Diagnosis

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.

Treatment

You and your doctor choose a cancer treatment plan based on a number of factors, such as your overall health, the type and stage of your cancer, and your preferences. Options typically include one or more treatments, including surgery, chemotherapy, radiation therapy or targeted drug therapy.

In some cases you may choose not to undergo treatment. For instance, you may feel that the side effects of treatment will outweigh the potential benefits. When that's the case, your doctor may suggest comfort care to treat only the symptoms the cancer is causing, such as pain or shortness of breath.

Surgery

During surgery your surgeon works to remove the lung cancer and a margin of healthy tissue. Procedures to remove lung cancer include:

  • Wedge resection to remove a small section of lung that contains the tumor along with a margin of healthy tissue
  • Segmental resection to remove a larger portion of lung, but not an entire lobe
  • Lobectomy to remove the entire lobe of one lung
  • Pneumonectomy to remove an entire lung

If you undergo surgery, your surgeon may also remove lymph nodes from your chest in order to check them for signs of cancer.

Lung cancer surgery carries risks, including bleeding and infection. Expect to feel short of breath after lung surgery. If a portion of your lung is removed, your remaining lung tissue will expand over time and make it easier to breathe. Your doctor may recommend a respiratory therapist who can guide you through breathing exercises to aid in your recovery.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be given through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that you can recover.

Chemotherapy is often used after surgery to kill any cancer cells that may remain. It may also be used before surgery to shrink cancers and make them easier to remove. In some cases, chemotherapy can be used to relieve pain and other symptoms of advanced cancer.

Radiation therapy

Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. Radiation therapy can be directed at your lung cancer from outside your body (external beam radiation) or it can be put inside needles, seeds or catheters and placed inside your body near the cancer (brachytherapy).

Radiation therapy can be used after surgery to kill any cancer cells that may remain. It may also be used as the first treatment for lung cancers that can't be removed during surgery. For people with advanced lung cancer, radiation therapy may be used to relieve pain and other symptoms.

For people with lung cancers that are very small, one option may be stereotactic body radiotherapy. This form of radiation aims many beams of radiation from different angles at the lung cancer. Stereotactic body radiotherapy treatment is typically completed in one or a few treatments. In certain cases, it may be used in place of surgery for small tumors.

Targeted drug therapy

Targeted therapies are newer cancer treatments that work by targeting specific abnormalities in cancer cells. Targeted therapy drugs are often used in combination with chemotherapy drugs.

Targeted therapy options for treating lung cancer include:

  • Afatinib (Gilotrif)
  • Bevacizumab (Avastin)
  • Ceritinib (Zykadia)
  • Crizotinib (Xalkori)
  • Erlotinib (Tarceva)
  • Nivolumab (Opdivo)
  • Ramucirumab (Cyramza)

Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells will be tested in a laboratory to see if these drugs might help you.

Clinical trials

Clinical trials are studies of experimental lung cancer treatments. You may be interested in enrolling in a clinical trial if lung cancer treatments aren't working or if your treatment options are limited.

The treatments studied in a clinical trial may be the latest innovations, but they don't guarantee a cure. Carefully weigh your treatment options with your doctor.

Your participation in a clinical trial may help doctors better understand how to treat lung cancer in the future.

Palliative care

People with lung cancer often experience signs and symptoms of the cancer, as well as side effects of treatment. Supportive care, also known as palliative care, is a specialty area of medicine that involves working with a doctor to minimize your signs and symptoms.

Your doctor may recommend that you meet with a palliative care team soon after your diagnosis to ensure that you're comfortable during and after your cancer treatment.

In one study, people with advanced non-small cell lung cancer who began receiving supportive care soon after their diagnosis lived longer than those who continued with treatments, such as chemotherapy and radiation. Those receiving supportive care reported improved mood and quality of life. They survived, on average, almost three months longer than did those receiving standard care.

You may be concerned that receiving palliative care means you can't undergo aggressive treatment for your cancer. But rather than replace curative treatments, palliative care complements your cancer treatment and may make it more likely that you can complete your treatments.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Coping with shortness of breath

Many people with lung cancer experience shortness of breath at some point in the course of the disease. Treatments, such as supplemental oxygen, and medications are available to help you feel more comfortable, but they aren't always enough.

To cope with shortness of breath, it may help to:

  • Try to relax. Feeling short of breath can be scary. But fear and anxiety only make it harder to breathe. When you begin to feel short of breath, try to manage the fear by choosing an activity that helps you relax. Listen to music, imagine your favorite vacation spot, meditate or say a prayer.
  • Find a comfortable position. It may help to lean forward when you feel short of breath.
  • Focus on your breath. When you feel short of breath, focus your mind on your breathing. Instead of trying to fill your lungs with air, concentrate on moving the muscles that control your diaphragm. Try breathing through pursed lips and pacing your breaths with your activity.
  • Save your energy for what's important. If you're short of breath, you may become tired easily. Cut out the nonessential tasks from your day so that you can save your energy for what needs to be done.

