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View Clinical TrialsLung Cancer Diagnosis
Early stage lung cancer often does not have symptoms. In addition, when symptoms 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.
You will then undergo an imaging exam, typically a chest X-ray. Images cannot diagnose lung cancer, but they can show areas of concern. If the image shows such an area, the doctor may order other scans, including a CT scan or PET scan, for additional details regarding the area of concern.
If the findings on the imaging scans indicate cancer, the doctor will request that tissue or fluid be removed from the lung for examination. The act of obtaining a tissue or fluid sample is called a biopsy. There are several ways doctors can perform biopsies of lung tumors:
- Needle biopsy: A CT-guided biopsy where a needle is inserted through the skin under local anesthesia to acquire a tumor sample. One type of needle biopsy is fine needle aspiration (FNA), which uses a very small needle and suction to remove a small amount of tissue.
- Thoracentesis: Fluid from around the lungs is drawn out with a needle and tested for cancer cells.
- 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. Bronchoscopies are rarely done alone. Bronchoscopy is usually performed with an endobronchial ultrasound.
- 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.
- Thorascopy/pleuroscopy: A thin, flexible tube with a tiny camera is inserted through a small incision in the back (for a thorascopy) or between the ribs (for a pleuroscopy). Doctors use this device to look for and retrieve suspected cancer tissue.
To complete assessment of how advanced the cancer is, which is called staging, the patient will undergo a PET-CT scan and an MRI or CT scan to check for signs of cancer spread to other organs, including the brain. This will guide the treatment decisions for each patient’s lung cancer.
In some cases, lung cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our family history site to learn more about genetic counseling and testing.
Lung cancer staging
If you are diagnosed with lung cancer, your doctor will determine the stage (or extent) of the disease. The various stages classify cancer by how far and to which parts of the body it has spread. Staging helps the doctor plan the best treatment for you.
Non-small cell lung cancer stages
Source: National Cancer Institute
Occult (hidden) stage
In the occult (hidden) stage, cancer cannot be seen by imaging or bronchoscopy. Cancer cells are found in sputum or bronchial washings (a sample of cells taken from inside the airways that lead to the lungs). Cancer may have spread to other parts of the body.
Stage 0
In stage 0, abnormal cells are found in the lining of the airways. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 may be adenocarcinoma in situ (AIS) or squamous cell carcinoma in situ (SCIS).
Stage I
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
- Stage IA: Stage IA lung cancer. The tumor is in the lung only and is 3 centimeters or smaller. Cancer has not spread to the lymph nodes.
The tumor is in the lung only and is 3 centimeters or smaller. Cancer has not spread to the lymph nodes. - Stage IB: Stage IB lung cancer. The tumor is larger than 3 centimeters but not larger than 4 centimeters. Cancer has not spread to the lymph nodes; OR the tumor is 4 centimeters or smaller. Cancer has not spread to the lymph nodes and one or more of the following is found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
The tumor is larger than 3 centimeters but not larger than 4 centimeters. Cancer has not spread to the lymph nodes.
or
The tumor is 4 centimeters or smaller and one or more of the following is found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pneumonitis.
Cancer has not spread to the lymph nodes.
Stage II
Stage II is divided into stages IIA and IIB.
Stage IIA: The tumor is larger than 4 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes and one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
The tumor is larger than 4 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes and one or more of the following may be found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pneumonitis.
Stage IIB: Stage IIB lung cancer. The primary tumor is 5 centimeters or smaller and cancer has spread to the lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus.
The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following may be found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pneumonitis.
or
Stage IIB lung cancer: Cancer has not spread to lymph nodes and one or more of the following is found: (a) the primary tumor is larger than 5 centimeters but not larger than 7 centimeters; and/or (b) there are one or more separate tumors in the same lobe of the lung as the primary tumor; and/or cancer has spread to any of the following: (c) the chest wall and/or the membrane that lines the inside of the chest wall, (d) the nerve that controls the diaphragm, and/or (e) the outer layer of tissue of the sac around the heart.
Cancer has not spread to the lymph nodes and one or more of the following is found:
- The tumor is larger than 5 centimeters but not larger than 7 centimeters.
- There are one or more separate tumors in the same lobe of the lung as the primary tumor.
- Cancer has spread to any of the following: the membrane that lines the inside of the chest wall; the chest wall, the nerve that controls the diaphragm, outer layer of tissues of teh sac around the heart.
Stage III
Stage III is divided into stages IIIA, IIIB, and IIIC.
Stage IIIA: Stage IIIA lung cancer. The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta (not shown), or where the trachea divides into the bronchi. Also, one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following may be found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pneumonitis.
or
Stage IIIA: Cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found: (a) the tumor is larger than 5 centimeters but not larger than 7 centimeters; and/or (b) there are one or more separate tumors in the same lobe of the lung as the primary tumor; and/or cancer has spread to any of the following: (c) the chest wall and/or the membrane that lines the inside of the chest wall, (d) the nerve that controls the diaphragm, and/or (e) the outer layer of tissue of the sac around the heart.
Cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:
- The tumor is larger than 5 centimeters but not larger than 7 centimeters.
- There are one or more separate tumors in the same lobe of the lung as the primary tumor.
- Cancer has spread to any of the following:
- The membrane that lines the inside of the chest wall.
- Chest wall.
- The nerve that controls the diaphragm.
- Outer layer of tissue of the sac around the heart.
or
Stage IIIA: Cancer may have spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found: (a) the primary tumor is larger than 7 centimeters; and/or (b) there are one or more separate tumors in a different lobe of the lung with the primary tumor; and/or the tumor is any size and cancer has spread to any of the following: (c) trachea, (d) carina, (e) esophagus, (f) breastbone or backbone, (g) diaphragm, (h) heart, (i) major blood vessels that lead to or from the heart (aorta or vena cava), or the nerve that controls the larynx (not shown).
Cancer may have spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:
- The tumor is larger than 7 centimeters.
- There are one or more separate tumors in a different lobe of the lung with the primary tumor.
- The tumor is any size and cancer has spread to any of the following:
- Trachea.
- Carina.
- Esophagus.
- Breastbone or backbone.
- Diaphragm.
- Heart.
- Major blood vessels that lead to or from the heart (aorta or vena cava).
- Nerve that controls the larynx (voice box).
Stage IIIB: Stage IIIB lung cancer. The primary tumor is 5 centimeters or smaller and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following may be found:
- Cancer has spread to the main bronchus, but has not spread to the carina.
- Cancer has spread to the innermost layer of the membrane that covers the lung.
- Part of the lung or the whole lung has collapsed or has developed pneumonitis.
or
The tumor may be any size and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta (not shown), or where the trachea divides into the bronchi. Also, one or more of the following is found: (a) there are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor; and/or (b) cancer has spread to any of the following: the chest wall or the membrane that lines the inside of the chest wall, the nerve that controls the voice box, the trachea, the carina, the esophagus, the breastbone or backbone (not shown), the diaphragm, the nerve that controls the diaphragm, the heart, the major blood vessels that lead to or from the heart (aorta or vena cava), or the outer layer of tissue of the sac around the heart.
The tumor may be any size and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following is found:
- There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
- Cancer has spread to any of the following:
- The membrane that lines the inside of the chest wall.
- Chest wall.
- The nerve that controls the diaphragm.
- Outer layer of tissue of the sac around the heart.
- Trachea.
- Carina.
- Esophagus.
- Breastbone or backbone.
- Diaphragm.
- Heart.
- Major blood vessels that lead to or from the heart (aorta or vena cava).
- Nerve that controls the larynx (voice box).
Stage IIIC lung cancer. The tumor may be any size and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following is found: (a) there are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor; and/or (b) cancer has spread to any of the following: the chest wall or the membrane that lines the inside of the chest wall, the nerve that controls the voice box, the trachea, the carina, the esophagus, the breastbone or backbone (not shown), the diaphragm, the nerve that controls the diaphragm, the heart, the major blood vessels that lead to or from the heart (aorta or vena cava), or the outer layer of tissue of the sac around the heart.
The tumor may be any size and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following is found:
- There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
- Cancer has spread to any of the following:
- The membrane that lines the inside of the chest wall.
- Chest wall.
- The nerve that controls the diaphragm.
- Outer layer of tissue of the sac around the heart.
- Trachea.
- Carina.
- Esophagus.
- Breastbone or backbone.
- Diaphragm.
- Heart.
- Major blood vessels that lead to or from the heart (aorta or vena cava).
- Nerve that controls the larynx (voice box).
Stage IV
Stage IV is divided into stages IVA and IVB.
Stage IVA: The tumor may be any size and cancer may have spread to the lymph nodes. One or more of the following is found: (a) there are one or more tumors in the lung that does not have the primary tumor; and/or (b) cancer is found in fluid around the lungs or heart or there are cancer nodules in the lining around the lungs or the sac around the heart; and/or (c) cancer has spread to one place in an organ or tissue not near the lung, such as the brain, adrenal gland, kidney, liver, or bone, or to a lymph node that is not near the lung.
The tumor may be any size and cancer may have spread to the lymph nodes. One or more of the following is found:
- There are one or more tumors in the lung that does not have the primary tumor.
- Cancer is found in the lining around the lungs or the sac around the heart.
- Cancer is found in fluid around the lungs or the heart.
- Cancer has spread to one place in an organ not near the lung, such as the brain, liver, adrenal gland, kidney, bone, or to a lymph node that is not near the lung.
Stage IVB: The cancer has spread to multiple places in one or more organs that are not near the lung, such as the brain, adrenal gland, kidney, liver, distant lymph nodes, or bone.
Small cell lung cancer stages
There are several staging systems for small cell lung cancer. Patients should speak with their care team about their stage and what it means for their treatment and prognosis.
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