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Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Upon hearing about the symptoms, a health-care provider will formulate a list of possible diagnoses. He or she will ask questions about the symptoms, medical and surgical history, smoking and work history, and other questions about lifestyle, overall health, and medications.

Unless severe hemoptysis is occurring, a chest X-ray will most likely be performed first to look for a cause of the respiratory symptoms.

• The X-ray may or may not show an abnormality.
• Types of abnormalities seen in lung cancer include a small nodule or nodules or a large mass.
• Not all abnormalities observed on a chest X-ray are cancers. For example, some people develop scarring and calcium deposits in their lungs that may look like tumors on a chest X-ray.

In most cases, a CT scan or MRI of the chest will further define the problem.

• If symptoms are severe, the X-ray may be skipped and a CT scan or MRI may be performed right away.
• The advantages of CT scan and MRI are that they show much greater detail than X-rays and are able to show the lungs in three dimensions.
• These tests help determine the stage of the cancer by showing the size of the tumor or tumors.
• They can also help identify spread of the cancer into nearby lymph nodes or certain other organs.

If a person's chest X-ray or scan suggests that a tumor is present, he or she will undergo a procedure for diagnosis.

• This procedure involves collection of sputum, removal of a small piece of the tumor tissue (biopsy) or a small volume of fluid from the sac around the lung.
• The retrieved cells are reviewed under a microscope by a doctor who specializes in diagnosing diseases by looking at cell and tissue types (a pathologist).
• Several different ways exist to obtain these cells.

Sputum testing: This is a simple test that is sometimes performed to detect cancer in the lungs.

• Sputum is thick mucus that may be produced during a cough.
• Cells in the sputum can be examined to see if they are cancerous. This is called cytologic review.
• This is not a completely reliable test. If negative, the findings usually need to be confirmed by further testing.

Bronchoscopy: This is an endoscopic test, meaning that a thin, flexible, lighted tube with a tiny camera on the end is used to view organs inside the body.

• Bronchoscopy is endoscopy of the lungs. The bronchoscope is inserted through the mouth or nose and down the windpipe. From there, the tube can be inserted into the airways (bronchi) of the lungs.
• A tiny camera transmits images back to a video monitor.
• The physician operating the bronchoscope can look for tumors and collect samples of any suspected tumors.
• Bronchoscopy can usually be used to determine the extent of the tumor.
• The procedure is uncomfortable. A local anesthetic is administered to the mouth and throat as well as sedation to make bronchoscopy tolerable.
• Bronchoscopy has some risks and requires a specialist proficient in performing the procedure.

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