Tell your doctor if you experience shortness of breath or if your symptoms worsen, as there are many other treatments available to relieve shortness of breath.

Alternative medicine

Complementary and alternative lung cancer treatments can't cure your cancer. But complementary and alternative treatments can often be combined with your doctor's care to help relieve signs and symptoms.

Your doctor can help you weigh the benefits and risks of complementary and alternative treatments.

The American College of Chest Physicians recommends people with lung cancer should consider:

  • Acupuncture. During an acupuncture session, a trained practitioner inserts small needles into precise points on your body. Acupuncture may relieve pain and ease cancer treatment side effects, such as nausea and vomiting, but there's no evidence that acupuncture has any effect on your cancer.

    Acupuncture can be safe when done by a certified practitioner. Ask your doctor to recommend someone in your community. But acupuncture isn't safe if you have low blood counts or take blood thinners.

  • Hypnosis. Hypnosis is a type of therapy that puts you in a trance-like state that can be relaxing. Hypnosis is typically done by a therapist who leads you through relaxation exercises and asks you to think pleasing and positive thoughts. Hypnosis may reduce anxiety, nausea and pain in people with cancer.
  • Massage. During a massage, a massage therapist uses his or her hands to apply pressure to your skin and muscles. Massage can help relieve anxiety and pain in people with cancer. Some massage therapists are specially trained to work with people who have cancer.

    Ask your doctor for names of massage therapists in your community. Massage shouldn't hurt. Your massage therapist shouldn't put pressure anywhere near your tumor or any surgical wounds. Avoid having a massage if your blood counts are low or if you're taking blood thinners.

  • Meditation. Meditation is a time of quiet reflection in which you focus on something, such as an idea, image or sound. Meditation may reduce stress and improve quality of life in people with cancer. Meditation can be done on your own, or there may be instructors in your community. Ask for recommendations from your health care team or friends and family.
  • Yoga. Yoga combines gentle stretching movements with deep breathing and meditation. Yoga may help people with cancer sleep better. Yoga is generally safe when taught by a trained instructor, but don't do any moves that hurt or don't feel right. Many fitness centers offer yoga classes. Ask your friends and family for opinions on yoga classes they've taken.

Coping and support

A diagnosis of cancer can be overwhelming. With time you'll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:

  • Learn enough about lung cancer to make decisions about your care. Ask your doctor about your lung cancer, including your treatment options and, if you like, your prognosis. As you learn more about lung cancer, you may become more confident in making treatment decisions.
  • Keep friends and family close. Keeping your close relationships strong will help you deal with your lung cancer. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
  • Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

    Ask your doctor about support groups in your area. Or check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.

Preparing for your appointment

If you have signs and symptoms that worry you, start by seeing your family doctor. If your doctor suspects you have lung cancer, you'll likely be referred to a specialist. Specialists who treat people with lung cancer can include:

  • Doctors who specialize in treating cancer (oncologists)
  • Doctors who diagnose and treat lung diseases (pulmonologists)
  • Doctors who use radiation to treat cancer (radiation oncologists)
  • Surgeons who operate on the lung (thoracic surgeons)
  • Doctors who treat signs and symptoms of cancer and cancer treatment (palliative care specialists)

What you can do

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. To help you get ready, try to:

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Note when your symptoms began.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you're taking.
  • Gather your medical records. If you've had a chest X-ray or a scan done by a different doctor, try to obtain that file and bring it to your appointment.
  • Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Questions to ask if you've been diagnosed with lung cancer

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For lung cancer, some basic questions to ask include:

  • What type of lung cancer do I have?
  • May I see the chest X-ray or CT scan that shows my cancer?
  • What is causing my symptoms?
  • What is the stage of my lung cancer?
  • Will I need more tests?
  • Should my lung cancer cells be tested for gene mutations that may determine my treatment options?
  • Has my cancer spread to other parts of my body?
  • What are my treatment options?
  • Will any of these treatment options cure my cancer?
  • What are the potential side effects of each treatment?
  • Is there one treatment that you think is best for me?
  • Is there a benefit if I quit smoking now?
  • What advice would you give a friend or family member in my situation?
  • What if I don't want treatment?
  • Are there ways to relieve the signs and symptoms I'm experiencing?
  • Can I enroll in a clinical trial?
  • Should I see a specialist? What will that cost, and will my insurance cover it?
  • Are there brochures or other material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Do you wheeze when breathing?
  • Do you have a cough that feels like you're clearing your throat?
  • Have you ever been diagnosed with emphysema or chronic obstructive pulmonary disease?
  • Do you take medications for shortness of breath?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Lung cancer care at Mayo Clinic

Sept. 25, 2015
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