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Lung Cancer (cont.)

More Tests for Lung Cancer Diagnosis

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%-5% of cases. Although this condition can be dangerous, it is almost always recognized quickly and treated without serious consequences.
  • Endoscopic ultrasound with fine-needle aspiration of an abnormal mass or lymph node may also be performed at the time of bronchoscopy.

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.


Staging is the process of establishing the extent of the cancer once the diagnosis is made, so that an appropriate course of treatment can be planned.

The results of all of the diagnostic testing and procedures are reviewed to determine what information might be needed to accurately stage the patient.

PET scan assess the presence or absence of distant metastases very well. If there are any questions about the patient's neurologic status, an MRI of the brain may be needed. CT scans of the chest abdomen and pelvis with contrast will likely be done to correlate with the PET scan imaging. Other tests may include the following:

  • Pulmonary function tests to assess breathing capacity
  • Blood tests to identify any chemical imbalances, blood disorders, or other problems that might complicate treatment
  • A bone scan can determine whether the cancer has spread to the bones.
  • A bone scan and bone X-rays, particularly in the absence of PET scan availability, can determine whether the cancer has spread to the bones.
  • Molecular testing on the cancerous tissue may help to determine eligibility for specific options for treatment.

Staging systems classify the patient's disease based upon the results of the evaluation completed.

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.
Last Reviewed 11/17/2017

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