Non-Small-Cell Lung Cancer (cont.)
IN THIS ARTICLE
Exams and Tests
Medical evaluation and tests
The symptoms of lung cancer can be caused by many different medical conditions. Even a chest X-ray film that shows what looks like a tumor is not enough to make the diagnosis of lung cancer. The health care provider’s job is to gather all available information and to make the diagnosis. Correct and prompt diagnosis is essential so that appropriate treatment can be started as soon as possible.
The first step in the evaluation is the medical interview. The health care provider asks the patient questions about symptoms and when they started, current or past medical problems, medications taken, family medical problems, work and travel history, and habits and lifestyle. This is followed by a thorough physical examination.
The remainder of the evaluation focuses on confirming the presence of lung cancer and staging the tumor. Although primary care providers are able to conduct this evaluation, they may prefer to refer the patient a specialist. At any time during this evaluation, the primary care provider may refer the patient to a surgeon or to a specialist in lung diseases (pulmonologist) or cancer (oncologist).
No blood test can confirm that a patient has lung cancer. Blood tests are performed to check the patient’s general health, to rule out other conditions that might cause similar symptoms, and to detect certain paraneoplastic syndromes. The usual blood tests include the following:
Respiratory (breathing) symptoms are usually evaluated with a chest X-ray film, CT scan of the chest, or both. X-ray films are limited in the amount of detail they provide, but they clearly show some tumors. CT scans shows much greater detail in a 3-dimensional format. A CT scan is needed if the X-ray film findings are not definitive. If imaging studies show evidence of a tumor, further testing is needed.
Bronchoscopy: This is the use of a device called an endoscope to view the lungs directly. An endoscope is a thin tube with a light and a tiny camera on the end. The endoscope is inserted through the mouth or nose into the bronchus (airway) and down to the lung. The camera transmits pictures of the inside of the patient’s airways that can be viewed on a video screen.
Biopsies from other sites: Material can also be obtained from other sites with abnormalities to confirm the diagnosis. These sites include enlarged lymph nodes or liver and collections of fluid around the lung (pleural effusion) or heart (pericardial effusion).
Staging is a system of classifying cancers based on the extent of the disease. In general, the lower the stage, the better the outlook for remission and survival. In NSCLC, staging is based on the size of the primary tumor, the number of cancerous lymph nodes, and the presence of any metastatic tumors. Accurate staging is essential in NSCLC because the stage of the cancer determines which treatment may offer the best results.
For people with lung cancer, the first step is to undergo a staging evaluation. The patient’s medical team cannot make recommendations for the best treatment until they know the cancer’s exact stage.
This evaluation includes many of the tests already described. Other tests are as follows:
NonSmall-Cell Lung Cancer Treatment
Tissue diagnosis is mandatory prior to any treatment. The goals of treatment are to remove or shrink the tumor, to kill all residual tumor cells, to prevent or minimize complications and paraneoplastic syndromes, and to relieve the symptoms and side effects associated with the disease and treatment. Available therapies cure only a small number of people with lung cancer. Other people’s tumors shrink substantially or even disappear, although residual cancer cells remain in the body. This is called remission. Most people feel well during remission and are able to resume their everyday activities. Remissions can last a few months, a few years, or even indefinitely. If and when the disease comes back, it is called recurrence or relapse. The disease may recur in the lung or in another part of the body. A loss of weight of more than 5% indicates a poor prognosis.
Medically Reviewed by a Doctor on 9/11/2014
Irfan Maghfoor, MD
Michael Perry, MD, FACP
Winston W Tan, MD
Mary L Windle, PharmD
Koyamangalath Krishnan, MD, FRCP
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