Lung Cancer

Diagnosis

The diagnosis of lung cancer is ultimately based on a biopsy sample reviewed by a pathologist. Then, depending on the type and stage of cancer, the doctor may request some of the following tests to determine the best treatment approach.

Bronchoscopy. Using a flexible tube passed down the nose or mouth, the physician can look inside the lungs and take a tissue sample for examination by the pathologist.

Fine-needle aspiration. A thin needle is inserted into tissue, such as a lymph node or tumor, to remove cells for a pathologist to review. This is frequently performed with computed tomography (CT) guidance — when the needle is inserted through the chest wall — or with endoscopic ultrasound through the airway or the esophagus.

Mediastinoscopy. While the patient is under anesthesia, a tube is passed through a small incision at the base of the neck. This allows doctors to take a biopsy of lymph nodes in the chest. A surgeon can then define the stage of the tumor and determine whether surgery is an option.

Thoracentesis. If fluid is present in the chest cavity, the physician can remove a sample by inserting a thin needle into the chest between the ribs. This fluid is then examined for cancer cells. If there is a large amount of fluid in the chest cavity, this procedure can also be used to remove enough fluid to improve the patient's breathing.

Video-assisted thoracoscopy (VATS). The doctor inserts a tube through a small incision to collapse one lung. This creates a space where a pen-sized instrument with a video device enters the chest wall. The physician then visually inspects the surface of the lung and chest wall. The doctor performs biopsies of nodules or masses while watching the procedure on a video screen.

Pulmonary function tests. These breathing tests determine lung capacity and respiratory reserve. Knowing the lung's strength allows doctors to determine if the patient can safely tolerate surgery or radiation treatment.

Complete blood count (CBC). This test determines the number of red blood cells, white blood cells, and platelets within the blood.

Chest X-ray. The chest X-ray offers a general view of the lungs and chest.

CT scan. The CT scan provides a detailed view of the lungs and chest.

Positron emission tomography (PET) scanning. For PET, the patient is injected with a radioactive isotope, a chemical used for imaging. About 45 minutes later, the doctor scans the patient's body to see where the chemical has gathered. This test is typically used to determine whether the tumor has spread and, if so, where. This test provides more detailed information than a chest X-ray.

Bone scan. This test helps doctors find cancer that has spread to the bone.

Imaging of the central nervous system. Cancer patients may have a CT scan or MRI scan that produces an image of the brain. These scans help the doctor determine whether the disease has spread to the brain.