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:
- 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 belly.
- Chest X-ray: X-ray pictures of your chest may show tumors or abnormal fluid.
- CT scan: Doctors often use CT scans to take pictures inside your chest. In a CT scan, an X-ray machine linked to a computer takes several pictures. Your doctor may want you to have a spiral CT scan. In this procedure, the CT scanner rotates around you as you lie still on a table. The table then travels through the center of the scanner. The pictures can show tumors, abnormal fluid, or swollen lymph nodes.
These are the first steps in diagnosis. However, lung cancer can only be completely diagnosed by checking samples of cells or tissue. The doctor collects a sample. Then that sample is examined under a microscope.
There are many different ways to collect samples:
- Sputumcytology: You cough up thick fluid (called sputum) from your lungs. The lab checks samples of sputum for cancer cells. This may be collected either at home or in your doctor's office.
- Thoracentesis: Your doctor uses a long needle to take fluid from your chest. This fluid is called pleural fluid. The lab checks the pleural fluid for cancer cells. This is a short procedure performed in your doctor's office.
- Bronchoscopy: Your doctor inserts a thin, lighted tube (called a bronchoscope) through your nose or mouth into your lung. This lets your doctor examine both the lungs and the air passages that lead to them. Your doctor may take a sample of cells with a needle, brush, or other tool. This procedure will be done at a hospital or special clinic. You will be given medicine to help you relax so you will need someone to drive you home. You may also be asked to restrict food and water intake the night before a bronchoscopy.
- Super Dimension Bronchoscopy/ Electromagnetic Navigational Bronchoscopy (ENB): This is less invasive then a traditional bronchoscopy, and allows your doctor to biopsy tumors or lymph nodes in harder to reach places, such as deep inside the lungs. This is usually done with local anesthesia and sedation.
- Endobronchial ultrasound (EBUS): Your doctor uses a special bronchoscope quipped with an ultrasound to help better see the tumor or lymph node that needs to be biopsied.
- Fine-needle aspiration: Your doctor uses a thin needle to remove tissue or fluid from your lung or lymph node. Sometimes the doctor uses a CT scan or other imaging method at the same time. This helps your doctor guide the needle to a lung tumor or lymph node. You will be sedated for the procedure so you will need a ride home afterwards. You may also be asked to restrict food and water intake the night before the procedure.
- Thoracoscopy: Your surgeon makes several small incisions in your chest and back. Then he or she looks at your lungs and nearby tissues. This is done with a thin, lighted tube. If the surgeon sees an abnormal area, then a biopsy may be needed to check for cancer cells. You will be sedated for the procedure so you will need a ride home afterwards. You may also be asked to restrict food and water intake the night before the procedure.
- Thoracotomy: Your surgeon will open your chest with a long incision. Then, he or she will remove lymph nodes and other tissue. You will be sedated for the procedure. You will likely need to say in the hospital for a few days after surgery to recover. You may also be asked to restrict food and water intake the night before the procedure.
- Mediastinoscopy: Your surgeon makes an incision at the top of your breastbone. Then he or she uses a thin, lighted tube to see inside your chest. The surgeon may take tissue and lymph node samples. You will be sedated for the procedure. You will need someone to drive you home. You may also be asked to restrict food and water intake the night before the procedure.
- Lymph node biopsy: A lymph node biopsy checks the lymph nodes for abnormal cells. A lymph node biopsy can be done in a few different ways. A needle can be inserted into the lymph node to collect a sample. This can be done alone or during a bronchoscopy or mediastinoscopy. Lymph nodes can also be completely removed during surgery.
- Core needle biopsy: Your surgeon uses a needle that is larger than the fine-needle aspiration needle to remove a cylindrical piece of tissue about ½ inches long. A CT scan may be used to help guide the needle into the tumor or lymph node. Your doctor will numb the area first.
- Video- Assisted Thoracoscopic Surgery (VATS): Your surgeon will make an incision in the chest wall and insert a thoracoscope. A thoracoscope is a thin tube with a light and a camera that allows your surgeon to examine your lungs and the inside of your chest. You will be asleep during the procedure.
Finding an Oncologist
The first step on the lung cancer treatment journey is to find an oncologist (medical or surgical) who inspires trust. You may want to discuss this with your nurse navigator. It may seem overwhelming to choose an oncologist. First, start with referrals from your primary care physician, specialist, or insurance carrier. Talk to family and friends who may have recommendations.
Here are some things to consider when choosing an oncologist:
- Is the oncologist board certified?
- How much experience does he or she have in treating lung cancer?
- Do you feel comfortable talking with this doctor? Does he or she listen well?
- Is the staff compassionate? Is the environment a good one or do you feel rushed?
- What hospital(s) does this oncologist see patients in?
- What are the office hours?
- What if you have an emergency? Can you call?
- Can this doctor be contacted after hours?
You will be spending a lot of time with the oncologist and staff nurses and technicians, so it's important to feel comfortable with them.
What is my diagnosis?
This question may seem like a no-brainer, but in the rush of appointments, you may not receive a clear answer. If you are unsure of your diagnosis, ask your oncologist. Sometimes more specific tests are needed to make an exact diagnosis.
What is my prognosis? What stage is my cancer?
Knowing your prognosis can help you better prepare for the future and select your best treatment plan. In order to know the stage of your cancer, your doctor will need to do tests. These may include scans, genetic testing, and/or a biopsy. The answer to these questions may be difficult to hear. You may consider having a family member or friend with you at this appointment.
What are my treatment options? What would you recommend?
Ask your oncologist to explain all your treatment options, including possible side effects and cost. Ask your oncologist which treatment he or she recommends. If you are unsatisfied with your options, do not be afraid to seek a second opinion. If you need more information about finding a second opinion, contact the cancer supportive services professionals at PearlPoint Cancer Support.
Am I eligible for a clinical trial?
Clinical trials help improve the standard of care for all cancer patients. Based on your situation, a clinical trial may also be your best treatment option. Each clinical trial has its own eligibility requirements.
What are the possible short-term and long-term side effects of treatment? How will these affect my normal activities?
Always ask about short-term and long-term side effects before beginning treatment so you are prepared. You should also consider short-term and long-term side effects when deciding which treatment plan is best for you.
How can I manage these side effects?
Some side effects can be easily managed through diet, exercise, or over-the-counter medication. Other side effects may require prescription medication, occupational therapy, or physical therapy which your oncologist can prescribe as needed.