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Lung 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. If the image shows an area of concern, 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 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: A CT-guided biopsy where a needle is inserted 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.

To complete assessment of how advanced the cancer is, which is called staging, the patient will undergo a PET-CT scan and, for most cases, an MRI of the brain to check for signs of cancer spread to other organs. This will guide the treatment decisions for each patients’ lung cancer.

Lung cancer staging

If you are diagnosed with lung cancer, your doctor will determine the stage (or extent) of the disease. This is a way to classify the cancer by how far and to which parts of the body it has spread. Staging helps the doctor plan the best treatment for you. Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.

Staging is often the most important part of your treatment. If the cancer is staged improperly, you may not receive the right treatment.

Stages of lung cancer

The following are the lung cancer staging systems of the National Cancer Institute.

Non-small cell lung cancer stages

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: The tumor is in the lung only and is 3 centimeters or smaller. Cancer has not spread to the lymph nodes.
Stage IB: 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:
- 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: 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.

nor 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.
- Chest wall.
- The nerve that controls the diaphragm.
- Outer layer of tissue of the sac around the heart.

Stage III

Stage III is divided into stages IIIA, IIIB, and IIIC.

Stage IIIA: 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 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 pne
- umonitis.

or 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 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.
- Nerve that controls the larynx (voice box).

Stage IIIB: 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 pneum
- onitis.

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 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.
- Nerve that controls the larynx (voice box).

Stage IIIC: 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.
  - Nerve that controls the larynx (voice box).

Stage IV

Stage IV is divided into stages IVA and IVB.

In 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:
- There are one or more tumors in the lung that does not have the primary tumor.
- 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, sac around the heart, or to a lymph node that is not near the lung.
In stage IVB, cancer has spread to multiple places in one or more organs that are not near the lung.

Small cell lung cancer stages

Limited-Stage Small Cell Lung Cancer

In limited-stage, cancer is in the lung where it started and may have spread to the area between the lungs or to the lymph nodes above the collarbone.

Extensive-Stage Small Cell Lung Cancer

In extensive-stage, cancer has spread beyond the lung or the area between the lungs or the lymph nodes above the collarbone to other places in the body.

Lung Cancer Diagnosis

Lung cancer staging

Stages of lung cancer

Non-small cell lung cancer stages

Occult (hidden) stage

Stage 0

Stage I

Stage III

Stage IV

Small cell lung cancer stages

Limited-Stage Small Cell Lung Cancer

Extensive-Stage Small Cell Lung Cancer

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