoscopic procedures into clinical practice, providing alternatives for conventional diagnostic and treatment modalities. Many lung cancer patients are limited in their pulmonary reserve capacity due to their smoking history, making them unfit to undergo more invasive medical procedures such as surgery. Surgical resection for lung cancer may also result in a relatively wasteful removal of normal lung parenchyma. In the case of superficial early stage lung cancer in the central airways, a more conserving approach such as surgical bronchoplasty is acceptable. With the move towards early detection of lung cancer, even smaller cancer lesions will be detected. Therefore, these lesions will be suitable for bronchoscopic treatment if nodal disease is absent. The potential of photodynamic therapy and alternative bronchoscopic techniques for the management of early stage lung cancer, as an alternative to, or in combination with, surgical resection should be considered.