Exams and Tests

• Initial examinations and tests for suspected lung cancer can include the following:
  
  
  • Medical, surgical, work, and smoking history
  
  
  
  • Physical examination to check for general signs of health 
  
  
  
  • Chest x-ray film
  
  
  
  • Sputum cytology: Cells in the sputum are examined to see if they are cancerous.
  
  
  
  • CT scan of the chest: An x-ray machine linked to a computer takes a series of detailed pictures of the inside of the chest from different angles. Other names of this procedure are computed tomography, computerized tomography, or computerized axial tomography.
  
  
  
  • Thoracentesis: The lungs are enclosed in a sac. Lung cancer can cause fluid to collect in this sac. This is called pleural effusion. In people who have cancer, this fluid may contain cancer cells. The fluid is removed by a needle and examined for the presence of cancer cells.
  
  
  
  • Bronchoscopy: This is a procedure used to look inside the trachea (windpipe) and large airways in the lung for abnormal areas. A bronchoscope (a thin, flexible, lighted tube with a tiny camera on the end) is inserted through the mouth or nose and down the windpipe. From there, it can be inserted into the airways (bronchi) of the lungs. During bronchoscopy, the doctor looks for tumors and takes a biopsy sample (a sample of cells that is removed for examination under a microscope) from the airways.
  
  
  
  • Lung biopsy: If a tumor is on the periphery of the lung, it may not be seen with bronchoscopy. Instead, a biopsy sample has to be taken with the help of a needle inserted through the chest wall and into the tumor. This procedure is called transthoracic needle aspiration biopsy.
  
  
  
  • Mediastinoscopy: This procedure is performed to determine the extent the tumor has spread into the mediastinum (area of the chest between the lungs). Mediastinoscopy is a procedure in which a tube is inserted behind the breastbone through a small cut at the lowest part of the neck. Samples of the lymph nodes (small, bean-shaped structures found throughout the body) are taken from this area to look for cancer cells.
     
• Once the patient has been diagnosed with lung cancer, examinations and tests are performed to find out whether the cancer has spread (metastasized) to other organs of the person’s body. These examinations and tests help to determine the stage of the cancer. Staging is important because lung cancer treatment is based on the stage of the cancer. Examinations and tests used to detect the spread of cancer may include the following:
  
  
  • Blood tests: Complete blood count (CBC) (provides information about the type and count of different types of blood cells), serum electrolytes, renal function studies (for assessing kidney function), and liver function tests are all part of the routine tests for staging. In some cases, these tests may identify the site of metastasis. For instance, an elevated serum calcium level is seen with spread of the cancer to the bone. These tests are also important to assess the organ functions before starting treatment.
  
  
  
  • CT scan of the brain, neck, abdomen, and pelvis: An x-ray machine linked to a computer takes a series of detailed pictures of areas inside the body from different angles. If required, the doctor may inject a dye into a vein and may give the patient a contrast agent to swallow so that the organs or tissues more clearly show up on the scan.
  
  
  
  • MRI of the brain and spine: MRI is an imaging technique used to produce high-quality images of the inside of the body. A series of detailed pictures of areas inside the body are taken from different angles. The difference between an MRI and CT scan is that MRI uses magnetic waves, whereas CT scan uses x-rays for the procedure.
  
  
  
  • Radionuclide bone scan: With the help of this procedure, the doctor determines whether the lung cancer has spread to the bones. The doctor injects a minute quantity of radioactive material into the vein; this material travels through the bloodstream. If the cancer has spread to the bones, the radioactive material collects in the bones and is detected by a scanner.
  
  
  
  • Bone marrow aspiration and biopsy: In this procedure, a large-bore needle is inserted into the pelvic bone to remove a small piece of bone and bone marrow. The sample is then viewed under a microscope to look for cancer cells.

Staging

• Staging of the cancer provides important information about the outlook of the patient’s condition and helps the doctor plan the best treatment. Although other cancers are staged from stage I to stage IV, small-cell lung cancer is classified into 2 stages. 
  
  
  • Limited stage: In this stage, the tumor is confined to one side of the chest, the tissues between the lungs, and nearby lymph nodes only.
  
  
  
  • Extensive stage: In this stage, cancer has spread from the lung to other organs of the body.