Lung Cancer Diagnosis and Treatment

How Is Lung Cancer Diagnosed?

Your doctor may suspect lung cancer if a physical exam reveals:

  • Swollen lymph nodes above your collarbone
  • A mass in your abdomen
  • Weak breathing
  • Abnormal sounds in your lungs
  • Dullness when your chest is tapped
  • Unequal pupils
  • Droopy eyelids
  • Weakness in one arm
  • Expanded veins in your arms, chest, or neck
  • Swelling of your face

Some lung cancers make abnormally high blood levels of certain hormones or substances such as calcium. If your calcium is higher than normal and no other cause is apparent, your doctor might suspect lung cancer.

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 it’s 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. Your doctor might order a CT scan of your chest for a more detailed exam.

Diagnosis of lung cancer is usually confirmed with a lung biopsy. The doctor guides a thin, lighted tube through your nose or mouth and down the air passages to the tumor and removes a tiny tissue sample. This is called a bronchoscopy. This is useful for tumors near the center of the lung.

If the biopsy confirms lung cancer, your doctor will use other tests to 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 area between the tissue layers lining the chest wall and lungs, 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 your doctor may do a procedure known as a video-assisted thoracoscopic surgery (or VATS) to examine the lining of the lung for tumors and to perform a biopsy.

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Because saliva, mucus, and chest X-rays have not proved particularly effective in finding small tumors, 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 low-dose helical 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.

What Are the Treatments for Lung Cancer?

If the cancer can be successfully removed surgically, you have an excellent chance of surviving at least 1 year and usually a better than 50% chance of living 5 years or more. The challenge comes in finding lung cancer early enough to make surgery possible.

Surgery for lung cancer

The decision to perform surgery is based on the type of lung cancer, how far it has spread, and your overall health, especially the function of your lungs. Many people with lung cancer -- especially smokers -- have other lung or heart problems that make surgery difficult. Cancer that has spread to lymph nodes between the lungs was once considered inoperable, but combining surgery with chemotherapy afterward has improved survival rates.

Surgery is the preferred treatment for non-small-cell lung cancer. A surgeon removes the tumor along with surrounding lung tissue and lymph nodes. Sometimes, the entire lung must be taken out. After surgery, you’ll stay in the hospital for several days.

Radiation for lung cancer

Radiation therapy may be necessary to kill remaining cancer cells, but it is usually delayed for at least a month while the surgical wound heals. Non-small-cell lung cancers that can’t be treated surgically are usually treated with radiation therapy, usually in combination with chemotherapy.

Chemotherapy and combination therapy for lung cancer

Because it tends to spread widely, small-cell lung cancer is typically treated with combination chemotherapy -- the use of more than one drug -- often along with radiation therapy. Surgery is occasionally used, but only if the cancer is thought to be at a very early stage. This is uncommon.

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People whose cancers have metastasized, or spread to distant parts of the body, are usually treated with either chemotherapy or radiation therapy. Since metastatic lung cancer is very difficult to cure, the main goals of treatment are to provide comfort and prolong life. Current treatments can shrink tumors, which may lessen pain and other symptoms.

It’s now recommended that patients with advanced lung cancer receive palliative care (care designed to ease pain and other symptoms) while also having the cancer treated. This has been shown not only to provide comfort, but to improve the outcome if chemotherapy is given at the same time.

Recent data also suggests that chemotherapy helps prevent recurrence of lung cancer in patients with early stages of the disease.

Other lung cancer treatments

Researchers are constantly looking for better ways to treat lung cancer, to relieve symptoms, and to improve quality of life. New combinations of chemotherapy, new forms of radiation, and the use of drugs that make cancer cells more sensitive to radiation are always being studied.

Stereotactic radiosurgery and radiofrequency ablation have been used to treat early lung cancers in people who can’t be treated with surgery. This type of therapy may also be used to treat localized tumors that come back.

Drugs that target a growth factor receptor (EGFR) such as afatinib (Gilotrif), dacomitinib (Vizimpro), erlotinib (Tarceva), necitumumab (Portrazza) and osimertinib (Tagrisso) and the tumor blood supply, bevacizumab (Avastin) and ramucirumab (Cyramza), have shown significant activity in helping to control advanced lung cancer. Gefitinib (Iressa) has been approved to treat metastatic NSCLC and offers another targeted therapy for tumors with specific EGFR mutations.

Atezolizumab (Tecentriq), durvalumab (Imfinzi), nivolumab (Opdivo) and pembrolizumab (Keytruda) are immunotherapy drugs that block a protein that keeps the body from fighting cancer. These drugs are given by IV infusion every 2-3 weeks.

The drugs alectinib (Alecensa), brigatinib (Alunbrig), certinib (Zykadia), crizotinib (Xalkori), and lorlatinib (Lorbrena) have been found to attack a certain molecule, an ALK gene rearrangement, seen in some lung cancers. Dabrafenib (Tafinlar) and trametinib (Mekinist) target certain proteins in tumors that have changes in the BRAF gene.

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Entrectinib (Rozlytrek) and larotrectinab (Vitrakvi) target a gene called neurotrophic tyrosine kinase (NTRK) found in some tumors.

It’s now common for patients to be tested to determine if these drugs can effectively fight their type of lung cancer.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on March 16, 2020

Sources

SOURCES:

National Cancer Institute. 

National Institutes of Health.

American Cancer Society.

American Lung Association.

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