How Is Non-Small Cell Lung Cancer Diagnosed?

This content has been reviewed and approved by

Chandra P. Belani, MD
Deputy Director, Penn State Cancer Institute
Miriam Beckner Professor of Medicine
Penn State University School of Medicine

The first step in diagnosing lung cancer is a thorough medical history and physical examination. Other tests include:

• Chest x-ray - This is typically the first step in any lung cancer diagnosis and is used to look for any mass or spot on the lungs. 
• Computerized tomogram (CT) of the chest - This is a more advanced form of x-ray that provides a three-dimensional view of your lungs. It confirms any abnormalities seen on the chest x-ray, can help your doctor locate others, and provides more detailed information to help your doctor stage the cancer.
• Positron emission tomography (PET) scan - radioactive-tagged glucose (sugar) is injected into the bloodstream. Tissues that use the glucose more than normal tissues (such as tumors) are detected by a scanning machine. PET scans can be used to find small tumors or to check if the cancer treatment is working. 
  
• Magnetic resonance imaging (MRI) - A powerful magnet linked to a computer makes detailed pictures of areas inside your body.
• Bone scan – Used to determine if the cancer has spread to the bones. Before a bone scan, the surgeon injects a small amount of radioactive substance into your vein. The substance travels through the bloodstream and collects in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas and records them on x-ray film.
• Biopsy - To confirm a cancer diagnosis and determine what type of cancer you have, your doctor needs a sample of lung tissue. This is obtained through a biopsy. There are several types:
  
  
  • Bronchoscopy - In this procedure, a thin tube with a camera on the end (bronchoscope) is inserted through your nose or mouth into your lungs. The doctor can examine the lungs and adjacent areas and take a tissue sample from a biopsy. Bronchoscopy is typically performed on an outpatient basis under a local anesthetic.
  • Needle biopsy (also called percutaneous fine needle aspiration) - This procedure involves inserting a needle through your chest into the lung, then using CT, x-ray, or ultrasound to guide the needle into position for the biopsy. The surgeon may also use this procedure to get a sample of your lymph nodes, where cancer cells often spread.
  • Video-assisted minimally invasive thoracoscopy - This procedure is performed under general anesthetic. The doctor makes several small cuts in the chest and inserts a camera and instruments. The camera allows the doctor to see inside the lungs without opening up your entire chest. This procedure is often used to examine nodules on the sides of the lungs, as well as in the mediastinum and pleura.
  • Thoracentesis – A surgeon uses a needle to remove a sample of the fluid that surrounds the lungs to check for the presence of cancer cells.
  • Mediastinoscopy - a process in which a small cut is made in the neck. The cut allows a tissue sample to be taken from the lymph nodes (mediastinal nodes) along the windpipe and the major bronchial tube areas. The tissue is then evaluated under a microscope.
  • Thoracotomy - A major operation that involves opening the chest to diagnose lung cancer.

  Other tests and procedures may be performed as well.