Learn About Lung Cancer
Lung cancer is the second most common cancer among men and women. Lung cancer happens when abnormal cells in the lung grow uncontrollably and form tumors in one or both lungs. Lung cancer is hard to detect in early stages. That’s why it is important to begin working with a pulmonologist – a physician who is specially trained to diagnose and treat lung diseases and conditions – as soon as you suspect you may have a serious lung condition. Once you or a loved one is diagnosed with lung cancer, your pulmonologist will bring together a full team of specialists to provide you a complete range of the latest treatment options. Your medical team could include your primary care physician, pulmonologist, oncologist, radiologist, pathologist, and thoracic surgeon. Together, these medical experts can determine the best care possible for your specific type of lung cancer.
Click on our guide, Navigating Lung Cancer, below to learn more.
Lung cancer is the leading cancer killer in both men and women in the United States. Lung cancer has the lowest 5-year survival rate among all common cancers, but the survival rate is more than 50% when detected at an early stage and it’s limited to one area of the lung. This is why early screening is so important.
Early diagnosis and treatment with surgery and/or new techniques of chemotherapy and radiation therapy may cure many patients with lung cancer. Watch the CHEST Foundation’s video on lung cancer biopsies to learn how lung cancer is diagnosed and how biopsies can aid in creating targeted therapies.
Lung Cancer Types
There are two types of lung cancer:
Non-small Cell Lung Cancer (NSCLC) represents 80% to 90% of all lung cancer cases each year. These lung cancers include adenocarcinoma, the most common form of lung cancer; squamous cell carcinoma, which accounts for about 25% of non-small cell lung cancers; and large cell carcinoma, which accounts for the remaining 10% of non-small cell lung cancers.
Small Cell Lung Cancer (SCLC) represents 10% to 20% of all lung cancer cases each year. Generally, small cell lung cancer tumors tend to grow more quickly than non-small cell lung cancer tumors, but they also tend to be more responsive to chemotherapy than NSCLC.
How Lung Cancer Affects The Body
The different types of lung cancer often behave differently in the body. Treatment decisions are based on the types of cancer and what is known as the stage of cancer. The stage is a way of describing the extent of cancer; for example, is it limited to one area in the lung or has it spread. Staging lung cancer is critically important because the treatment chosen can be very different depending on the stage. The lung cancer’s projected outcome, also known as the prognosis, is also impacted by the stage; lower stages, where the cancer is more localized, have a more favorable outcome than advanced stages.
By understanding where the lung cancer is located and how and where it spreads, the medical team can create a treatment plan that is designed expressly for the type and stage of the cancer.
The stages of non-small cell lung cancer are:
Stage III: The cancer is in one lung and the lymph nodes between the two lungs in the middle of the chest. The term Stage IIIA usually describes lung cancer that has spread to lymph nodes on the same side of the chest as the cancer, or that may have spread to adjacent structures like the chest wall, esophagus, or heart. Stage IIIB means that the cancer has spread from the lungs to the lymph nodes on the opposite side of the chest or above the collarbone.
Stage IV: The cancer has spread to the space around the lungs (the pleura), the other lung, or to another part of the body, such as the brain, bones, liver or adrenal glands. You may hear the term “metastasis” being used in Stage IV cancer. This refers to when the cancer has spread beyond its original site in the lung to other, more distant parts of the body.
Small cell lung cancer has two stages:
Early lung cancer usually does not cause noticeable symptoms. Unfortunately, many times it is discovered later, though even in these situations, there are often good options for treatment.
Sometimes lung cancer is discovered on a chest x-ray, CT or CAT scan or other test that’s being performed for another reason, such as a respiratory infection. Pulmonologists can play a key role in the prompt diagnosis, staging, and treatment of patients with lung cancer.
Symptoms of lung cancer can affect the entire body. Persistent cough and shortness of breath are the most common symptoms, but other common symptoms and complications for lung cancer may include:
- Coughing up blood
- Chest, shoulder, or back pain
- Changes in the voice, especially hoarseness
- Repeated lung infections (such as pneumonia or bronchitis)
- Difficulty swallowing
Everyone coughs sometimes, but a cough that continues repeatedly – especially if it occurs with other symptoms, such as blood-tinged sputum and overall weakness – should lead you to set up an appointment to see your physician.
