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Some lung cancers can be found by screening, but most lung cancers are found because they are causing problems. The actual diagnosis of lung cancer is made by looking at a sample of lung cells in the lab. If you have possible s or symptoms of lung cancersee your doctor. Your doctor will ask about your medical history to learn about your symptoms and possible risk factors.
Your doctor will also examine you to look for s of lung cancer or other health problems. If the of your history and physical exam suggest you might have lung cancer, more tests will be done. Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body.
Imaging tests might be done for a of reasons both before and after a diagnosis of lung cancer, including:. A chest x-ray is often the first test your doctor will do to look for any abnormal areas in the lungs.
If something suspicious is seen, your doctor may order more tests.
A CT scan uses x-rays to make detailed cross-sectional images of your body. Instead of taking 1 or 2 pictures, like a regular x-ray, a CT scanner takes many pictures and a computer then combines them to show a slice of the part of your body being studied. A CT scan is more likely to show lung tumors than routine chest x-rays. It can also show the size, shape, and position of any lung tumors and can help find enlarged lymph nodes that might contain cancer that has spread.
This test can also be used to look for masses in the adrenal glands, liver, brain, and other organs that might be due to the lung cancer spread. CT-guided needle biopsy: If a suspected area of cancer is deep within your body, a CT scan might be used to guide a biopsy needle into this area to get a tissue sample to check for cancer. But MRI scans use radio waves and strong magnets instead of x-rays. MRI scans are most often used to look for possible spread of lung cancer to the brain or spinal cord.
For a PET scana slightly radioactive form of sugar known as FDG is injected into the blood and collects mainly in cancer cells. This lets the doctor compare areas of higher radioactivity on the PET scan with a more detailed picture on the CT scan.
This is the type of PET scan most often used in patients with lung cancer. For a bone scana small amount of low-level radioactive material is injected into the blood and collects mainly in abnormal areas of bone. A bone scan can help show if a cancer has spread to the bones.
Symptoms and the of certain tests may strongly suggest that a person has lung cancer, but the actual diagnosis is made by looking at lung cells in the lab. The cells can be taken from lung secretions mucus you cough up from the lungsfluid removed from the area around the lung thoracentesisor from a suspicious area using a needle or surgery biopsy. The choice of which test s to use depends on the situation. A sample of sputum mucus you cough up from the lungs is looked at in the lab to see if it has cancer cells. The best way to do this is to get early morning samples 3 days in a row.
This test is more likely to help find cancers that start in the major airways of the lung, such as squamous cell lung cancers.
It might not be as helpful for finding other types of lung cancer. If your doctor suspects lung cancer, further testing will be done even if no cancer cells are found in the sputum. If fluid has collected around the lungs called a pleural effusiondoctors can remove some of the fluid to find out if it is caused by cancer spreading to the lining of the lungs pleura.
The buildup might also be caused by other conditions, such as heart failure or an infection. For a thoracentesis, the skin is numbed and a hollow needle is inserted between the ribs to drain the fluid. The fluid is checked in the lab for cancer cells. Other tests of the fluid are also sometimes useful in telling a malignant cancerous pleural effusion from one that is not. If a malignant pleural effusion has been diagnosed and is causing trouble breathing, a thoracentesis may be repeated to remove more fluid which may help a person breathe better.
Doctors often use a hollow needle to get a small sample from a suspicious area mass.
The drawback is that they remove only a small amount of tissue and in some cases, the amount of tissue removed might not be enough to both make a diagnosis and to perform more tests on the cancer cells that can help doctors choose anticancer drugs.
The doctor uses a syringe with a very thin, hollow needle to withdraw aspirate cells and small fragments of tissue. A FNA biopsy may be done to check for cancer in the lymph nodes between the lungs. Transtracheal FNA or transbronchial FNA is done by passing the needle through the wall of the trachea windpipe or bronchi the large airways leading into the lungs during bronchoscopy or endobronchial ultrasound described below.
In some patients an FNA biopsy is done during an endoscopic esophageal ultrasound described below by passing the needle through the wall of the esophagus. A larger needle is used to remove one or more small cores of tissue. Samples from core biopsies are often preferred because they are larger than FNA biopsies. If the suspected tumor is in the outer part of the lungs, the biopsy needle can be put through the skin on the chest wall.
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The area where the needle is to be inserted may be numbed with local anesthesia first. The doctor then guides the needle into the area while looking at the lungs with either fluoroscopy which is like an x-ray or a CT scan.
A possible complication of this procedure is that air may leak out of the lung at the biopsy site and into the space between the lung and the chest wall. This is called a pneumothorax. It can cause part of the lung to collapse and sometimes trouble breathing. If the air leak is small, it often gets better without any treatment.
Large air leaks are treated by inserting a chest tube a small tube into the chest space which sucks out the air over a day or two, after which it usually heals on its own. Bronchoscopy can help the doctor find some tumors or blockages in the larger airways of the lungs, which can often be biopsied during the procedure.
Several types of tests can be used to look for this cancer spread. An endobronchial ultrasound can be used to see the lymph nodes and other structures in the area between the lungs if biopsies need to be taken in those areas. An endoscopic esophageal ultrasound goes down into the esophagus where it can show the nearby lymph nodes which may contain lung cancer cells. Biopsies of the abnormal lymph nodes can be taken at the same time as the procedure.
Targeted drug therapy for non-small cell lung cancer
These procedures may be done to look more directly at and get samples from the structures in the mediastinum the area between the lungs. The main difference between the two is in the location and size of the incision. A mediastinoscopy is a procedure that uses a lighted tube inserted behind the sternum breast bone and in front of the windpipe to look at and take tissue samples from the lymph nodes along the windpipe and the major bronchial tube areas.
For this procedure, a slightly larger incision usually about 2 inches long between the left second and third ribs next to the breast bone is needed. Thoracoscopy can be done to find out if cancer has spread to the spaces between the lungs and the chest wall, or to the linings of these spaces.
Tests for lung cancer
It can also be used to sample tumors on the outer parts of the lungs as well as nearby lymph nodes and fluid, and to assess whether a tumor is growing into nearby tissues or organs. This procedure is not often done just to diagnose lung cancer, unless other tests such as needle biopsies are unable to get enough samples for the diagnosis.
Thoracoscopy can also be used as part of the treatment to remove part of a lung in some early-stage lung cancers. Lung or pulmonary function tests PFTs are often done after lung cancer is diagnosed to see how well your lungs are working.
This is especially important if surgery might be an option in treating the cancer. These tests can give the surgeon an idea of whether surgery is a good option, and if so, how much lung can safely be removed. There are different types of PFTs, but they all basically have you breathe in and out through a tube that is connected to a machine that measures airflow. Sometimes PFTs are coupled with a test called an arterial blood gas. In this test, blood is removed from an artery instead of from a vein, like most other blood tests so the amount of oxygen and carbon dioxide can be measured. Samples that have been collected during biopsies or other tests are sent to a pathology lab.
A pathologist, a doctor who uses lab tests to diagnose diseases such as cancer, will look at the samples and may do other special tests to help better classify the cancer. Cancers from other organs also can spread to the lungs. The of these tests are described in a pathology report, which is usually available within a week. If you have any questions about your pathology or any diagnostic tests, talk to your doctor.
If needed, you can get a second opinion of your pathology report by having your tissue samples sent to a pathologist at another lab. For more information, see Understanding Your Pathology Report. In some cases, especially for non-small cell lung cancer NSCLCdoctors may look for specific gene changes in the cancer cells that could mean certain targeted drugs might help treat the cancer.