Lung Cancer: Diagnosis

Early Screening

Early screening for lung cancer often detects the disease in early-stage when it is potentially curable in patients considered high-risk because they have been heavy smokers.

Lung cancer screening with computed tomography (CT) helps detect lung cancer at an early stage when it can be removed completely and cured. A CT scan combines a series of x-ray views taken from many different angles to explore the condition of the patient’s lungs.

The CUMC lung cancer screening program offers high quality imaging with state-of-the-art CT equipment, run by a multidisciplinary team of specialists. Patients have access to chest radiologists as well as board-certified pulmonologists, oncologists and thoracic surgeons.

The National Lung Screening Trial (NLST) demonstrated a 20 percent decrease in lung cancer related mortality in current and former smokers age 55 to 74 screened with CT when compared to smokers who did not have CT screening. The American Lung Association recommends lung cancer screening for patients who meet these criteria. Other people at increased risk for lung cancer, such as current and former smokers in all age groups, people with a strong family history of lung cancer, and people with asbestos exposure, may also benefit.

Diagnostic Tests

A spot may appear on a simple chest x-ray, or on a CT scan, taken for other diagnostic purposes. Other tests will be required to determine if this growth is cancerous.

Any of the following can be used to determine the type of lung cancer a patient has, and the most appropriate treatment.

  • Bronchoscopy A bronchoscopy is a minimally invasive procedure that requires anesthesia and allows the physician to take tissue samples from a growth accessible from the patient’s airway. The physician inserts a slender tube called a bronchoscope through the patient’s nose or mouth, then gently guides it down the throat and into the bronchial passage. Small tools at the end of the scope remove the tissue. A physician can also obtain a sample by washing out the bronchial passages during this procedure.
     
  • Endobronchial Ultrasound (EBUS) A bronchoscope is employed to explore a suspicious mass that is located just outside, but very close, to the bronchial tubes. In this case, the scope is guided by ultrasound images.
     
  • Fine Needle Aspiration/Biopsy If the suspicious growth cannot be reached by a bronchoscopy, a needle biopsy may be performed. After numbing the area, a physician inserts a needle into the patient’s chest to extract a tissue sample from the lung. The cells from that sample are then examined under a microscope. Most needle biopsies are performed by radiologists using x-rays or a CT scan to guide the placement of the needle.
     
  • Surgical Biopsy Sometimes, the size or location of the mass requires a full surgical biopsy with general anesthesia. 
     
  • Molecular Testing Only a few hospitals like Columbia University Medical Center/NewYork-Presbyterian currently offer a personalized approach to non-small cell lung cancer, using a tissue sample to map out the patient’s unique genetic mutations.  Such changes occur only in some types of small-cell lung cancer, and enable physicians to tailor their treatment to the individual. More than half of all patients with adenocarcinoma, for example, have a mutation that is known to respond to FDA-approved drugs and experimental treatments. Since genetic changes are not associated with squamous cell carcinoma, patients with this type of cancer will not undergo this type of testing.

Further diagnostic tests may be necessary to determine if the disease has spread to other parts of the body. These tests may include one or more of the following:

  • X-rays and scans of the brain, liver, bone, and adrenal glands
     
  • A computed tomography (CT) scan, using x-rays to create images of the chest, abdomen or pelvis
     
  • Magnetic Resonance Imaging (MRI) using magnetic resonance to produce images of the brain or head
     
  • A positron emission tomography (PET) scan, an imaging test that uses a radioactive substance called a tracer to look for disease in in the trunk of the body (the area between the neck and thighs)
     
  • Mediastinoscopy, a minimally invasive procedure that uses a small incision in the neck to take a tissue sample from the lymph nodes (mediastinal nodes) along the windpipe and the major bronchial tube areas to evaluate under a microscope