Sometimes, lung cancer spreads beyond the lungs to other parts of the body. Symptoms that may be seen when lung cancer has spread include:
- Unexplained weight loss
- Bone or joint pain
- Unexplained broken bones
- Blood clots or bleeding
- Unsteady movement or seizures
- Memory loss
- Swelling of the neck or face
Any persistent, unusual or unexplained symptom should be checked out by a health-care provider. Everyone coughs sometimes, but a cough that persists –especially if it’s accompanied by other signs, such as blood in the mucus or unexplained pain – should always be evaluated. Like all cancers, lung cancer is best treated when caught early.
It should also be noted that many of these symptoms are non-specific and can be the result of other medical problems, not necessarily related to lung cancer. For example, patients with COPD can have a chronic cough and repeated infections. That’s why it is so important to see your doctor if you are experiencing any of these symptoms to be sure get an accurate diagnosis.
Smoking is still the number one cause of lung cancer. In fact, smoking is the cause of many cancers, including in the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia. The American Cancer Society estimates that 80% to 85% of all lung cancer cases in the United States are related to smoking, which includes people who have quit smoking.
Any kind of smoking seems to increase the risk of lung cancer. Smoking cigarettes, cigars, and pipes have all been linked to lung cancer. Smoking marijuana may also increase the risk of lung cancer, especially in young people. People who are exposed to secondhand smoke also increases the risk of lung cancer. It is estimated that more than 3,000 nonsmoking adults die of lung cancer each year as a result of breathing secondhand smoke.
No one knows for sure the impact of smoking e-cigarettes (vaping) on lung health. E-cigarettes contain nicotine, and, like tobacco cigarettes can lead to nicotine addiction. Some claim that inhaling e-cigarettes may be safer than tobacco smoking and that it may help smokers quit. Others believe that e-cigarettes may lead more young people to start smoking tobacco. Much more research is needed to find the answers to these questions.
Lung cancer can run in families. Researchers are learning that certain genetic mutations – genes that work differently than their “normal” versions – are linked to lung cancer. People who have those mutations may be more likely to get lung cancer than people who have the normal genes. Having one of these genes may be a reason why some nonsmokers develop lung cancer.
Exposure to other harmful substances can also cause lung cancer. Radon is a naturally occurring odorless, tasteless, invisible radioactive gas. People who are exposed to high levels of radon are more likely to get lung cancer than people with low levels of exposure. In fact, radon exposure is a leading cause of lung cancer in nonsmokers. Radon levels can be high not only in underground mines but also in tightly sealed, poorly ventilated homes, generally those with basements.
Exposure to asbestos, a mineral-based substance that was once used in insulation and building construction, can cause lung cancer, especially in smokers. Air pollution has also been linked to lung cancer.
Smoking is the single greatest risk factor for lung cancer. Regular exposure to secondhand smoke also increases the risk. It is also important to understand that the risk of developing lung cancer seems to be dose-dependent: the more you smoke (more cigarettes, more years), the greater your risk. Research shows that quitting smoking at any time of your life decreases your risk of lung cancer.
Other risk factors are the same as the causes for lung cancer:
- A history of cancer in another part of the body. People with a history of head and neck cancer or esophageal cancer, both of which are also associated with tobacco use, are at higher risk for lung cancer. People who have had cancer in a different place, such as breast, colon, or prostate cancer, are at increased risk of having lung cancer.
- Age. Lung cancer risk increases with age. Only about 10% of lung cancer cases occur in people younger than 50 years old.
- Family history. If one of your parents, brother, or sister has had lung cancer, your risk of developing lung cancer may increase.
- Prior radiation therapy.Radiation is an important cancer treatment, but radiation to the chest area, especially for treatment of another cancer, seems to increase the risk of developing lung cancer.
- Exposure to radon, asbestos, and/or industrial chemicals.Radon, asbestos, arsenic, beryllium, and uranium have all been linked to lung cancer. Anyone who has worked with these substances may have an increased risk of developing lung cancer.
- Other lung disease. Diseases such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, and tuberculosis (TB) may increase lung cancer risk. In addition, scarring of the lungs, which from other diseases may set the stage for developing lung cancer.
