Make an appointment with your doctor if you think you have symptoms of lung cancer. They will evaluate your medical history, assess any risk factors you have, and perform a physical examination. Your doctor may then refer you to a specialist for additional testing.
Because lung cancer testing can be invasive, it’s debated in the medical community whether or not general screening for lung cancer is beneficial. Some believe it puts the patient at unnecessary risk. Since people don’t usually exhibit symptoms until the disease has advanced, others think it is the key to catching lung cancer in the early, more treatable stages. Your doctor will most likely recommend testing only if there is cause to believe you might have lung cancer.
Your doctor will check your vitals, listen to your breathing, and check for a swollen liver or lymph nodes. You will likely be sent for testing if lung cancer is suspected. There are various methods that can be used.
A computed tomography (CT) scan is a special kind of X-ray that takes several internal pictures as it rotates around your body. This provides a more complete picture of the size, shape, and location of any possible tumors.
A thin, lighted tube (bronchoscope) is inserted through your mouth or nose into your lung to examine the bronchi and lungs. A cell sample may be taken for examination.
Sputum, or phlegm, is a thick fluid coughed up from the lungs. A sample of sputum is sent to the lab for a microscopic examination for any cancer cells.
Imaging tests can detect masses or tumors, but they cannot determine if they are benign or malignant. Based on preliminary findings, your doctor may order a biopsy of the lung tissue to check for cancerous cells. This biopsied tissue is sent for examination by a pathologist.
There are several methods of lung biopsy.
- thoracentesis: A long needle is used to take a sample of fluid (pleural effusion) between the layers of tissue that line your lung.
- fine-needle aspiration: A thin needle is used to remove a tissue or fluid sample from your lungs or lymph nodes.
- thoracosopy: Small incisions are made in your chest and back to examine tissue with a thin tube.
- mediastinoscopy: The doctor will insert a thin, lighted tube through a small incision at the top of your breastbone to take tissue and lymph node samples.
- thoracotomy: The chest is opened with a long incision to remove lymph node and other tissue for examination.
- endobronchial ultrasound: This procedure uses sound waves to guide a bronchoscope down your windpipe to locate and photograph tumors. If present, samples from the areas in question will be taken for biopsy.
Other tests may be required to locate where the cancer may have spread (metastasis).
- MRI (magnetic resonance imaging): This is an imaging test that uses magnets and radio waves instead of radiation. This test is often used in cases when lung cancer is suspected to have spread to the brain or spinal cord.
- PET (positron emission tomography) scan: A PET scan is a procedure that sends sugar containing a radioactive atom into your body. Cancer cells consume the sugar and a special camera locates the radioactivity, creating 3-D color images.
- bone scan: A trace amount of radioactive material is injected into a vein. The radioactive material will build up in any abnormal bone. This test is only done in cases where the cancer is suspected to have spread to the bones.
Once you have completed testing and received a lung cancer diagnosis, the next step is to categorize the cancer by stage. The stage describes the progression or extent of the cancer. This will help your doctor determine which treatment is best for you. Keep in mind that staging does not necessarily indicate the likely course and outcome (prognosis) of your lung cancer. Your prognosis depends on your overall health, strength, other health conditions, and response to treatment.
Lung cancer is usually classified as either small cell lung cancer or non-small cell lung cancer.
Small Cell Lung Cancer
Small cell lung cancer is described in two stages — limited and extensive:
- limited: This type of cancer is confined to the chest. It’s usually just in one lung, and neighboring lymph nodes. It can be treated with chemotherapy and radiation therapy.
- extensive: This type of cancer has spread to both lungs and other parts of the body and is treated with chemotherapy and supportive care. The patient may be a candidate for a clinical trial, used to evaluate the efficacy and safety of new drugs.
Non-Small Cell Lung Cancer
- occult stage: Lung cancer cells are found in sputum or in a sample collected during a test, but there is no sign of a tumor in the lungs.
- stage 0: Cancer cells are found only in the innermost lining of the lung and the cancer is not invasive.
- stage 1A: Cancer is found in the innermost lining of the lungs and in deeper lung tissue. The tumor is not more than 3 centimeters across and has not invaded the bronchus or the lymph nodes.
- stage 1B: Cancer has grown larger and deeper into the lung tissue. The tumor has grown through the lung into the pleura, is more than 3 centimeters in diameter, or has grown into the main bronchus. The cancer has not yet invaded the lymph nodes. Surgery and sometimes chemotherapy is used to treat lung cancers in stage 1A/1B.
- stage 2A: Cancer is less than 3 centimeters in diameter but has spread to the lymph nodes on the same side of the chest as the tumor areas.
- stage 2B: The lung cancer has not spread to the lymph nodes but has grown into the chest wall, main bronchus, pleura, diaphragm, or heart tissue. This stage can also mean that the cancer has spread to the lymph nodes and one of the following is true: the tumor is more than 3 centimeters in diameter, the tumor has grown into the bronchus, or the tumor has grown into the pleura.
- stage 3A: The tumor is any size, and the cancer has spread to the lymph nodes in the center of the chest, but on the same side as the tumor. This stage is treated with a combination of chemotherapy and radiation.
- stage 3B: The tumor can be any size. The lung cancer has invaded the lymph nodes on the opposite side of the chest and neck and possibly the heart, major blood vessels, or esophagus. This stage is treated with chemotherapy and sometimes radiation.
- stage 4: The lung cancer has spread to other areas of the body, likely the adrenal glands, liver, bones, and brain. This stage is treated with chemotherapy and supportive (or comfort) care. The patient may be a candidate for a clinical trial, used to evaluate the efficacy and safety of new drugs.