Lung Cancer Diagnosis

Early stage lung cancer often does not have symptoms. When symptoms do appear they can easily be mistaken for common respiratory illnesses like bronchitis or pneumonia. Because of this, many cases are diagnosed at an advanced stage.

Patients at high risk for lung cancer, especially those with a history of smoking, should undergo regular screenings in order to catch the disease at its early stages, when there is a better chance of cure.

If you have symptoms that signal lung cancer, your doctor will ask you questions about your medical, smoking and family history and whether you have been around certain chemicals or substances. Your doctor will likely also perform a physical exam to assess your lung function and overall health. This may involve listening to your lung sounds and performing blood tests. No one blood test can detect lung cancer. However, blood tests can give clues about the root cause of your symptoms. They may be used to rule out infection or to determine if other organ systems are being impacted. Additionally, if you have a productive cough, your doctor might look at a sample of your sputum (the mucus produced by your respiratory tract) under a microscope to see if cancer cells are present. This is called sputum cytology.

You will then undergo an imaging exam, typically a chest X-ray. If the image shows a lung mass or other area of concern, the doctor may order other more detailed scans. These may include a CT scan or PET scan. In a CT scan, an x-ray machine takes pictures from several different angles, creating a more detailed picture of the lungs. A PET scan can show areas of high cell activity and division, an indicator of cancer. These and other imaging tests may also be used to determine whether and how far the cancer has spread. For more information on these imaging exams, visit our Diagnostic Imaging Procedures page.

If the findings on the imaging scans indicate cancer, the doctor will request that tissue or fluid be removed from the lung and examined by microscope. The act of obtaining a tissue or fluid sample is called a biopsy. There are several ways doctors can perform biopsies of lung tumors:

• Bronchoscopy: A thin flexible tube with a tiny camera is inserted through the nose or mouth and down into the lungs to obtain a small tissue sample (biopsy). This is usually performed under mild sedation.
• Needle biopsy: Guided by a CT scanner, your doctor will insert a needle through the skin under local anesthesia to acquire a tumor sample
• Fine needle aspiration (FNA): A very small needle is placed into the tumor. Suction is used to remove a small amount of tissue.
• Thoracentesis: Fluid from around the lungs is drawn out with a needle and tested for cancer cells
• Endobronchial Ultrasound (EBUS): a bronchoscope with an attached ultrasound device is used to check for lung cancer inside nearby chest lymph nodes. EBUS is often performed at the same time as a bronchoscopy and requires general anesthesia.
• Video-assisted thoracoscopic surgery (VATS): This minimally invasive surgical procedure uses a small camera to help retrieve tumor samples that are otherwise difficult to access. VATS requires a general anesthetic and is performed in the operating room by a thoracic surgeon.

Lung cancer treatment