Some lung cancers produce abnormally high blood levels of certain hormones or substances such as calcium. If a person shows such evidence and no other cause is apparent, a doctor should consider lung cancer.
In occult lung cancer, a diagnostic evaluation often includes chest x-ray and selective bronchoscopy with close follow-up (e.g., computed tomography scan), when needed, to define the site and nature of the primary tumor; tumors discovered in this fashion are generally early stage and curable by surgery.
After discovery of the primary tumor, treatment involves establishing the stage of the tumor. Therapy is identical to that recommended for other NSCLC patients with similar stage disease.
Lung cancer, which originates in the lungs, can also spread to other parts of the body, such as distant bones, the liver, adrenal glands, or the brain. It may be first discovered in a distant location, but is still called lung cancer if there is evidence it started there.
Once lung cancer begins to cause symptoms, it is usually visible on an X-ray. Occasionally, lung cancer that has not yet begun to cause symptoms is spotted on a chest X-ray taken for another purpose. A CT scan of the chest may be ordered for a more detailed exam.
Though exams of mucus or lung fluid may reveal fully developed cancer cells, diagnosis of lung cancer is usually confirmed through a lung biopsy. With the patient lightly anesthetized, the doctor guides a thin, lighted tube through the nose and down the air passages to the site of the tumor, where a tiny tissue sample can be removed. This is called a bronchoscopy and the scope is called a bronchoscope. This is useful for tumors near the center of the lung.
If the biopsy confirms lung cancer, other tests will determine the type of cancer and how far it has spread. Nearby lymph nodes can be tested for cancer cells with a procedure called a mediastinoscopy, while imaging techniques such as CT scans, PET scans, bone scans, and either an MRI or a CT scan of the brain can detect cancer elsewhere in the body.
If fluid is present in the lining of the lung, removal of the fluid with a needle (called a thoracentesis) may help diagnose cancer as well as improve breathing symptoms. If the fluid tests negative for cancer cells -- which occurs about 60% of the time -- then a procedure known as a video-assisted thoracoscopic surgery (or VATS) may be performed to examine the lining of the lung for tumors and to perform a biopsy.
Because saliva, mucus, and chest X-rays have not proved particularly effective in detecting small tumors characteristic of early lung cancer, annual chest X-rays for lung cancer screening are not recommended.
However, groups such as the American Cancer Society and the National Cancer Institute say CT screening should be offered to those at high risk of lung cancer. That includes smokers and former smokers ages 55 to 74 who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years. A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Their guidelines are based on research that showed CT screening decreases the chance of death overall but increases the chance of having a false alarm that requires more testing.