Diagnosing Lung Cancer

At Virginia Mason in Seattle, your doctor has a number of excellent tests and procedures to choose from for diagnosing lung cancer and determining the severity or extent of the disease. He or she will first take your medical history and perform a physical exam.

Following the physical exam, you may have one or more of the following tests and procedures:

  • Chest x-ray
    A simple chest x-ray may show a tumor in the lungs. If the tumor is small, however, it may not be seen. If a tumor is found or if lung cancer is suspected, a bronchoscopy and CT scan often will be scheduled.

  • Low-Dose Chest CT to Screen for Lung Cancer
    In some cases, a low-dose chest CT is performed to screen for lung cancer in patients at high risk. However, it is not appropriate in every case.
    Lung Cancer Screening with Low-Dose Chest CT.

  • CT (Computed Tomography) Scan
    Once lung cancer is suspected, a CT scan may be performed to determine the location of the tumor and whether or not the cancer has spread to the lymph nodes. A CT scan uses x-rays and computer imaging to show three-dimensional pictures of your organs. With this technology, your doctor will also look at your liver and adrenal glands (which sit on top of your kidneys) in addition to the lymph nodes in your lungs and chest.

  • PET (Positron emission tomography) scan
    A PET scan shows how organs and tissues metabolize sugar. Malignant tumors use sugar at a higher rate than benign tumors. For this procedure, you will be given an intravenous (IV) injection of a radioactive substance, called a radioisotope or tracer, which has been attached to a simple sugar. The procedure is performed in a nuclear imaging department.

  • Bone scan
    This imaging device provides pictures of your skeleton to determine if lung cancer has spread to your bones. For this procedure, you will be given an intravenous (IV) injection of a radioactive substance called a radionuclide or radioisotope, also called a tracer. A special camera then records areas in the body with more greater concentration of the radioactive material, such as tumors. The procedure will be done if you have pain in your bones or an abnormal blood test.

  • Bronchoscopy
    A broncoscope, a type of endoscope, is a lighted tube that is gently guided down your throat and into the bronchial tubes in your lungs. It allows your doctor to view these large airways and to take samples of tissue or secretions. This procedure is performed in the clinic under a local anesthetic (to numb your throat) and conscious sedation (medicines to make you sleepy), or in the operating room under a general anesthetic (to induce sleep).

    Lung wash
    During the bronchoscopy procedure, your doctor may perform a "lung wash" or bronchoalveolar lavage to obtain samples of suspicious cells. This procedure is performed by flushing a small amount of sterile saline solution through the bronchoscope and into the airways.

    Bronchoscopic biopsy
    During this procedure, your doctor will take a sample of tissue from the bronchial tubes or lung. A pathologist will test the sample for the presence of cancer.

  • Mediastinoscopy
    During this procedure, your doctor will guide an endoscope through a small incision at the base of your neck and into the mediastinum, the area between your lungs in your chest cavity and behind the breastbone. He or she will then obtain a tissue sample of your lymph nodes. This procedure is performed under a general anesthetic in the operating room.

  • Thoracentesis
    This procedure is performed to obtain a sample of pleural fluid from the pleural space, which is the space between the lungs and the chest wall. After first numbing the area with a local anesthetic, a needle is inserted through the skin, between the ribs and into the fluid that has collected outside of the lung. The fluid is then removed and tested for the presence of cancerous cells.

  • Lung biopsy
    This procedure is performed after a tumor or nodule has been located. A biopsy may be obtained at the time of surgery, bronchoscopy or during a CT scan.

    Needle biopsy
    A needle is inserted through the chest wall to take a sample of the tumor. This procedure is also called percutaneous (through the skin) needle biopsy. The physician observes the tumor with a CT scan of your chest on a monitor. The procedure is performed in the radiology department under a local anesthetic and mild sedation.

  • Thoracoscopy
    This procedure uses video-assisted instruments to operate in the pleural space of the thorax. It is now often the preferred way to obtain a sample (biopsy) of suspicious tissue or to treat lung disease because the chest wall is not opened. The procedure is performed in the operating room under a general anesthetic. Three small incisions are made in the side of the chest. Endoscopic instruments, including those containing a miniature light and camera, are then inserted through the incisions and images are transmitted to a monitor. Guided by these images, your physician will maneuver the instruments to obtain tissue samples or perform surgery.