Having more than one risk factor also increases your odds of developing lung cancer. For instance, a smoker with asbestos exposure has about four times the risk of developing lung cancer as a smoker who has not had asbestos exposure, and 80 times the risk compared with someone who neither smoked nor was exposed to asbestos. If you are at an increased risk for lung cancer, talk to your health-care provider about the risks and benefits of screening for lung cancer.
Screening for Lung Cancer
If you are at increased risk for lung cancer, ask your health-care provider about lung cancer screening with a chest CT scan. Your physician can help you consider the risks and benefits of screening for lung cancer. It’s important to remember, though, that chest CT scans do not find all lung cancers, and sometimes they raise false alarms. If the screening shows a suspicious abnormality, your health-care provider may recommend repeating the scan right away or in several months to see if any abnormalities disappear or change. Your health-care provider can help you weigh the risks and benefits of screening for lung cancer.
Lung cancer treatment depends on what kind of lung cancer you have, its stage, and whether the cancer contains any specific features (biomarkers) that indicate which treatment might work best for you. Your health-care team will also consider your overall health and wishes when planning your treatment.
Some of the most common treatments for lung cancer include:
- Surgery. Each lung is divided into sections, or lobes. The right lung has three lobes: the upper, middle, and lower lobes. The left lung has just two lobes: the upper and lower. If the cancer is in only one lobe of one lung, surgery may be able to remove the cancer; in these cases, surgery offers the highest rate of cure. Depending on the location and stage of the lung cancer, surgeons may remove just part of a lobe (this kind of surgery is called a sublobar resection), an entire lobe (lobectomy), or an entire lung (pneumonectomy). A person can survive with just one lung.
- Chemotherapy. Chemotherapy in combination with radiation therapy is the treatment of choice for small cell lung cancer that is limited to a defined area of the chest that can be safely targeted with radiation. Chemotherapy is usually given without radiation therapy for other patients with more extensive small cell lung cancer.If chemotherapy is going to be delivered through the veins, your heath-care provider may recommend that a special access line, referred to as a “port”, be placed in the upper part of the patient’s chest or arm and into a major vein before chemotherapy treatment begins. These ports are non-invasive and are placed by interventional radiologists or general surgeons. Ports, or other types of long-term access to veins, are commonly used for chemotherapy because treatment often extends over many weeks or months. A port means that patients don’t have to have their veins stuck with needles every time they go for chemotherapy.
Chemotherapy uses medications to kill cancer cells.Most chemotherapy drugs are given directly into the veins through an intravenous (IV) line, although some come in pill form (oral chemotherapy). In advanced non-small cell lung cancer, chemotherapy can be used alone or with other cancer treatments. Sometimes, chemotherapy is given before surgery (referred to as “neoadjuvant”). In some patients with larger tumors, where surgery is felt to be the best first step, chemotherapy is given after surgery (referred to as “adjuvant)”. Chemotherapy combined with radiation therapy is commonly used to treat patients with stage IIIA and IIIB lung cancer and is usually given alone in stage IV.
Targeted therapies. Targeted cancer therapy is a type of treatment that uses drugs to attack cancer cells, including some kinds of lung cancers. As researchers have learned more about the changes in cells that cause cancer, they have been able to develop drugs that directly target some of these changes. These drugs target specific parts of cells and the signals that proteins send to cells that cause them to grow and divide uncontrollably.Targeted cancer therapies are sometimes also called “precision medicines,” “molecularly targeted drugs,” or “molecularly targeted therapies.” If recommended, be sure to find out more about the cell changes or mutations that they target, whether and how to get your tumor tested for mutations, whether targeted therapy might be a good treatment option for you, and what targeted therapy options are available now.
All of the drugs that have already been studied and FDA-approved belong to a class of drug called tyrosine kinase inhibitors (TKIs). Tyrosine kinases are specific enzymes that may signal cancer cells to grow. Tyrosine kinase inhibitors (TKIs) are targeted therapies that block these cell signals. By blocking these signals, they keep the cancer from getting bigger and spreading. TKIs are named for the enzyme they block. The first TKIs for which there has been FDA approval are:
EGFR inhibitors(Tarceva, Iressa, Gilotrif, Tagrisso)
ALK inhibitors (Xalkori, Zykadia)
ROS1 inhibitor (Xalkori)
- Immunotherapy is a new therapy in non-small cell lung cancer using drugs that make the immune system stronger and that help your own body fight its cancer. This treatment is used in patients with stage IV cancer.Immunotherapy is considered a type of biological therapy. It aims to enhance the body’s immune response and stop lung cancers from escaping from the immune system. Immunotherapy is a treatment that strengthens the natural ability of the patient’s immune system to fight cancer. Instead of targeting the person’s cancer cells directly, immunotherapy trains a person’s natural immune system to recognize cancer cells and selectively target and kill them.
