Diagnosing Lung Cancer 

How is lung cancer diagnosed?

Diagnosing lung cancer may take several steps and consultations. With them, your provider can find out whether you have lung cancer, identify the type of lung cancer and determine what stage (how advanced) the cancer is.

To start, your primary care provider or a pulmonologist will review your symptoms and recommend certain tests. They will usually review your medical history and perform a physical examination. Bring a list of your symptoms and your questions. You may also want to have a family member or close friend with you to help you understand and remember information.

If your health care provider suspects you might have lung cancer, they will recommend more specialized tests and refer you to oncologists and other specialists. You may need tests such as:

Imaging tests

• Chest X-rays: X-rays can uncover masses or nodules in the lungs. An X-ray is often the first recommended test to check for lung cancer, but you need more testing to make a diagnosis.
• Computed tomography (CT) scans: CT scans give more detailed images than X-rays. They can help detect smaller areas that might not appear on an X-ray. They can better show the size, shape and location of lung tumors.
• Positron emission tomography (PET) scans: PET scans use a radioactive substance to highlight areas with high metabolic activity, which could be a sign of cancer. Your provider may recommend a PET scan to see if the cancer has spread to other parts of the body.
• Endobronchial ultrasound (EBUS): This test uses a flexible tube that goes into your lungs through your mouth. It creates images of your lungs and lymph nodes with a small video camera and ultrasound probe.  It can be used to biopsy lymph nodes that are concerning to determine if the cancer has spread and identify staging.

Your provider will tell you if you need to avoid eating or drinking before certain scans. It can help to wear loose, comfortable clothing and to remove jewelry and other metal objects before any imaging tests.

Other tests

• Blood tests: Markers in your blood could be a sign that you might have cancer. Blood tests also give your provider information about your overall health and how well your organs are working.
• Sputum cytology: Using a microscope to examine mucus (sputum) coughed up from the lungs may reveal lung cancer cells, especially in central lung tumors.

Biopsies

• Needle biopsy: With a needle biopsy, a provider inserts a thin needle through the skin, guided by CT or ultrasound, to collect a sample of lung tissue. 
• Bronchoscopy: A provider inserts a thin, flexible tube with a camera through the nose or mouth into the lungs to collect tissue samples or examine the airways.
• Mediastinoscopy: A provider makes an incision at the base of your neck and takes tissue samples from lymph nodes behind your breastbone.
• Surgical biopsy: In some cases, your provider may need to surgically remove a larger tissue sample to analyze it.

When your provider examines the tissue sample from the biopsy, they may check it for genetic changes (mutations). Having some genetic changes can mean certain treatments may be options for you.

Your provider will give you instructions based on the type of biopsy. You may need to avoid eating and drinking, arrange for transportation and stop taking certain medications.

If you have lung nodules that aren’t cancerous but could become lung cancer later, your provider may recommend ways to monitor and manage them. 

What are the stages of lung cancer?

Staging describes how much the cancer has spread to other parts of the body:

• Stage 0: Abnormal cells are found that may become cancer.
• Stage 1: The cancer is found only in the lungs.
• Stage 2: The cancer has spread closer to the lymph nodes or may be in the lymph nodes.
• Stage 3: Cancer cells have spread to the lymph nodes and possibly to other parts of the lung.
• Stage 4: The cancer is found in both lungs and potentially other parts of the body.

Your provider will evaluate the size of the tumor, whether it has reached your lymph nodes and whether it has spread to other organs (metastasized) to decide what stage the cancer is. 

Staging helps guide treatment decisions and predict outcomes. Early-stage cancers might only need surgery. Advanced cancers might need a combination of treatments such as chemotherapy, radiation and targeted therapy.

What is the prognosis for lung cancer?

The prognosis varies. In general, early-stage lung cancer has higher survival rates than advanced cancers. The prognosis depends on the type and stage of cancer, your overall health and your response to treatment. Research and treatment advancements are improving outcomes for lung cancer patients.

Your health care team can give you more details about your prognosis, based on your circumstances.

Learn about treatment and support for lung cancer.  

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