Lung Cancer Diagnosis

Imaging tests play a crucial role in diagnosing lung cancer. They provide detailed images of the lungs and surrounding structures, helping doctors identify any abnormalities. The most common imaging tests used for lung cancer diagnosis include:

• Chest X-ray: A chest X-ray is often the first imaging test performed. It can reveal the presence of any abnormal masses or nodules in the lungs.
• Computed Tomography (CT) Scan: A CT scan provides more detailed images than a chest X-ray. It can help determine the size, location, and extent of the tumor, as well as the involvement of nearby lymph nodes.
• Magnetic Resonance Imaging (MRI): In some cases, an MRI may be used to obtain additional information about the tumor’s characteristics and its relationship with nearby structures.

A biopsy is the definitive method for confirming a lung cancer diagnosis. It involves the removal of a small tissue sample from the suspicious area for examination under a microscope. There are different types of biopsies, including:

• Needle Biopsy: This minimally invasive procedure involves the insertion of a thin needle through the skin and into the lung to collect tissue samples. It can be done using imaging guidance, such as CT scan or ultrasound, to ensure accurate placement.
• Bronchoscopy: In a bronchoscopy, a thin, flexible tube with a camera on the end is inserted through the nose or mouth and into the airways. This allows the doctor to visualize the lung tissue and collect samples for analysis.
• Surgical Biopsy: In some cases, a surgical biopsy may be necessary to obtain an adequate tissue sample. This procedure involves making an incision in the chest and removing a portion of the lung tissue for examination.

Biomarker testing, also known as or genomic testing or molecular testing, is performed on the tissue sample obtained during the biopsy. It helps identify specific genomic mutations or alterations in the cancer cells. This information is crucial in determining the most appropriate treatment options for the patient. Some common molecular tests for lung cancer include:

• EGFR Mutation Testing: Epidermal Growth Factor Receptor (EGFR) mutations can be targeted with specific drugs known as EGFR inhibitors.
• ALK Rearrangement Testing: Anaplastic Lymphoma Kinase (ALK) rearrangements can be targeted with ALK inhibitors.
• PD-L1 Testing: Programmed Death-Ligand 1 (PD-L1) expression levels can help determine the suitability of immunotherapy.

Once a lung cancer diagnosis is confirmed, the next step is determining the stage of the disease. Staging involves assessing the size of the tumor, its spread to nearby lymph nodes, and the presence of distant metastases. Staging helps guide treatment decisions and provides an estimate of the prognosis. The most commonly used staging system for lung cancer is the TNM system, which stands for Tumor, Nodes, and Metastasis.

In some cases, additional tests may be necessary to gather more information about the lung cancer and its impact on the patient’s overall health. These tests may include:

– Pulmonary Function Tests: These tests measure lung capacity and function, providing valuable information about the patient’s lung health.

– Positron Emission Tomography (PET) Scan: A PET scan uses a radioactive tracer to identify areas of increased metabolic activity in the body. It can help detect the presence of distant metastases.

– Brain Imaging: Since lung cancer can spread to the brain, imaging tests such as MRI or CT scan may be performed to assess the brain for any metastases.

You should be seen by a thoracic oncologist. Thoracic oncologists have extensive training specific to lung cancer and are well versed in treatment options, medications, and clinical trials. Ideally, they will be affiliated with a Comprehensive Cancer Center which will afford them access to cutting edge treatments and the benefits of a multidisciplinary approach to treating your disease.

A good resource for finding a physician is to join a lung cancer patient group, such as Smart Patients, and ask them for references on your oncologist. There are also oncogene groups on social media that may have referrals.

It’s important to think ahead and plan for your appointment. Here are a few suggestions:

• Bring a notebook or computer. A notebook or computer to take notes about your lung cancer will prove to be invaluable.You will be given a lot of information and will have many questions. It is easy – and totally normal – to become overwhelmed. Lung cancer has a language all its own, and, unless you’ve been exposed to it, everything will be new to you. Referring back to your notes will help not only you, but your family and support system. If you are unclear on anything your oncologist tells you, ask them to explain it more clearly and/or to write it down.
• Bring a calendar. During the course of your diagnosis and treatment, you will have many appointments with doctors, surgeons, and for scans, blood tests, and other testing. It is also important that you ask your oncologists office to share this information with your primary care physician,
• Arrive prepared with questions. Remember: there is no such thing as a “dumb” question. Ask anything that you want and, if you do not understand the answer, ask the doctor to explain things more clearly.

