Screening for those at high risk before lung cancer symptoms appear
Because lung cancer doesn’t often cause early symptoms, lung cancer screening has proven to be effective in identifying lung cancers earlier than ever before. If you have a history of smoking, talk to your doctor about whether lung cancer screening is right for you.
Tests used for lung cancer diagnosis
For others who are diagnosed after symptoms appear, such as a cough that won’t go away, shortness of breath, and/or chest pain, a chest x-ray is likely to be performed to see if there is anything unusual in the lungs. If something is spotted, further testing is needed.
Often the doctors will start by running lab tests of the blood and/or urine. These tests can show indicators that cancer may be present by looking for tumor markers in the blood. They may also perform a sputum cytology where sputum (mucus coughed up from the lungs) is used to check for cancer cells. If these tests show signs of cancer cells, a biopsy is most often the next step so that tissue samples can be tested.
Commonly a fine-needle aspiration (FNA) biopsy of the lung is performed. To do this a CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision is made in the skin where the thin biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is performed afterward to ensure no air leaks from the lung into the chest.
Other tests used to see if cancer has spread to other areas of the body.
The tests used will vary for each patient based on the type of lung cancer and whether it’s suspected that it has spread (metastasized) outside of the lungs. Factors that may influence which tests to be used include:
- Size, location, and type of lung cancer suspected
- Your signs and symptoms
- Your age and general health
- The results of earlier medical tests
In addition to a physical examination and discussion about your family health history, the following tests may be used to diagnose and stage both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC):
- CT Scan or MRI of the brain, chest, and abdomen: This is a series of detailed pictures of areas inside the body taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show more clearly.
- PET Scan (positron emission tomography scan): A small amount of radioactive glucose (sugar) is injected into a vein, which aims to find malignant tumor cells in the body. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Cancerous cells appear as bright spots on the images taken during the scan. Even if a tumor is not visible, the PET scan results give the oncologist a sense of where the cancer is trying to go.
- Bronchoscopy: This test uses a bronchoscope, which is a thin, tube-like instrument with a light and a lens for viewing, that is inserted through the nose or mouth into the trachea and lungs to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
- Thoracoscopy: A surgical procedure to check for abnormal areas by looking at the organs inside the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. Typically, an incision (cut) is made between two ribs to insert a thoracoscope into the chest for viewing or for using a tool to remove tissue or lymph node samples that are then checked under a microscope for signs of cancer.
- Thoracentesis: This test uses a needle to remove fluid from the space between the lining of the chest and the lung. A pathologist then views the fluid under a microscope to look for cancer cells.
- Radionuclide bone scan: This procedure is used to check if there are rapidly dividing cells in the bone, such as cancer cells. A very small amount of radioactive material is injected into a vein and travels through the bloodstream, where it collects in the bones and is detected by a scanner.