Testing healthy people for lung cancer
Several organizations recommend people with an increased risk of lung cancer consider annual computerized tomography (CT) scans to look for lung cancer. If you're 55 or older and smoke or used to smoke, talk with your doctor about the benefits and risks of lung cancer screening.
Some studies show lung cancer screening saves lives by finding cancer earlier, when it may be treated more successfully. But other studies find that lung cancer screening often reveals more benign conditions that may require invasive testing and expose people to unnecessary risks and worry.
Tests to diagnose lung cancer
If there's reason to think that you may have lung cancer, your doctor can order a number of tests to look for cancerous cells and to rule out other conditions. In order to diagnose lung cancer, your doctor may recommend:
- Imaging tests. An X-ray image of your lungs may reveal an abnormal mass or nodule. A CT scan can reveal small lesions in your lungs that might not be detected on an X-ray.
- Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.
Tissue sample (biopsy). A sample of abnormal cells may be removed in a procedure called a biopsy.
Your doctor can perform a biopsy in a number of ways, including bronchoscopy, in which your doctor examines abnormal areas of your lungs using a lighted tube that's passed down your throat and into your lungs; mediastinoscopy, in which an incision is made at the base of your neck and surgical tools are inserted behind your breastbone to take tissue samples from lymph nodes; and needle biopsy, in which your doctor uses X-ray or CT images to guide a needle through your chest wall and into the lung tissue to collect suspicious cells.
A biopsy sample may also be taken from lymph nodes or other areas where cancer has spread, such as your liver.
Lung cancer staging
Once your lung cancer has been diagnosed, your doctor will work to determine the extent (stage) of your cancer. Your cancer's stage helps you and your doctor decide what treatment is most appropriate.
Staging tests may include imaging procedures that allow your doctor to look for evidence that cancer has spread beyond your lungs. These tests include CT scans, magnetic resonance imaging (MRI), positron emission tomography (PET) and bone scans. Not every test is appropriate for every person, so talk with your doctor about which procedures are right for you.
Stages of lung cancer
- Stage I. Cancer is limited to the lung and hasn't spread to the lymph nodes. The tumor is generally smaller than 2 inches (5 centimeters) across.
- Stage II. The tumor at this stage may have grown larger than 2 inches, or it may be a smaller tumor that involves nearby structures, such as the chest wall, the diaphragm or the lining around the lungs (pleura). Cancer may also have spread to the nearby lymph nodes.
- Stage III. The tumor at this stage may have grown very large and invaded other organs near the lungs. Or this stage may indicate a smaller tumor accompanied by cancer cells in lymph nodes farther away from the lungs.
- Stage IV. Cancer has spread beyond the affected lung to the other lung or to distant areas of the body.
Small cell lung cancer is sometimes described as being limited or extensive. Limited indicates cancer is limited to one lung. Extensive indicates cancer has spread beyond the one lung.
Jan. 02, 2014
- Non-small cell lung cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Sept. 3, 2013.
- Estimated new cancer cases and deaths by sex for all sites, U.S., 2011. American Cancer Society. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2013/index. Accessed Sept. 3, 2013.
- Small cell lung cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Sept. 3, 2013.
- Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008. http://www.clinicalkey.com. Accessed Sept. 3, 2013.
- What you need to know about lung cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/lung. Accessed Sept. 3, 2013.
- Lung cancer prevention (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/prevention/lung. Accessed Sept. 3, 2013.
- Aberle DR, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. New England Journal of Medicine. 2011;365:395.
- Detterbeck FC, et al. Diagnosis and management of lung cancer, 3rd ed.: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(suppl):7S.
- Xalkori (prescribing information). New York, N.Y.: Pfizer Labs; 2013. www.xalkori.com. Accessed Sept. 3, 2013.
- Avastin (prescribing information). South San Francisco, Calif.: Genentech Inc.; 2013. http://www.avastin.com/patient. Accessed Sept. 3, 2013.
- Tarceva (prescribing information). Farmingdale, N.Y.: OSI Pharmaceuticals LLC; 2013. http://www.tarceva.com/patient/considering/index.jsp. Accessed Sept. 3, 2013.
- Cairns LM. Managing breathlessness in patients with lung cancer. Nursing Standard. 2012;27:44.
- Taking time: Support for people with cancer. National Cancer Institute. http://cancer.gov/cancertopics/takingtime. Accessed Sept. 3, 2013.
- Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine. 2010;363:733.
- Moynihan TJ (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 16, 2013.