A few questions to consider:

1. What kind of lung cancer do I have: Small cell? Non small cell?
2. What stage is my cancer? And what does the stage mean?
3. Is there a patient portal for routine questions? If so, how do you access it?
4. Is there a nurse or physician assistant to whom you can speak directly?
5. What is the protocol for communicating after business hours or on the weekend?

If surgery is recommended, be sure to use a thoracic surgeon. Ask your doctor. If you are not a candidate for surgery, ask if targeted therapy or immunotherapy might be the right treatment for you.

If a treatment is recommended:

1. What are possible side effects?
2. Discuss your medical history and tell your doctor about any medications – both prescribed and over the counter (OTC) – that you are currently taking.
3. Inquire as to whether medications are covered by insurance and, if they are not, what is the cost?

Your team of lung cancer physicians may include thoracic surgeons, medical oncologists, radiation oncologists, radiologists, and pathologists. Allowing yourself to stay organized alleviates stress.

In addition to your notebook or computer you take to your doctor appointments. 
Keep your own copies of medical records up to date. Always ask for a copy of each scan, test, or x-ray you may have done. This is always useful in the event that you may need to seek counsel from a different medical facility or are in fact requesting a second opinion. It’s your right as a patient to obtain such things at the time the procedure is performed.

Here are some downloadable documents that can be printed to take with you to your doctor appointments:

My Healthcare Team
Patient appointment notes
My History
My Test Results

Yes. Lung cancer diagnosis and lung cancer treatments are increasingly complex and continue to rapidly change. Some oncologists may not be familiar with all of the most current research and available clinical trials. It is very acceptable and strongly advisable to get a second opinion.

However, if your lung cancer is making you feel very sick, you may not want to delay treatment while trying to set up this appointment. There are many cancer centers nationwide with highly trained thoracic oncologists available to render second opinions.

They will be able to talk with you about:

• standard treatment options that you may be able to receive closer to home
• recent developments in the treatment of lung cancer
• review available clinical trials.

COVID-19 changed how healthcare is delivered for people across the country, but lung cancer patients have been at the forefront of using this technology (telemedicine) to manage their diagnosis for years.

Find a Comprehensive Cancer Center designated by the National Cancer Institute.

It is very important to insist on having comprehensive genetic profiling of your lung cancer tissue. Some lung cancer patients report being told that there is no treatment option for them. If no biomarker testing has previously been done for these patients, the next step is to make sure to get the biomarker testing done, if at all possible.

First, there needs to be enough tumor tissue available for testing. A fine needle aspiration (FNA) biopsy may not provide enough tissue. A core needle biopsy is more likely to provide sufficient tissue for testing. If you had your tumor surgically removed, there likely will be enough tissue available for testing.

Secondly, you or a loved one need to advocate on your behalf and speak to your oncologist about having your tumor tested for molecular biomarkers. You may be required to undergo another procedure to obtain enough tissue. But the potential benefits of knowing the biomarker status of your tumor may, in most instances, outweigh the risks of most biopsies. New biomarkers are regularly being discovered, and targeted therapies are being developed for these biomarkers.

Therefore, in order to take advantage of emerging therapies, and to maximize your treatment options, it is suggested that you request that your doctor order your tumor be tested for a wide range of biomarkers.

A new and exciting way to identify biomarkers is through blood tests called liquid biopsies. In the past, some lung cancer patients could not take advantage of the latest discoveries in personalized medicine because there was not enough tissue to do biomarker testing. With FDA approval of the first liquid biopsy in 2016 and advances in research, specific genetic drivers, or suspected drivers, can be detected in more than half of lung cancers.

[ LINK TO LIQUID BIOPSY VIDEOS ]

Learn more about what a liquid biopsy for lung cancer is and what uses it has.

A clinical trial is a research program conducted with patients to determine if an investigational treatment, drug, or device is a better line of defense than the current “best standard of care.”

Most people find out about clinical trials from their doctors. Many times the doctor brings up the subject of a clinical trial with the patient, but, you don’t have to wait for your doctor to begin the discussion. Thoracic oncologists are well versed in the latest research and experimental treatments. Let your doctor know that you are interested in being part of a clinical trial.

Search for Clinical Trials with Antidote Match™

Antidote Match™ connects people with medical research studies, in the fastest and easiest way possible. All you need to do is answer a few questions, and they will find the right trials for you. You gain access to the latest medical developments and world-class care.

Search for Clinical Trials at ClinicalTrials.gov

ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world.