• Diagnosis of Lung Cancer

    The doctor will ask about your symptoms, and medical and family history. A complete physical exam will be done. The lungs, throat, and chest areas will be thoroughly examined. Your doctor may suspect lung cancer based on your symptoms, but will look for other possible causes.

    Suspicion of Lung Cancer

    If you have symptoms, your doctor may conduct certain tests to identify abnormalities. These may include:
    • Blood tests—Certain substances are released into the blood when a tumor develops. These markers may be elevated in the presence of cancer.
    • Pulmonary function tests—A series of breathing tests that evaluate air movement and overall lung function.
    • Sputum cytology—Mucus is coughed up from the lungs and evaluated under a microscope.
    • Imaging tests—To assess internal structures for the presence and location of tumors. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
    • Bronchoscopy—A thin, lighted tube with a tiny camera is attached is inserted through the respiratory tract and into the lungs for visual examination. Suspicious tissue will be removed with specialized tools or a saline wash, and examined under a microscope. For many people, this is the standard test for examining the bronchi and lungs.

    Diagnosis of Lung Cancer

    Diagnosis of lung cancer is confirmed with a biopsy. A biopsy is a tissue sample that is removed from the bronchi or lungs. After removal, the sample is examined under a microscope. This is the only way to confirm a diagnosis of lung cancer.
    Biopsies needles may be guided by imaging, such as an MRI scan or ultrasound, to improve accuracy. Biopsy types include:
    • Needle aspiration—A needle is inserted through the chest wall to remove a sample of tissue from the tumor. This tissue is checked for cancer cells. This can be done using a fine needle or a wider needle called a core.
    • Transthoracic needle biopsy—A needle is inserted through the chest wall to remove tissue on the outer edges of the lungs.
    • Thoracentesis—A needle is inserted through the chest wall to remove a sample of the fluid from around the lungs to check for cancer cells.
    Placement of Thoracentesis Needle
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Staging of Lung Cancer