Immunotherapies do this in one of two ways: by enabling the immune system to mount or maintain a response, or by suppressing factors that prevent the immune response. There are many different types of immunotherapy. Three main types are currently being studied in people with non-small cell lung cancer (NSCLC): immune checkpoint inhibitors, therapeutic cancer vaccines, and adoptive T cell transfer. Immune checkpoint inhibitors have made the most progress at this time, and the first FDA-approved immunotherapy drugs for lung cancer belong to this group. Immunotherapy is also being studied in small cell lung cancer.
Currently, there are three FDA-approved immunotherapy drugs available for people with metastatic non-small cell lung cancer. The choice of immunotherapy drug depends on line of therapy, presence or absence of an EGFR/ALK/ROS1 alteration, and the proportion of cancer cells that stain positive for the PD-L1 protein.
- Radiation Therapy. Radiation therapy uses high-energy x-rays or other forms of radiation to kill cancer cells. Radiation can be delivered in several different ways. In most cases, the patient lies on a special treatment table while a machine delivers invisible radioactive beams through the skin to the cancer.
Because radiation can harm healthy tissue, the radiation oncology team will carefully measure and mark the spot that should receive radiation. Each time you go for a treatment, the beams will be aimed at this precise spot. Each treatment only takes a few minutes.
Radiation therapy for lung cancer is usually given several days each week for several weeks. The schedule is always planned specifically for each patient depending on the type, size, and location of the cancer. Your health-care team will create a plan for radiation therapy with the goal of eliminating as much cancer as possible with minimal side effects and limiting the exposure of radiation to normal tissues outside the cancer.
- Stereotactic body radiation therapy (SBRT). This type of radiation therapy uses advanced techniques to focus and intensify each dose of radiation to a tumor. SBRT causes less damage to the healthy tissue near the tumor. Throughout the treatment, the strength and direction of the radiation are constantly adjusted to target any changes in the tumor (such as it getting smaller) and spare healthy tissue. SBRT may be used to deliver a single high dose of radiation or several radiation doses, usually three to five treatments (one per day).
- Other Treatments. Other lung cancer treatments may be used in particular situations. For example:
- Radiofrequency ablation uses heat to kill cancer cells, delivering heat through a thin, needle-like probe through the skin near the cancer.
- Photodynamic therapy (PDT) uses a special light delivered through a bronchoscope to cancer cells inside the breathing tubes.
- Laser beams may be delivered through a bronchoscopy to kill cancer cells in order to open blocked airways.
- Cryosurgery uses extreme cold to kill cancer cells.
Your health-care team will be able to discuss these options and whether they would be right to treat your type of cancer.
Lung cancer treatments have side effects. Not everyone has side effects, and over the past decade or so much progress has been made in using chemotherapy agents that are less toxic. Many people have side effects that are mild, and some may have side effects that are severe. Common side effects include:
- Loss of appetite
- Hair loss
- Mouth sores
- Sores at the site of radiation treatment
- Decreased immunity (your resistance to other illness or disease)
- Memory problems
- Pain and discomfort
- Diarrhea or constipation
- Skin rashes
Your side effects will depend on what treatments you receive and how your body responds to the treatments.
Also remember that sometimes side effects can be eased using medication before you even begin treatment. For instance, it’s common to give antinausea medication to lung cancer patients before chemotherapy in order to avoid vomiting. Ask your health-care providers about the possible side effects of your lung cancer treatment, and ask what you can do to help manage any side effects. It is important for you to report any side effects to your health-care provider throughout your treatment. Your physician can’t help you feel better if he or she doesn’t know what you are experiencing.
