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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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Needle biopsy: If a tumor is on the periphery of the lung, it usually cannot be seen with bronchoscopy. Instead, a biopsy is taken through a needle inserted through the chest wall and into the tumor.

• Typically, a chest X-ray or CT scanning is used to guide the needle.
• This procedure is safe and effective in obtaining sufficient tissue for diagnosis. After the chest surface is cleaned and prepared, the skin and the chest wall are numbed.
• The most serious risk with this procedure is that the needle puncture may cause an air leak from the lung (pneumothorax). This air leak occurs in as many as 3% to 5% of cases. Although this condition can be dangerous, it is almost always recognized quickly and treated without serious consequences.

Thoracentesis: This a procedure that removes a sample of fluid from the pleural cavity surrounding the lungs. Lung cancers, both primary and metastatic, can cause fluid to collect in the sac surrounding the lung. This fluid is called a pleural effusion.

• The fluid usually contains cells from the cancer.
• Sampling this fluid can confirm the presence of cancer in the lungs.
• The fluid sample is removed by a needle in a procedure similar to needle biopsy.
• Thoracentesis can be important for both staging and diagnosis of the condition.

Thoracotomy: Sometimes a lung cancer tumor cannot be reached by bronchoscopy or needle procedures.

• In these cases, the only way to obtain a biopsy is by performing an operation.
• The chest is opened (thoracotomy), and as much of the tumor as possible is removed surgically. The removed tumor is then examined microscopically.
• Unfortunately, this operation may not be successful in removing all tumor cells if the tumor is large or has spread to the lymph nodes outside of the lungs.
• Thoracotomy is a major operation that is performed in a hospital.

Mediastinoscopy: This is another endoscopic procedure. It is performed to determine the extent that the cancer has spread into the area of the chest between the lungs (the mediastinum).

• A small incision is made into the lower part of the neck above the breastbone (sternum). A variation is to make the incision in the chest.
• A mediastinoscope that is similar to a bronchoscope is inserted behind the breastbone.



• Samples of the lymph nodes are taken to evaluate for cancer cells.
• Mediastinoscopy is a very important step to determine whether the tumor can be surgically removed or not.

Other tests: Other tests are performed to stage the tumor and to assess a person's ability to withstand surgery and other treatment.

• Pulmonary function tests assess breathing capacity.
• Blood tests are performed to identify any chemical imbalances, blood disorders, or other problems that might complicate treatment.
• CT scans or MRIs may be performed on the most common areas of spread to check for metastatic disease. These tests are generally performed only if symptoms occur that suggest metastatic disease. Certain treatment protocols require that these tests be performed.
• A bone scan can determine whether the cancer has spread to the bones.

Staging: Staging is a method of classifying the tumor for purposes of treatment planning.

• Staging is based on size of the tumor, location of the tumor, and degree of metastasis of the tumor (if any).
• The treatment will be individually tailored to the tumor stage.
• Tumor stage is related to the outlook for cure and survival (prognosis). The higher the tumor stage, the less likely the disease will be cured.
• In contrast to staging, "grading" of lung cancer involves classification of the tumor cells under a microscope. The grade of a cancer is a measure of the abnormality of the cancer cells when compared to normal cells. High-grade tumors have a very abnormal appearance and tend to grow rapidly.

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