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Lung Cancer Screening and Tests

Medically Reviewed by Melinda Ratini, DO, MS on July 19, 2022

If you're a smoker or have other risks for lung cancer, you may want to get a screening test. It may help your doctor find the disease before you notice any symptoms. The heads up would let you start treatment early, when the condition is easier to treat.

If your screening shows you may have lung cancer, your doctor will likely order diagnostic tests. Those can pinpoint the type of the disease and whether it has spread to other places in the body.

Your doctor will also use diagnostic tests to find out what's going on if you have possible lung cancer symptoms like a long-lasting cough, shortness of breath, or chest pain.

Who Should Get Screened?

Experts have different views. Lung cancer screening guidelines from the U.S. Preventive Services Task Force say you should get screened if you're between 50 and 80, have a 20 pack-year smoking history, currently smoke or it has been less than 15 years since you quit smoking. If you haven't smoked in the last 15 years, you shouldn't have to be screened.

A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Talk to your doctor about your smoking history to see if you should be screened based on these guidelines.

Besides smoking, there are other reasons you could have higher chances of getting lung cancer. Your doctor may suggest you get screened if you:

How Screening Works

If you decide to get a screening test, you'll likely get something called low-dose computed tomography (LDCT). It's a machine that uses X-rays to make detailed pictures of your lungs.

It's a super-easy exam to take. You don't need any special prep, like fasting. You just need to hold your breath for about 6 seconds while a technician takes a scan. The whole thing takes about 10 minutes.

One thing to keep in mind: Sometimes an LCDT can give a result that looks like cancer but really isn't. Doctors call this situation a false-positive. You may need to take some other tests to double-check.

To find out if a screening test is right for you, take this quiz from the American Lung Association.

Diagnostic Tests

If you have possible symptoms of lung cancer, your doctor will probably start with a physical exam and a review of your medical history.

If they think you may have cancer, either because of your symptoms or your screening test, you may need some of these exams:

Sputum cytology. This test looks for cancer cells in your mucus. To get a sample, you'll breathe deeply and then cough with enough force to bring some mucus up from your lungs. Then you'll spit it out into a cup.

Imaging tests. They look for growths that might be lung cancer. Your doctor will be able to figure out if the disease has spread, and if so, where in your body it is.

Some imaging tests that may be useful to make a diagnosis are:

Chest X-ray. It uses radiation in low doses to make images of your lungs. 

CT (computed tomography). This powerful X-ray can show the size and shape of cancer and where it is. You may get a scan of your chest and belly. If you have the disease, the doctor can see whether it has spread to places like your liver or adrenal glands.

PET (positron emission tomography). It uses a special type of radiation that collects in cancer cells. A camera then takes pictures of these areas. Your doctor can use this exam to find out if a growth that showed up on an X-ray is really cancer, and to see if it's moved to other places.

Biopsy

In this test, your doctor removes some cells from your lungs to check under a microscope for cancer, and to figure out which kind it is. There are a few different ways it's done:

Needle biopsyor needle aspiration. Your doctor numbs your skin and uses a needle to remove a sample of tissue.

You may hear them talk about two different types. If a thin needle is used, it's called fine needle aspiration.

A procedure that uses a slightly thicker, hollow needle to remove a piece of tissue along with the cells is called a core biopsy. Your doctor may use a CT scan or X-ray to guide the needle to the right spot.

Bronchoscopy. For this test, they remove a tissue a tissue sample is removed through a thin tube that is placed into your lungs.

Thoracentesis. Your doctor puts a needle into the space between your lung and chest wall to remove fluid, which is checked for cancer cells.

Endoscopic ultrasoundWhen you get this test, they insert a needle through a lighted tube called an endoscope.

Open biopsy. You need to be in a hospital operating room to get this done. A surgeon removes tissue through a cut in your chest. You'll get anesthesia that puts you to sleep while this is going on.

However your biopsy is done, after it's over the cells that were removed are sent to a lab. A specialist called a pathologist looks at them under a microscope to check if any of them are cancer.

The lab might also do biomarker testing on the tissue sample from your biopsy. This test provides more detailed information about the makeup of your cancer. That helps your doctor understand which treatments might work best.

If you get a diagnosis of lung cancer, your doctor will discuss a treatment plan. But make sure you also get the emotional support you need. Reach out to your family and friends. They can be a huge source of support while you manage and treat your condition. Also look into support groups, where you can talk to people who are going through the same things you are.

Tests to Check for Cancer Spread in Your Chest

If your doctor spots lung cancer, they’ll usually want to find out if it has spread to nearby parts of your body. It can help them figure out the right treatment plan for you.

Some tests that can look for cancer spread are:

Endoscopic esophageal ultrasound. This test lets your doctor check your esophagus, where it can make images of the nearby lymph bodes that might have lung cancer cells. If the doctor decides to do a biopsy of any usual-looking lymph nodes, they can do it during this procedure.

Mediastinoscopy. This procedure lets your doctor look more closely inside the area between your lungs, called the mediastinum. They’ll make a small cut just above your breastbone and place a lighted tube with a camera through it to check and take samples from the lymph nodes along your windpipe and the main bronchial tube areas. Before the procedure, you’ll get medicine that puts you under and keeps you from feeling pain (anesthesia).

Mediastinotomy. If your doctor can’t reach some lymph nodes with a mediastinoscopy, they can do this similar procedure instead. A mediastinotomy involves getting a slightly larger cut (typically about 2 inches long) between the left second and third ribs next to your breastbone.

Thoracoscopy. Your doctor can use this procedure to figure out if your lung cancer has spread to the areas between your lungs and chest wall, or to the lining of those spaces. They can also use it to take samples of tumors on the outer parts of your lungs and to take samples of nearby lymph nodes and fluid. The test can help them gauge whether a tumor is growing into nearby organs or tissues, too.

Some people who get a thoracoscopy only need drugs that make you groggy but don’t put you into a deep sleep.

Doctors can also use thoracoscopy as part of the treatment to take out part of a lung in certain lung cancers that are at an early stage. This is an operation called video-assisted thoracic surgery (VATS).

Show Sources

SOURCES:

American Cancer Society: "Exams and tests that look for lung cancer," "Tests for small cell lung cancer," "Can Lung Cancer Be Found Early?" “Tests for Lung Cancer,” “Thoracoscopy.”

Johns Hopkins: “Mediastinoscopy.”

American Society of Clinical Oncology: "Lung Cancer - Non-Small Cell: Diagnosis."

CDC: "Lung Cancer Screening Guidelines and Recommendations," "What are the Risk Factors for Lung Cancer?" "What Screening Tests are There?"

National Comprehensive Cancer Network: "Lung Cancer Screening."

National Institute for Health and Care Excellence: "Lung cancer: diagnosis and management."

U.S. Preventive Services Task Force: "Screening for Lung Cancer: Consumer Guide."

University of Kansas Cancer Center: "Frequently Asked Questions About Lung Cancer Screening with Low-Dose CT."

UptoDate: "Endoscopic ultrasound-guided fine-needle aspiration in the mediastinum."

Penn Medicine: "Lung Cancer Diagnosis."

American Lung Association: "Lung Cancer Biomarker Testing."

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