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Diagnosis of Lung Cancer

by Debra Wood, RN

En Español (Spanish Version)

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

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.
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

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 —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.

Lung cancer staging considers three categories: tumor, lymph nodes, and metastases.

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 cm (centimeter) 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 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

Stage NO—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.

Stage MO—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
Stage IIB	T3	N0	M0
Stage IIIA	T1	N2	M0
	T2	N2	M0
	T3	N1 or N2	M0
Stage IIIB	Any T	N3	M0
Stage IIIB	T4	Any N	M0
Stage IV	Any T	Any N	M1

Learn about cancer—non-small cell. American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp. Accessed October 7, 2008.

Learn about cancer—small cell. American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp. Accessed October 7, 2008.

Lung cancer. American Lung Association website. Available at: http://www.lungusa.org/. Accessed October 7, 2008.

Lung cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/lung. Accessed October 7, 2008.

Last reviewed September 2012 by Igor Puzanov, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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