    If lung cancer is confirmed, results from completed tests and new tests will help determine the stage of cancer. Staging is used to determine characteristics of the tumor that will help develop the prognosis and treatment plan. Factors that play a role in staging include how far the original tumor has spread, whether lymph nodes are involved, if cancer has spread to other tissue, and microscopic cellular details.
    Staging Tests
    Tests that may help determine lung cancer stage:
    • Blood tests to look for abnormal numbers of certain blood cells, proteins, indications of cancer, and abnormal cells. The tests may also show changes in kidney or liver function.
    • Imaging tests—To help determine how deep the tumor has moved into the layers of the lung, chest wall, or nearby structures. They may also help to determine if there are any metastatic growths in other areas of the body. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
      • CT scan
      • MRI scan
      • PET/CT scan
      • Endobronchial or endoscopic esophageal ultrasound
      • Bone scan
      Visual tests use scopes with lighted tips and cameras to assess specific structures, including lymph nodes around the chest. These may include:
      • Bronchoscopy—a scope is inserted through the nose or mouth
      • Thoracoscopy—a scope is inserted through a small incision between 2 ribs
      • Mediastinoscopy—a scope is inserted through a small incision through the breastbone
    • Lymph node biopsy—Cancer cells can drain from the tumor site into nearby lymph nodes. From here, cancer cells can travel through the lymph fluid to the bloodstream and other areas of the body. Lymph nodes are normally checked if suspicious tissue is removed, or if they are swollen or felt during the physical exam
    • Tissue evaluation—Cancer tissue from the biopsy will be closely examined to look for characteristics that can help with prognosis and treatment selection. Important characteristics include presence of genetic mutations. For example, some genetic mutations cause resistance to certain chemotherapy drugs.
    Stages of Lung Cancer
    Staging depends on the type of lung cancer that is found. There are 2 different systems for staging lung cancer:
    Non-small Cell Lung Cancer
    Non-small cell lung cancer is staged from occult to stage IV:
    • Occult—Lung cancer tumors cannot be seen using visual or imaging tests. Cancer cells are found after a sputum test or saline wash during a bronchoscopy. Even though tumors cannot be seen, cancer may have already spread.
    • Stage 0—Carcinoma in situ—A very localized group of abnormal cells are found in the in the lining of the respiratory tract. These abnormal cells have the potential to become cancerous.
    • Stage IA—A tumor 3 centimeters (cm) or less is present and has NOT spread beyond the primary site.
    • Stage IB—Cancer is NOT in the lymph nodes, WITH one or more conditions:
      • Tumor is 3-5 cm in size
      • Cancer is in the bronchial tube AND is 2 cm or more away from the junction of the trachea and bronchi
      • Cancer is found in the innermost layer of the pleura (the protective membrane of the lung)
      • Partial lung collapse OR inflammation of lung tissue is present near the junction of the trachea and bronchi
      Stage IIA—Cancer is found in the lymph nodes on the same side as the tumor WITH one or more conditions:
      • Tumor is less that 5 cm in size
      • Cancer is in the bronchial tube AND is 2 cm or more away from the junction of the trachea and bronchi
      • Cancer is found in the innermost layer of the pleura
      • Partial lung collapse OR inflammation of lung tissue is present near the junction of the trachea and bronchi
      • OR
      • Cancer is NOT found in the lymph nodes. The tumor is 5-7 cm in size, WITH one or more of the condition listed above
      Stage IIB—Cancer is found in the lymph nodes on the same side as the tumor AND are in the lung OR near the bronchial tube WITH one or more of the following conditions:
      • The tumor is 5-7 cm in size
      • Cancer is in the bronchial tube AND is 2 cm or more away from the junction of the trachea and bronchi
      • Cancer is found in the innermost layer of the pleura
      • Partial lung collapse OR inflammation of lung tissue is present near the junction of the trachea and bronchi
      • OR
      • Cancer is NOT found in the lymph nodes. The tumor is more than 7 cm in size, WITH one or more of the condition following conditions:
      • Cancer is in the bronchial tube AND is 2 cm or more away from the junction of the trachea and bronchi, the chest wall, diaphragm, or the phrenic nerve (the nerve that controls the diaphragm)
      • Cancer is found in the pleura OR the pericardium (the membrane around the heart)
      • Complete lung collapse OR inflammation of lung tissue is present near the junction of the trachea and bronchi
      • One or more tumors in a the same lung lobe
      Stage IIIA—Cancer is found in the lymph nodes on the same side as the tumor, near the central chest bone OR where the bronchi branch into the lungs, the tumor can be any size WITH:
      • Partial or complete lung collapse OR inflammation of lung tissue
      • One or more tumors in the same lung lobe
      • The presence of cancer in the main bronchial tube, chest wall, diaphragm, phrenic nerve, pleura, OR pericardium
      • OR
      • Cancer is found in the lymph nodes on the same side as the tumor, near the central chest bone OR where the bronchi branch into the lungs, the tumor can be any size WITH:
      • Partial or complete lung collapse OR inflammation of lung tissue
      • One or more tumors in any lung lobe
      • The presence of cancer in the main bronchial tube, chest wall, diaphragm, phrenic nerve, pleura, pericardium, heart, great blood vessels to and from the heart, trachea, esophagus, vagus nerve that controls the voice box, central chest bone, vertebrae, or the junction of the trachea and bronchi
      • OR
      • Cancer is NOT found in the lymph nodes, the tumor is any size, but has spread to the heart, great blood vessels to and from the heart, trachea, esophagus, vagus nerve that controls the voice box, central chest bone, or the junction of the trachea and bronchi
      Stage IIIB—Cancer is found in the lymph nodes above the collarbone OR to the opposite side of the chest WITH a tumor of any size AND:
      • Partial or complete lung collapse OR inflammation of lung tissue
      • One or more tumors in any lung lobe
      • The presence of cancer in the main bronchial tube, chest wall, diaphragm, phrenic nerve, pleura, pericardium, heart, great blood vessels to and from the heart, trachea, esophagus, vagus nerve that controls the voice box, central chest bone, vertebrae, or the junction of the trachea and bronchi
      • OR
      • Cancer is found in the lymph nodes on the same side as the tumor, near the main chest bone OR where the bronchi branch into the lungs WITH a tumor of any size AND:
      • One or more tumors in any lung lobe
      • The presence of cancer in the heart, great blood vessels to and from the heart, trachea, esophagus, vagus nerve that controls the voice box, central chest bone, vertebrae, or the junction of the trachea and bronchi
      Stage IV—Tumor of any size WITH cancer in the lymph nodes AND one or more of the following conditions:
      • Tumors in one or more lungs
      • The presence of cancer in the pleural or pericardial fluid
      • Cancer has spread to other parts of the body, such as the brain, liver, or bones
    Small cell Lung Cancer
    Small cell lung cancer is staged and classified differently than non-small cell lung cancer:
    • Limited stage—Cancer is found in the lung and may be present in the area between the lungs or lymph nodes above the collarbone.
    • Extensive stage—Cancer has spread outside of the lungs OR the area between the lungs OR lymph nodes above the collarbone TO other parts of the body.

    References

    Lung cancer (non-small cell). American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf. Accessed July 13, 2016.

    Lung cancer (small cell). American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003116-pdf.pdf. Accessed July 13, 2016.

    Non-small cell lung cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 25, 2016. Accessed July 13, 2016.

    Small cell lung cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 15, 2015. Accessed July 13, 2016.

    Stages of non-small cell lung cancer. National Cancer Institute website. Available at: http://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq#section/%5F134. Updated July 8, 2016. Accessed July 13, 2016.

    Stages of small cell lung cancer. National Cancer Institute website. Available at: http://www.cancer.gov/types/lung/patient/small-cell-lung-treatment-pdq#section/%5F77. Updated July 7, 2016. Accessed July 13, 2016.

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