Preparing For Your First Appointment
Whether your are going to your first appointment with a primary care physician or cancer specialist, take time to prepare for an informative discussion about lung cancer. Consider bringing a trusted friend or loved one to the appointment. They may remember details of the visit that you may forget or misunderstand. Some people also find it useful to record their appointments with a cell phone voice recorder or audio recorder device. Plan on taking notes during your visit and bring questions you’ve written down in advance so that you can understand any potential diagnosis or treatment information that may confuse you.
Your pulmonologist is just one part of the multidisciplinary team approach to lung cancer care. The following specialists are also important to your care team:
Family practitioners and internists are doctors who have completed a residency in family medicine or internal medicine. They are often the first to find your cancer. They can work together with the specialists and subspecialists to help coordinate your care.
Pulmonologists (also called pulmonary specialists) are doctors who specialize in diagnosing and treating lung diseases. They can also treat breathing problems caused by cancer or its treatment.
Pathologists are doctors who specialize in identifying diseases. They use a microscope to examine the tissue sample taken during a biopsy. From this exam, the pathologist will diagnose the type of cancer and how advanced it is. You may never meet your pathologist, but he or she will consult with other doctors on your team.
Thoracic surgeons (chest surgeons) are doctors who specialize in surgery on the lungs and other organs inside the chest. A thoracic surgeon can treat cancers of the lung, esophagus, and chest wall. Some thoracic surgeons also have special training in surgical oncology.
Oncologists are doctors who specialize in treating cancer. There are three main types of oncologists:
- Medical oncologiststreat cancer by using medicines, such as chemotherapy or targeted therapy. Your medical oncologist may also refer you to other specialists for treatment.
- Radiation oncologistsuse X-rays and other types of radiation therapy to treat cancer.
- Surgical oncologistsuse surgery to diagnose and treat cancer. They can do biopsies and remove tumors. A thoracic surgical oncologist specializes in surgeries on lung tumors and other tumors found inside the chest.
Diagnostic or interventional radiologists are doctors who specialize in diagnosing disease by using imaging tests, such as X-ray, MRI, CT scan, PET scans, and ultrasound. Interventional radiologists may also use imaging tests to guide them as they perform biopsies. A diagnostic radiologist may specialize in radiation oncology, to diagnose cancerous growths specifically. Having a radiologist with experience in diagnosing lung cancer can improve the accuracy of diagnosis.
In addition to physicians, your medical team may consist of some or all of these health care professionals:
Oncology nurses specialize in treating and caring for people who have cancer. They are often a major point of contact for patients and their families.
Patient navigators are trained, culturally sensitive health care workers who provide support and guidance throughout the cancer care continuum. They help people "navigate" through the maze of doctors' offices, clinics, hospitals, outpatient centers, insurance and payment systems, patient-support organizations, and other components of the health care system.
Respiratory therapists are trained to evaluate and treat people who have breathing problems or other lung disorders.
Social workers are trained to talk with people and their families about emotional or physical needs, and to find them support services.
Registered dieticians have special training in the use of diet and nutrition to keep the body healthy. A registered dietitian may help the medical team improve the nutritional health of a patient.
Your medical team will want to know as much as possible about your symptoms, overall health, and medical history.
Before your appointment, gather:
- Information about your symptoms.What symptoms are you having? When did they start? Have your symptoms changed, or have you noticed new symptoms over time? Does anything relieve your symptoms? Make them worse?
- Information about smoking. A complete description of smoking habits is very important. Did you ever smoke? If so, when did you start? How many packs of cigarettes did you typically smoke, and for how long? If you stopped, when?
- Work history. A complete description of all the jobs you have held is also important, even if the job was decades ago. People with work exposure to asbestos or other harmful substances may develop lung cancer long after they stopped being exposed.
- Complete list of your medications, supplements, and vitamins.Include all prescription and over-the-counter medications and supplements, even herbal and natural remedies. If possible, bring the bottles and containers with you to your appointment, so your health-care provider can see exactly what you’re taking.
- Your medical history.Have you had cancer? What kind? What sort of treatment did you undergo? Your health-care provider will also want to know about any lung and breathing problems you’ve had in the past. If you have medical records at another clinician’s office, ask to have copies sent to your pulmonologist.
- Medical records. Bring all the medical records you can get your hands on, especially any copies of old chest x-rays. Comparing current films with old ones tells the clinician a lot about the likelihood that there is a lung cancer. These records will help your health-care provider determine which tests are needed. If suspicious tissue has been there for several years without changing, it is probably not lung cancer.
