Diagnosis of Lung Cancer

The doctor will ask about your symptoms and medical history and perform a physical exam. The doctor will also ask about the following:

  • Smoking history
  • Exposure to environmental and occupational substances
  • Family history of cancer

Diagnostic Tests

Tests may include:
  • Chest x-ray—An x-ray to check for abnormal areas on the lungs.
  • CT scan —A series of x-rays put together by a computer to create images of the lung. A special spiral or helical CT scan may identify smaller tumors than a regular x-ray.
  • PET/CT scan—A combined PET and CT scan to enhance structures and detect cellular function.
  • Sputum cytology—Examination of a sample of mucus from the lungs.
  • Biopsy—Removal of a sample of lung tissue to be tested for cancer cells. Methods of lung biopsy include:
    • Bronchoscopy—A visual examination of the lungs and air passages with a bronchoscope, an instrument with a lighted tip. The doctor can remove tissue samples or wash the tissues with saline (a procedure called lavage) to obtain cells to check for cancer.
    • Needle aspiration—A needle is inserted through the chest to remove a sample of tissue from the tumor. This tissue is checked for cancer cells.
    • Thoracentesis—A needle is inserted through the chest to remove a sample of the fluid from around the lungs to check for cancer cells.
  • Pulmonary function tests—This series of tests is done to see how well your lungs work. This test is very important and provides your doctor with information about what kind of treatments may be appropriate for you.
Placement of Thoracentesis Needle
Copyright © Nucleus Medical Media, Inc.

Staging Tests

If cancer is found, treatment will depend on the stage of your cancer. The doctor will order additional tests to determine the stage of the cancer. Staging is a careful attempt to determine whether the cancer has spread and, if it has, what body parts are affected. Additional tests to determine staging may include:
  • CT scan
  • MRI scan—A test that uses magnetic waves to create detailed pictures of areas inside the body.
  • Bone or liver scans—Tests that look for evidence of tumors. A radioactive substance is injected into the bloodstream and tracked by a scanning machine. Cancerous areas absorb more of the radioactive substance than normal tissue and show up as “hot spots.”
  • Mediastinoscopy—A test to check lymph nodes in the chest for cancer cells. The doctor will insert a scope into the chest to remove lymph node tissue.

Stages of Lung Cancer

Lung cancer staging considers 3 categories: tumor, lymph nodes, and metastases. Lung Cancer Tumor (T) Stages
  • Stage Tis (in situ)—The tumor is found in the sputum, but cannot be seen in the airways or the lung.
  • Stage T1—The tumor is 3 centimerters (cm) or smaller, has not spread to the skin or pleura that surround the lungs, and is not affecting the main branches of the airways (bronchi).
  • Stage T2—The cancer has one or more of the following characteristics:
    • It is larger than 3 cm.
    • It involves the main bronchus, but is not closer than 2 cm to where the windpipe branches left and right.
    • It has spread to the pleura that surround the lungs.
    • It may block part of the airway and can cause some collapse of the lung, but has not caused the entire lung to collapse.
  • Stage T3—The cancer has one or more of the following characteristics:
    • It has spread to the chest wall, diaphragm, or pleura surrounding the space between the lungs or the membranes surrounding the heart.
    • It involves a main bronchus and is closer than 2 cm to where the windpipe branches left and right.
    • It has grown into the airways and caused a lung to collapse or pneumonia in the entire lung.
  • Stage T4—The cancer has one or more of the following characteristics:
    • It has spread to structures inside the chest other than the lung (spinal bones, heart, esophagus, large blood vessels).
    • Two or more separate tumors in the same lobe.
    • Cancer cells in the space surrounding the lungs.
Lung Cancer Lymph Node (N) Stages
  • Stage N0—The cancer has not spread to the lymph nodes.
  • Stage N1—The cancer has spread to lymph nodes in the lung or the area where the bronchus meets the lung and affected the lymph nodes on the same side of the body as the cancer.
  • Stage N2—The cancer has spread to the lymph nodes where the windpipe branches left and right, or to lymph nodes in the space between the chest bone and heart. The affected lymph nodes are on the same side of the body as the cancer.
  • Stage N3—The cancer has spread to lymph nodes near the collarbone on either side or to the opposite side of the lung from where the lung cancer is located.
Lung Cancer Metastatic (M) Stages
  • Stage M0—The cancer has not spread.
  • Stage M1—The cancer has spread to other parts of the body beyond the chest, other lobes of the lung, or lymph nodes beyond those considered in the N stages.
The overall cancer stage is based on the above rankings.
Overall Stage T Stage N Stage M Stage
Stage 0 Tis N0 M0
Stage IA T1 N0 M0
Stage IB T2 N0 M0
Stage IIA T1 N1 M0
Stage IIB T2 N1 M0
T3 N0 M0
Stage IIIA T1 N2 M0
T2 N2 M0
T3 N1 or N2 M0
Stage IIIB Any T N3 M0
T4 Any N M0
Stage IV Any T Any N M1

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