From the Guidelines
Diagnosing lung cancer should begin with a thorough medical history and physical examination, followed by imaging tests such as chest X-rays and CT scans, and if necessary, a biopsy using the least invasive method possible, as recommended by the European expert group in 2016 1. The diagnosis of lung cancer typically involves a combination of imaging tests and biopsy methods to confirm the presence of cancer cells and identify the specific type of lung cancer.
- Imaging tests such as chest X-rays and CT scans are usually ordered first to detect abnormal masses and provide detailed images of the lungs.
- If these tests reveal suspicious areas, a biopsy is necessary to confirm the diagnosis.
- Biopsy methods include:
- Bronchoscopy (inserting a thin tube through the mouth into the lungs)
- Needle biopsy (using a needle inserted through the chest wall)
- Surgical procedures like mediastinoscopy or thoracoscopy The collected tissue is examined under a microscope to determine if cancer cells are present and to identify the specific type of lung cancer. Additional tests may include PET scans, MRIs, bone scans, and blood tests to determine if the cancer has spread beyond the lungs. Molecular testing of the cancer tissue may also be performed to identify specific genetic mutations that could guide treatment options, as recommended by the American College of Chest Physicians in 2013 1. Early diagnosis is crucial for better treatment outcomes, so individuals with persistent respiratory symptoms like chronic cough, chest pain, shortness of breath, or coughing up blood should seek medical attention promptly, especially those with risk factors such as smoking history or exposure to carcinogens. It is essential to note that the diagnostic strategy should be individualized for each patient depending on the size and location of the tumor, the presence of mediastinal or distant disease, patient characteristics, and local experience, as recommended by the National Comprehensive Cancer Network in 2013 1.
From the Research
Diagnosis of Lung Cancer
To diagnose lung cancer, several methods can be employed, including:
- Imaging tests such as chest radiography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) 2
- Sputum cytology, thoracentesis, fine-needle aspiration, or mediastinoscopy for confirmation 3
- Low-dose computed tomography (CT) for screening, which has been shown to have higher sensitivity and lower specificity compared to traditional screening methods such as chest X-ray 4
Screening and Detection
Screening for lung cancer is essential, especially for individuals with a high risk of developing the disease. The U.S. Preventive Services Task Force recommends annual lung cancer screening using low-dose computed tomography starting at 50 years of age in patients with a 20 pack-year history 3. The sensitivity and specificity of lung cancer screening using low-dose CT have been reported to be 88.9% and 92.6%, respectively, by the detection method 4.
Symptoms and Referral
The most common symptoms of lung cancer include cough, hemoptysis, shortness of breath, anorexia, and weight loss 3. If lung cancer is suspected, referral to a multidisciplinary lung cancer team is recommended for further evaluation and treatment. Treatment options vary based on staging, histology, immunotherapy biomarker testing, and patient health status, and may include surgical resection, immunotherapy, chemotherapy, and/or radiotherapy 3.