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Lung cancer: Diagnostics & staging

Prevention & detection | Diagnostics & staging | Treatments | Our team | For physicians | Stats & links | Lung cancer home

Tests are key to diagnosis and treatment

Cancer forms when cells divide and grow abnormally. Cancer refers to malignant tumors that can spread to nearby tissues and other parts of the body and cause death. Benign tumors are not cancerous and do not invade other tissues or spread.

There are 2 types of cancer originating in the lungs. Non-small cell lung cancer (NSCLC) accounts for up to 85% of all lung cancers. There are 3 main kinds of NSCLC, named for the cells where the cancer develops: squamous cell carcinoma, adenocarcinoma and large cell carcinoma. NSCLC typically grows and spreads more slowly than the second type of lung cancer, small cell lung cancer.

Small cell lung cancer accounts for 15-20% of all lung cancers and is more likely to grow faster and spread more quickly. Small cell lung cancer is also called oat cell cancer or poorly differentiated neuroendocrine carcinoma.

Diagnostic tests

Sputum cytology: a sample of phlegm (mucus from the lungs) is analyzed to see if cancer cells are present.

Chest X-ray: an X-ray of the organs and bones inside the chest to detect tumors. [ See what to expect ]

Bronchoscopy: a thin, lighted tube is passed through the mouth into the trachea (windpipe) and lungs to check for abnormal areas or collect tissue samples for biopsy. [ See what to expect ]

Needle aspiration: a needle is inserted through the surface of the chest and into the tumor to remove a tissue sample for testing.

Thoracentesis: fluid is removed from the pleural cavity (space between the lungs and chest wall) through a needle inserted between the ribs. [ See what to expect ]

Thoracoscopy: a thin, lighted tube connected to a video camera is inserted through a tiny incision to view the space between the chest wall and lungs, including tumors on the surface of the lungs. A biopsy can also be taken of any suspicious areas.

Thoracotomy: surgery to open the chest and examine the lungs and surrounding tissues. [ See what to expect ]

Staging tests

“Staging” is the process of determining the size of the cancer and whether it has spread in the chest or to other parts of the body.

Staging helps determine treatment. There are 5 stages of non-small cell lung cancer (Stages 0, I, II, III, IV) and 2 for small cell lung cancer (limited-stage and extensive-stage). As the stage of the cancer increases, the prognosis becomes less optimistic. Additional staging tests include:

64-slice Computed Tomography (CT/CAT scan)
An X-ray procedure that produces detailed cross-sectional images of the body, providing information about the size, shape and position of the tumor or enlarged lymph nodes. St. Luke's 64-slice CT scanners offer greater speed and more precise image detail.

Magnetic Resonance Imaging (MRI)
MRI uses a strong magnetic field and radio frequency waves to provide a clear picture of the body's soft tissues. MRI can also detect tumors that have spread (metastasized) to the brain or spine and identify suspicious areas that other imaging techniques can't. [ See what to expect ]

Bone Scan
A radionucleotide bone scan helps show if cancer has spread to bone. A small amount of radioactive substance is injected into a vein and spreads throughout the body. It collects in areas of abnormal bone growth, which is recorded on X-ray film. [ See what to expect ]

PET Scan
A procedure in which a small amount of radionucleotide glucose is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Cancer cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. [ See what to expect ]

Mediastinoscopy
A surgical procedure that can help to show whether cancer has spread to 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. This is done through a small incision at the base of the neck. The scope may be used to remove tissue samples.

Bone Marrow Biopsy
To stage small cell lung cancer, a needle may be inserted into the hipbone or breastbone to extract a small piece of bone and bone marrow for analysis. [ See what to expect ]

Lymph Node Biopsy
All or part of a lymph node may be removed for analysis by inserting a needle through the skin or a small incision. There are several types of biopsy (see what to expect):

• Excisional biopsy: removal of entire lymph node
• Incisional biopsy: removal of part of a lymph node
• Core biopsy: Removal of part of a lymph node using a wide needle
• Needle biopsy: Removal of part of a lymph node using a thin needle. Also called fine-needle aspiration.

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