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Tests and diagnosis
By Mayo Clinic staff
Testing healthy people for lung cancer
Doctors aren't sure whether people with no signs or symptoms of lung cancer should undergo screening for the disease. Even if you have an increased risk of lung cancer — for instance, if you're a smoker — it isn't clear that a chest X-ray or computerized tomography (CT) scan can be beneficial. Some studies show that these tests can find cancer earlier, when it may be treated more successfully. But other studies find that these tests often reveal more benign conditions that require invasive testing and expose people to unnecessary risks.
Screening for lung cancer is controversial among doctors. Studies are ongoing to determine what types of tests may be helpful and who would benefit from lung cancer screening. In the meantime, talk with your doctor if you're concerned about your risk of lung cancer. Together you can determine strategies to reduce your risk and decide whether screening tests are appropriate for you.
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 samples (biopsy). A sample of abnormal cells may be removed in a procedure called a biopsy in order to diagnose lung cancer. 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 and into a suspicious lump or nodule to collect 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, or 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 appropriate for you.
Stages of non-small cell lung cancer
- Stage I. Cancer at this stage has invaded the underlying lung tissue but hasn't spread to the lymph nodes.
- Stage II. This stage cancer has spread to neighboring lymph nodes or invaded the chest wall or other nearby structures.
- Stage IIIA. At this stage, cancer has spread from the lung to lymph nodes in the center of the chest.
- Stage IIIB. The cancer has spread locally to areas such as the heart, blood vessels, trachea and esophagus — all within the chest — or to lymph nodes in the area of the collarbone or to the tissue that surrounds the lungs within the rib cage (pleura).
- Stage IV. The cancer has spread to other parts of the body, such as the liver, bones or brain.
Stages of small cell lung cancer
- Limited. Cancer is confined to one lung and to its neighboring lymph nodes.
- Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and may have invaded both lungs, more-remote lymph nodes, or other organs, such as the liver or brain.
- Non-small cell lung cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf. Accessed Sept. 23, 2009.
- Estimated new cancer cases and deaths. American Cancer Society. http://www.cancer.org/docroot/MED/content/downloads/MED_1_1x_CFF2009_Est_Cancer_Cases_Deaths.asp. Accessed Sept. 25, 2009.
- Small cell lung cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf. Accessed Sept. 23, 2009.
- Johnson DH, et al. Cancer of the lung: Non-small cell lung cancer and small cell lung cancer. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone; 2008:1307.
- What you need to know about lung cancer. National Cancer Institute. http://www.nci.nih.gov/cancertopics/wyntk/lung/allpages/print. Accessed Sept. 23, 2009.
- Lung cancer prevention (PDQ): Patient version. National Cancer Institute. http://www.nci.nih.gov/cancertopics/pdq/prevention/lung/patient/allpages/print. Accessed Sept. 23, 2009.
- Cancer of the lung and bronchus. Surveillance Epidemiology and End Results. http://seer.cancer.gov/statfacts/html/lungb.html. Accessed Sept. 25, 2009.
- Questions to ask your medical team. Lung Cancer Alliance. http://www.lungcanceralliance.org/facing/questions.html. Accessed Sept. 23, 2009.
- Lung cancer screening (PDQ): Patient version. National Cancer Institute. http://www.nci.nih.gov/cancertopics/pdq/screening/lung/patient/allpages/print. Accessed Sept. 23, 2009.
- Avastin (prescribing information). South San Francisco, Calif.: Genentech Inc.; 2009. http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/125085s0168lbl.pdf. Accessed Sept. 25, 2009.
- Tarceva (prescribing information). Melville, N.Y.: OSI Pharmaceuticals Inc.; 2009. http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021743s015lbl.pdf. Accessed Sept. 25, 2009.
- Kvale PA, et al. Palliative care in lung cancer. Chest. 2007;132(suppl):368S.
- Cassileth BR, et al. Complementary therapies and integrative oncology in lung cancer. Chest. 2007:132(suppl):340S.
