At Mayo Clinic, lung cancer diagnosis begins with a thorough medical evaluation. The diagnosis and staging of cancer is based on lung tissue samples (biopsy) reviewed by a pathologist. Mayo's experienced pathologists have extensive expertise in identifying and staging lung cancer to help the treatment team determine the most appropriate treatment or combination of treatments for each patient.
Biopsy samples may be gathered through various procedures, including the following:
A flexible tube is passed down the nose or mouth to look inside the lungs and remove a tissue sample for examination by the pathologist.
A thin needle is inserted into tumor, lymph node or other tissue to remove cells for pathologist review. This is frequently performed with computed tomography (CT) imaging guidance — when the needle is inserted through the chest wall. Lymph node tissue also can be sampled with endoscopic ultrasound-guided fine-needle aspiration through the airway or esophagus.
During this procedure, a tube is passed through a small incision at the base of the neck while the patient is under anesthesia. This allows doctors to take a biopsy of the lymph nodes in the chest. A surgeon can then define the tumor stage and determine whether surgery is an option.
If fluid is present in the chest cavity, a sample can be removed by inserting a thin needle into the chest between the ribs and examined for cancer cells. If there is a large amount of fluid in that region, this procedure also can be used to remove enough fluid to improve the patient's breathing.
During video-assisted thoracoscopy (VATS), a tube is inserted through a small incision to collapse one lung. This creates a space where a pen-sized instrument with a video device can enter the chest cavity so that the doctor can visually inspect the surface of the lung and chest wall and perform biopsies, guided by images on a video screen.
These breathing tests determine lung capacity and respiratory reserve. Knowing the lungs' strength allows doctors to determine if the patient can safely tolerate surgery or radiation treatment.
Chest X-rays, and MRI, CT, PET and bone scans may be performed to provide a detailed view of the lungs, chest or other areas of the body to determine whether the disease has spread.
A complete blood count test may be recommended to determine the number of red blood cells, white blood cells and platelets (blood cell fragments) within the blood.