Lung Cancer: Diagnosis
How is lung cancer diagnosed?
If your healthcare provider thinks you may have lung cancer, you will need certain exams and tests to be sure. Diagnosing lung cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, possible risk factors, and family history of disease. Your provider will also give you a physical exam. He or she might also:
Do a sputum cytology test. For this test, each morning for 3 to 5 days in a row, you collect the mucus (sputum) that you cough up from your lungs. The sputum is then looked at under a microscope to see if there are cancer cells in it. Not all types of lung cancer show up in this test.
Schedule an X-ray of your chest. This is done to look for masses in your lungs.
Arrange for other imaging tests. This helps to get a better picture of your lungs. This may include a CT scan or an MRI to get detailed pictures of the inside of your body.
Any of these tests might suggest that you have lung cancer. But if imaging tests show a change, such as a mass or fluid, you will need to have a biopsy. This is when the healthcare provider takes out a tiny piece of the change or some of the fluid (called a sample) for testing. A biopsy is almost always needed to diagnose lung cancer.
What kind of biopsy might I need?
The method used to get a biopsy sample is determined partly by where the tumor is and how large it is. Your doctor may suggest that you have one or more of the tests below to help diagnose lung cancer.
After any kind of biopsy, the biopsy samples are looked at under a microscope and tested for cancer cells. It often takes several days for biopsy results to come back. Along with telling if you have lung cancer, a biopsy can often tell what kind of lung cancer it is.
A lung biopsy can be done in several ways:
Each is described below.
A doctor called a pulmonologist often does this test. This is a doctor who specializes in lung diseases. To get a sample in this type of biopsy, a long, thin, lighted tube called a bronchoscope is used. The bronchoscope may be flexible or rigid. It goes through your mouth or nose, through your breathing passages, and into your lungs. It has a tiny camera on the end so that your doctor can see inside your lungs to get the sample from the right place.
How it is done
This procedure often takes about an hour. If your doctor is using a flexible bronchoscope, a local numbing medicine (anesthesia) is sprayed inside your nose or mouth. You may feel as if fluid is running down your throat. It may make you cough or gag. That feeling will stop when the numbness kicks in. You may also have an IV (intravenous) line with medicine to help you relax. If your doctor uses a rigid bronchoscope, you will get general anesthesia so you sleep during the test.
With either type of bronchoscopy, your doctor might put a small amount saltwater solution (saline) into the lung passageways. This liquid flushes the area and helps collect cells, fluids, and other materials in your airways. It's then taken out through the bronchoscope for testing. Your doctor may also put tiny brushes, needles, or forceps (which are like tweezers) through the bronchoscope to collect cells from any suspicious-looking areas. All of the collected samples are sent to a lab and checked for cancer.
As the numbing medicine wears off, your throat may feel scratchy. You won’t be able to eat for a few hours. You'll need to have someone drive you home. Some people want to rest the day after the biopsy. So you may want to take the day off from your normal activities.
This is also called needle aspiration or transthoracic needle aspiration. Your doctor may use this test if your tumor can’t be reached easily with a bronchoscope. The doctor puts a thin, hollow needle through the skin of your chest and into the tumor to remove some tissue. Often an X-ray or CT scan is done at the same time. That helps the doctor see the tumor and guide the needle to it.
How it is done
This procedure is often done by a doctor called an interventional radiologist. You may have a chest X-ray or a chest CT scan to help your doctor see exactly where to get the cells that might be cancer. If you're getting an X-ray, you'll sit with your arms resting on a table. If you're getting a CT scan, you will lie down. In either case, it’s important that you don’t move. You may get medicine to relax you and help you stay still. The doctor uses a small needle to put in medicine that numbs your skin. To get the bigger biopsy needle in, the doctor may need to make a very small cut in your skin. You will feel pressure and a short, sharp pain when the needle touches your lung. The needle goes into the tumor or abnormal tissue and is used to pull out cells. The needle is then removed and pressure is put on the site until the bleeding stops. It's then covered with a bandage.
The doctor sends the collected cells to a lab to be checked for cancer. Right after the biopsy, you'll get a chest X-ray. This is to make sure there are no problems, such as a collapsed lung (pneumothorax). You may be able to drive yourself home after the test. But ask to be sure that this is OK.
This is also called a pleural fluid aspiration or a pleural tap. If you have fluid around your lungs, this test can be used to see if the fluid contains cancer cells. To get the fluid, the doctor puts a hollow needle into the skin between your ribs to drain out the fluid. This test may be done to diagnose lung cancer. Or it can be used to drain fluid that's making it hard for you to breathe.
How it is done
You will lie on a bed. Or you may sit on the edge of a bed or a chair and rest your head and arms on a table. A small needle is used to put medicine into the skin on your chest or back to numb the area. Then the doctor outs in the thoracentesis needle. It goes in above a rib and into the space between the lining of the outside of your lungs and your chest wall (called the pleural space). You may feel pressure. Your doctor sends the collected fluid to a lab to be checked for cancer. Ask your doctor if you'll be able to drive yourself home after the test.
Thoracotomy or thoracoscopy
A thoracotomy is a type of surgery. It's done in an operating room. The surgeon opens up your chest to look for lung cancer. This is often done when the doctor can’t make a clear diagnosis using any of the other methods. If possible, the surgeon removes the entire tumor during a thoracotomy.
How it is done
You must be in the hospital for a thoracotomy. On the day of your surgery, you get medicine so you will sleep through the surgery. You won’t feel anything. The surgeon cuts between your ribs to reach your lungs and look for diseased tissue. Some or all of the diseased tissue is taken out and sent to a lab to be checked for cancer. When you wake up, you'll have a tube in your chest to drain air, fluid, and blood. You may need to stay in the hospital for a couple of days. During that time, you will get pain .
A thoracoscopy is much the same, but smaller cuts are used. The surgeon can do this to look at and take a biopsy of the outer surface or the linings of the lungs and other nearby structures. Like a thoracotomy, you get medicine so that you sleep during the surgery. But instead of making one long cut, the surgeon makes a few small cuts in the chest wall. A long, thin tool with a small camera on the end is put in through one of the cuts to let the surgeon see inside your body. Special tools are put in through the other cuts to take out samples of any abnormal areas. Because the cuts are smaller, people often recover more quickly from this type of procedure.
Getting your test results
When your healthcare provider has your biopsy results, he or she will contact you. Your provider will talk with you about other tests you may need if lung cancer is found. Make sure you understand the results and what follow-up you need.