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Diagnosis
Finding Lung Cancer Cells
Types of Lung Cancer
If you have a symptom that suggests lung cancer, your doctor must find out whether it's from cancer or something else. Your doctor may ask about your personal and family medical history. Your doctor
may order blood tests, and you may have one or more of the following tests:
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Physical exam: Your doctor checks for general signs of health, listens to your breathing, and checks for fluid in the lungs. Your doctor may feel for swollen lymph nodes and a swollen liver.
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Chest x-ray: X-ray pictures of your chest may show tumors or abnormal fluid.
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CT scan: Doctors often use CT scans to take pictures of tissue inside the chest. An x-ray machine linked to a computer takes several pictures. For a spiral CT scan, the CT scanner rotates around you as you lie on a table. The table passes through the center of the scanner. The pictures may show a tumor, abnormal fluid, or swollen lymph nodes.
The only sure way to know if lung cancer is present is for a
pathologist
to check samples of cells or tissue. The pathologist studies the sample under a microscope and performs other tests. There are many ways to collect samples.
Your doctor may order one or more of the following tests to collect samples:
- Sputum cytology: Thick fluid (sputum) is coughed up from the lungs. The lab checks samples of sputum for cancer cells.
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Thoracentesis: The doctor uses a long needle to remove fluid (pleural fluid) from the chest. The lab checks the fluid for cancer cells.
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Bronchoscopy: The doctor inserts a thin, lighted tube (a bronchoscope) through the nose or mouth into the lung. This allows an exam of the lungs and the air passages that lead to them. The doctor may take a sample of cells with a needle, brush, or other tool. The doctor also may wash the area with water to collect cells in the water.
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Fine-needle aspiration: The doctor uses a thin needle to remove tissue or fluid from the lung or lymph node. Sometimes the doctor uses a CT scan or other imaging method to guide the needle to a lung tumor or lymph node.
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Thoracoscopy: The surgeon makes several small incisions in your chest and back. The surgeon looks at the lungs and nearby tissues with a thin, lighted tube. If an abnormal area is seen, a
biopsy
to check for cancer cells may be needed.
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Thoracotomy: The surgeon opens the chest with a long incision. Lymph nodes and other tissue may be removed.
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Mediastinoscopy: The surgeon makes an incision at the top of the breastbone. A thin, lighted tube is used to see inside the chest. The surgeon may take tissue and lymph node samples.
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You may want to ask these questions before the doctor takes a sample of tissue:
- Which procedure do you recommend? How will the tissue be removed?
- Will I have to stay in the hospital? If so, for how long?
- Will I have to do anything to prepare for it?
- How long will it take? Will I be awake? Will it hurt?
- Are there any risks? What is the chance that the procedure will make my lung collapse? What are the chances of infection or bleeding after the procedure?
- How long will it take me to recover?
- How soon will I know the results? Who will explain them to me?
- If I do have cancer, who will talk to me about next steps? When?
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The pathologist checks the sputum, pleural fluid, tissue, or other samples for cancer cells. If cancer is found, the pathologist reports the type. The types of lung cancer are treated differently. The most common types are named for how the lung cancer cells look under a microscope:
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Small cell lung cancer: About 13 percent of lung cancers are small cell lung cancers. This type tends to spread quickly.
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Non-small cell lung cancer: Most lung cancers (about 87 percent) are non-small cell lung cancers. This type spreads more slowly than small cell lung cancer.
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