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Introduction to Lung Cancer - Diagnosis and Staging

In the video below, Thoracic Surgeon, Dr. Jed Gorden provides an introduction to the diagnosis and staging of lung cancer.

Diagnosis and Testing

If an abnormality is found on any chest x-ray, it is important to confirm if cancer is indeed present or if it is possibly another condition, such as an infection. Various tests and procedures may be used to facilitate a diagnosis.

X-rays of the chest (from the back and side) are typically the first test used for patients suspected of having lung cancer. If there is a suspicious finding on the x-rays, patients are then usually asked to get a CT scan.

CT scans show the anatomy of any masses, or tumors, in the lung and chest. If the tumor is malignant, CT scans also help determine if the cancer has metastasized, or spread, to lymph nodes or other organs.

Although imaging technology is one tool in determining if lung cancer is present, the only way to know for certain is to remove and test samples of cells or tissue. This is called a biopsy. Rarely, some patients may need to have surgery to explore the chest area in order to obtain a biopsy.

One or more of the following procedures may be used for biopsy. Your thoracic surgeon is often asked to recommend the best option based on a patient's specific case.

  • Bronchoscopy: A bronchoscope is a viewing instrument inserted through the nose or mouth and into the trachea and bronchial tubes. The physician is able to view the air passages leading to the lungs and take a sample of cells for examination. Swedish uses the superDimension inReachTM electromagnetic navigation bronchoscopy, which allows the physician to take tissue samples from the lung earlier and potentially more safely than traditional bronchoscopy. Because it is minimally invasive, it may also be an option for patients who are not candidates for more invasive diagnostic procedures.
  • Mediastinoscopy: An incision is made by a surgeon at the top of the breastbone. A viewing instrument is used to examine inside the chest, and obtain lymph-node samples to accurately stage the patient’s cancer, if lung cancer is present.
  • Needle Aspiration: A needle is inserted through the chest to remove a sample of tissue from the tumor. This tissue is examined under the microscope for cancer cells. The physician may use a CT scan or other imaging technique to help guide the needle into the tumor.
  • Sputum cytology: This is an examination of the mucus, or sputum, that may be coughed up from the lungs.
  • Thoracentesis: A long needle is used to remove pleural fluid (when present) from the chest. The fluid is examined to see if cancer cells are present.
  • Thoracoscopy: A surgeon makes small incisions in the chest and back to examine the lungs with a viewing instrument. The surgeon can biopsy any abnormal areas, including masses and/or lymph nodes, as well as obtain pleural fluid if present for analysis.
  • Thoracotomy: The chest is opened by a surgeon with an incision. Lymph nodes and other tissue are examined and may be removed.

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