Diagnosis and Staging

The first step in lung cancer detection and diagnosis is a routine history and physical examination by a primary care physician. Learning about the patient's symptoms and observing possible indicators such as difficulty breathing, bluish skin or nail bed clubbing may alert the physician to the possibility of lung disease.

• Diagnostic Imaging
  The first step in determining if a mass is cancer or benign is a diagnostic image. One or several of these may be used:
  • X-Ray
    The first diagnostic step is a chest X-ray. A chest X-ray can detect suspicious lung masses, but cannot be used to determine if they are cancerous or benign. Patients are exposed to small amounts of radiation during the X-ray procedure.

  • CT Scan
    A computerized tomography (or CT or Cat) scan can provide a more-detailed image of the lung. CT scans are a series of X-rays combined by a computer in a cross-section view. They can be performed with injected contrast material to highlight lung tissue and suspicious masses. Since the basic imaging mechanism of a CT scan is X-rays, patients receive a low dose of radiation during the procedure. The radiation dosage is significantly lower with low-dose helical CT scans, but masses detected with this technology must be reexamined.

  • MRI
    Magnetic resonance imaging (or MRI) scans uses magnetism, radio waves and computer image manipulation to produce an extremely detailed image without radiation. Because of the extremely powerful magnetism of MRI scanners they cannot be used on patients with any metal implants or pacemakers.

  • PET Scan
    Positron-emission tomography (or PET) scans are three-dimensional images of the metabolic functioning of body tissues. PET scans can be used to determine the type of cells in a mass and to detect whether or not a tumor is growing. Patients receiving PET scans are injected with a radioactive drug with about as much radiation as two chest X-rays.

• Biopsies
  Biopsies are procedures in which a small amount of a suspicious mass is removed for examination by a pathologist. There are three main types of biopsy for suspected lung masses:
  • Surgical
    A surgical biopsy is a procedures in which patient's chests is opened to gain access to a small sample of a suspected mass. The sample is analyzed by a pathologist while the surgery is proceeding, and all - or as much as possible - of the mass is usually removed during the operation, called a thoractomy. A thoractomy is a major surgical procedure performed under anesthetic in a hospital operating room.

  • Bronchoscopy
    In bronchoscopy a fiber-optic tube - called a bronchoscope - is inserted through the patient's mouth or nose and passed through the trachea and bronchial tubes to the suspected area. The tube has a lens and light source which allow the physician to examine the lung mass. Frequently the bronchoscope has a sampling devise to retrieve a small section of the suspected mass for analysis. A bronchoscopy can be performed in an outpatient suite or a hospital operating room and requires a sedative and anesthetic.

  • Needle Aspiration or Core Biopsy
    In needle aspiration (often called core biopsy) a thin needle is inserted into the suspected mass and a small sample withdrawn for analysis. Needle aspiration is performed on an outpatient basis and requires a local anesthetic.

• Sputum cytology
  In sputum cytology a pathologist examines the patient's sputum under a microscope. The cells of centrally-located tumors are often present in sputum, and if they are, the pathologist can diagnose the condition by simple visual examination.

• Lung Cancer Staging
  Staging is the evaluation of the extent to which a lung cancer tumor has grown and/or spread. Different lung cancer treatments are specifically for various stages of the disease. The stages of non-small cell and small cell cancers are:
  • NSCLC stage I - The cancer is only in the lung.
  • NSCLC stage II - The cancer is confined to the chest area.
  • NSCLC stage III - The cancer is confined to the chest, but the tumors are larger and more invasive.
  • NSCLC stage IV - The cancer has spread beyond the chest to other parts of the body.
  • Limited-stage SCLC - The cancer is confined to the chest.
  • Extensive-stage SCLC - The cancer has spread beyond the chest to other parts of the body.