Lung Cancer

Diagnosis

To help find the cause of lung cancer symptoms, the doctor evaluates a person's medical history, smoking history, exposure to environmental and occupational substances, and family history of cancer. The doctor also performs a physical exam and may order a chest x-ray and other tests. If lung cancer is suspected, sputum cytology (the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs) is a simple test that may be useful in detecting lung cancer. To confirm the presence of lung cancer, the doctor must examine tissue from the lung. A biopsy--the removal of a small sample of tissue for examination under a microscope by a pathologist--can show whether a person has cancer. A number of procedures may be used to obtain this tissue:

  • Bronchoscopy. The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue.

  • Needle aspiration. A needle is inserted through the chest into the tumor to remove a sample of tissue.

  • Thoracentesis. Using a needle, the doctor removes a sample of the fluid that surrounds the lungs to check for cancer cells.

Thoracotomy. Surgery to open the chest is sometimes needed to diagnose lung cancer. This procedure is a major operation performed in a hospital.

If a lung cancer diagnosis is made, the doctor will want to learn the stage (or extent) of the disease. Lung cancer staging is done to find out whether the cancer has spread and, if so, to what parts of the body. Lung cancer often spreads to the brain or bones. Knowing the stage of the lung cancer helps the doctor plan the most appropriate treatment for your lung cancer. Some tests used to determine whether the cancer has spread include:

  • CAT (or CT) scan (computed tomography). A computer linked to an x-ray machine creates a series of detailed pictures of areas inside the body.

  • MRI (magnetic resonance imaging). A powerful magnet linked to a computer makes detailed pictures of areas inside the body.

  • Radionuclide Scanning. Scanning can show whether cancer has spread to other organs, such as the liver. The patient swallows or receives an injection of a mildly radioactive substance. A machine (scanner) measures and records the level of radioactivity in certain organs to reveal abnormal areas.

  • Bone Scan. A bone scan, one type of radionuclide scanning, can show whether cancer has spread to the bones. A small amount of radioactive substance is injected into a vein. It travels through the bloodstream and collects in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas and records them on x-ray film.

  • Mediastinoscopy/Mediastinotomy. A mediastinoscopy can help show whether the cancer has spread to the lymph nodes in the chest. Using a lighted viewing instrument, called a scope, the doctor examines the center of the chest (mediastinum) and nearby lymph nodes. In mediastinoscopy, the scope is inserted through a small incision in the neck; in mediastinotomy, the incision is made in the chest. In either procedure, the scope is also used to remove a tissue sample. The patient receives a general anesthetic.

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