- Family medical history.Has anyone in your family ever been diagnosed with lung cancer? Does anyone else in your family have a history of lung or breathing problems?
- Questions. Write down any questions you may have, so you don’t forget to ask them when you’re at your appointment.
Questions To Ask Your Health-Care Provider
- Should I be screened for lung cancer?
- Which procedure will be used to diagnose my disease?
- Can we have my tumor tested?
- How will the tissue be removed?
- How severe is my lung cancer?
- What type of lung cancer do I have?
- What stage is my lung cancer?
- Is the cancer located anywhere else in my body?
- Do I need more tests?
- Are there any biomarkers in my tumor?
- What is my prognosis?
- What are my treatment options?
- What are the risks and benefits of my treatment options?
- What are the possible side effects to my treatment?
- How soon do I need to decide on a treatment?
- How much will treatment cost?
- How do I stay healthy?
- Where can I turn for support?
Living With Lung Cancer
There’s no magic cure for lung cancer, but there are some things you can do at home to increase your comfort and improve your overall health.
- If you smoke, quit.It’s not easy to stop smoking, but your health-care team can help by prescribing medication as well as referring you to local classes and support groups to help you stop smoking. Quitting smoking will keep you healthier.
- Get plenty of rest.Getting enough rest reduces stress, increases feelings of well-being, and may strengthen your immune system (the body’s natural ability to fight disease). Many people find cancer treatment exhausting. You may feel wiped out after chemotherapy or radiation. Listen to your body and rest when you feel tired. It’s okay to be active when you feel good, but healing takes time and energy.
- Keep active and exercise. You may not feel like exercising, but physical activity is helpful. Studies now show that exercise can help reduce the symptoms and side effects of lung cancer and improve quality of life. Talk to your doctor to find a safe exercise program for you and try to do some physical activity – even if it is a long walk – every day.
- Eat a healthy diet.It’s not easy to eat well, or, at times, to even eat at all if your cancer treatment interferes with your appetite and sense of taste. But getting enough calories and nutrients is an important way to support healing. Tell your health-care team if eating has become a challenge for any reason. Your physician may be able to prescribe medication that can help. Some medications, for example, stimulate appetite. Others relieve mouth sores or can soothe nausea. Your health-care provider may also recommend supplements to help you maintain your nutrition. Many cancer centers have nutritionists on staff. A nutritionist can help you figure out an eating plan that fits your needs and personal preferences.
- Get emotional, spiritual, and psychological support. Few things hit harder than a diagnosis of cancer. You may feel stunned, angry, upset, sad, frightened, or overwhelmed and sometimes, you may feel all of these emotions at once. This reaction is completely normal. Anxiety and depression may begin to negatively affect your work or relationships, and that might be time for some professional help. Talk about your feelings with your health-care team. Your doctor can assess you for clinical depression and, if appropriate, prescribe medication to help or refer you to a professional counselor or mental health professional. Some patients find that conversations with a spiritual or religious advisor to be helpful.
Don't forget that a diagnosis of lung cancer can be stressful for the entire family. Try to remember that your family members may feel as overwhelmed as you do. Support groups can help both patients and families. Talking to other people who have had or are living with lung cancer can be very helpful. Many patient advocate groups offer support and survivorship services. LUNGevity offers vast online and peer-to-peer support services, including a toll-free helpline and PhoneBuddy program. The Lung Cancer Alliance maintains a list of online and in-person support groups across the country. CancerCare also has lists of support groups, as well as online phone counseling with social workers who specialize in cancer care. Many hospitals and health-care organizations host lung cancer support groups, too. Ask your health-care team what support options are available near you.
As you begin working with your health-care team, there are three primary issues that they will need to address about your lung cancer:
- What type of lung cancer is it? (the diagnosis)
- Where is it located? (the stage)
- What do we do about it? (the treatment plan)
While it is important to find the answers to the first two questions as quickly as possible, it is essential that the activities required to find the answers are done correctly, which may take a little longer. That’s because the best recommendation for your treatment plan depends on accuracy in the diagnosis and staging of your cancer.
