Diagnosing Lung Cancer

If something suspicious is detected in your lungs during your low-dose CT screening, or your primary care physician finds a worrisome mass on a chest X-ray, you'll be referred to one of EvergreenHealth's expert pulmonologists.

The possibility of lung cancer increases with the size of the nodule discovered. Eight millimeters - slightly smaller than a pea - is generally the dividing line. If it is smaller than that, the chances of cancer are minimized. If it is larger, your pulmonologist will want to test it to determine if it is cancer, what kind of cancer it is, and how to proceed with treatment.

Types of lung cancer

There are two main types of lung cancer:

Non-small cell lung cancer (NSCLC).  This is the most common type of lung cancer. Roughly 85% of people diagnosed with lung cancer each year have NSCLC. There are two distinct types of NSCLC: adenocarcinoma and squamous cell carcinoma.

Small cell lung cancer (SCLC).  About 10-15% of lung cancers are small cell lung cancers. This type of cancer is more aggressive than non-small lung cancers, and can spread quickly.  It creates large tumors and is often not discovered until it has spread to sites outside the lungs. Small cell lung cancer occurs almost exclusively in heavy smokers.

Stages of lung cancer

Once your lung cancer has been diagnosed, the next question is the extent, or stage, of your cancer. That will then determine the treatment you will need.

Stage I means the cancer is small and only in one area. 

Stage II means the cancer is found in the lung and nearby lymph nodes.

Stage III means the cancer is in the lung and lymph nodes in the middle of the chest.

Stage IIIA means the cancer is found in the lung and lymph nodes, but only on the same side of the chest where cancer first started growing.

Stage IIIB means the cancer has spread to lymph nodes on the opposite side of the chest or to lymph nodes above the collarbone.

Stage IV means the cancer has spread to other parts of your body; it's also called advanced or metastatic cancer.

How is the stage of your lung cancer determined?

Your pulmonologist will use a biopsy to determine the stage of your lung cancer, which ultimately determines the type(s) of treatment you will need.

There are three common procedures to obtain a sample of your tumor for a biopsy:

EBUS or endobronchial ultrasound

This is a minimally-invasive procedure done under general anesthesia. Your pulmonologist inserts a bronchoscope, a thin lighted tube, through your mouth and down your windpipe into your lung.

The broncoscope has a small camera attached to it so your doctor can guide it to your lung lymph nodes, then a fine needle on the broncoscope takes small samples of your lymph nodes to biopsy.

You may be a little sore after the procedure, but you are able to go home when it's finished.

Navigational bronchoscopy

Navigational bronchoscopy provides a virtual three-dimensional map of your lung, using your CT scan and special software to map out how to get to your lung cancer. A small camera, a catheter and an ultrasound probe confirm that the pulmonologists have reached the site of your tumor, so they can get a sample for an accurate biopsy.

This procedure takes about an hour under general anesthesia, and you're able to go home when it's done.

Surgical biopsy

This involves cutting open your chest, and going into your lung to take a sample of your tumor.  This is most effective when the tumor is in an easy-to-get-to location, and is well-defined. If there are no other issues, the entire mass may be removed and then diagnosed at the same time.

You will be under general anesthesia for the procedure, and will likely remain in the hospital overnight.

Diagnostic imaging scans

There are two other tests that are often used to help your pulmonologist determine the stage of your lung cancer:

  • a brain MRI, to make sure your cancer hasn't spread to your brain
  • a PET scan, short for Positron Emission Tomography. You're injected with a substance made up of sugar and a small amount of radioactive material. Cancer cells tend to be more active than normal cells, and they absorb more of the radioactive sugar as a result. A special camera will then pick up these glowing or "highlighted” areas on a computer screen, giving your pulmonologist a better idea of just how small, or how large, your tumor is.

Not every test is appropriate for every person, but the medical specialists at EvergreenHealth's Halvorson Cancer Center have the expertise to determine which are right for you.

What happens after your diagnosis is made?

Once your diagnosis is made, and the stage of your lung cancer is determined, you'll meet with your pulmonologist to go over the results and talk about what happens next. 

Learn how your treatment plan is created

Your lung cancer nurse navigator will also be at that meeting. She will be your partner and your advocate as you navigate the treatment part of your journey. But there is so much more to her role in your lung cancer fight.

Meet your lung cancer nurse navigator