Your health-care team will ask you lots of questions about your health and medical history and perform a thorough physical examination. They will also order some tests to figure out what’s causing your symptoms. If the tests suggest cancer, additional tests will be done to learn as much as possible about the potential cancer. Test results will help your medical team arrive at an accurate diagnosis and stage, and develop a treatment plan.
Tests and Diagnosis
- Chest x-rays. A chest x-ray is a painless test that allows clinicians to look at what’s going on in your lungs and airways. Chest x-rays can help health-care providers see spots (nodules) or other abnormal areas in the lungs, but there’s no way to tell from an x-ray whether or not any of these are cancerous. If your chest x-ray looks suspicious, additional tests will be required.
- CT scans. A CT scan (sometimes called a “CAT scan”) uses x-rays to create cross-sectional pictures of the body. CT scans can be used to look for lung abnormalities with more detailed pictures of the size and location of abnormalities identified on a chest x-ray.
- Positron-emission tomography(PET scan). This imaging test uses injection of a radioactive sugar to provide information about whether or not something seen on a CT scan is metabolically active (whether it is changing or growing). PET scans can also be used to tell if a tumor is spreading from the primary site to other parts of the body.
- Bronchoscopy. A bronchoscope is a thin, flexible tube that contains a tiny video camera. The tube is passed through your nose or mouth, down through your windpipe (trachea) and into your lungs. A bronchoscopy allows the doctor, usually a pulmonologist or thoracic surgeon, to see inside your air passages. Physicians can also take small tissue samples (biopsies) and fluid samples from the lungs and send them to a lab to see if they’re cancerous.
- Endobronchial ultrasound. This test is sometimes used during bronchoscopy to diagnose lung cancer and to determine if has spread to the lymph nodes (staging). The bronchoscope has a sound-wave probe on the end so clinicians can locate and visualize masses and lymph nodes next to the airway but not within the lung. Physicians can then use needles to sample the mass and/or lymph nodes to be analyzed for cancer. Endobronchial ultrasound is not available at all hospitals and medical centers.
- Transthoracic fine needle aspiration. If a CT scan shows a suspicious mass or nodule or possible tumor in the lungs, a radiologist may use a CT scan to guide a thin needle through the skin of the chest into the lung to take a sample of the abnormal area and sent to a lab to see if there are cancer cells.
- Transthoracic core needle biopsy. Transthoracic biopsy can also be done with a hollow (“core”) needle to determine if an abnormality is cancer. Core needle biopsies provide a bigger sample than fine needle aspirates.
- Surgical lung biopsy. Depending on the location of the suspected abnormality or tumor, surgery is sometimes the best way to get a good tissue sample. The tissue is analyzed to see if it’s cancerous.
- Thoracentesis. This test may be done if there is an abnormal fluid collection between the chest wall and the lung, an area known as the pleura. (You may also hear the phrase pleural effusion to describe fluid collection from the pleura.) In this test, the skin on the chest is thoroughly numbed and a needle is inserted into the space around the lung to remove fluid, and then the fluid can be sent to the lab and checked for the presence of cancer cells.
- Medical thoracoscopy: This test may be done to biopsy the inside layer of the chest, called the pleura. It can be used if fluid builds up in the chest and thoracentesis testing has not given your physician a diagnosis. It is done under monitored anesthesia by inserting a small camera into the chest cavity to inspect and biopsy the pleura. It is safe, accurate, and patients may go home the same day.
- Biomarker testing. Tumor tissue removed during any biopsy procedure can be tested for several biomarkers, features of cancer cells that can give the doctor speciﬁc information about the tumor. Biomarker testing gives health-care providers more information about your lung cancer. This personalized information is important, because all lung cancers are not the same. Biomarker testing can help your health-care provider decide what types of treatment will be most effective for you.
These tests not only identify the lung cancer, but also help determine the stage of the lung cancer, which helps your health-care team determine the best treatment plan.
For more resources on lung cancer, finding support, and getting answers, please visit our partners:
There are many places to get support dealing with lung cancer. There are local and online groups that can help you find answers to your questions and provide assistance. Your health-care provider will likely know the support groups in your local area. Other online resources are:
American Cancer Society
American Lung Association Lung Cancer Support Groups
The Better Breathers Clubs and American Lung Association
Bonnie J. Addario Lung Cancer Foundation
National Cancer Institute at the National Institutes of Health
Shareable Digital Tools
Click any image below to download and share on social media.