Diagnosis & Types

Several imaging tests can be undertaken to provide information on areas of the lungs that do not appear normal. Doctors sometimes refer to these areas as tumours, spots, lesions, nodules or masses. These imaging techniques can provide information beyond what can be seen with a chest X-ray. Imaging can help doctors identify if a suspicious area is cancerous (malignant) and the results will help determine a recommended treatment plan. Imaging tests may include:

• CT (computed tomography), also known as a CAT scan, uses a series of x-rays to make a detailed picture of the area of the body under investigation. CT can show tumours that may not be visible on a normal chest X-ray.
• PET (positron emission tomography) is a specialised imaging test where specialised glucose solution is injected into a vein in your arm. Cancer cells take up more of the glucose solution than normal cells do. Tumours appear as “hot spots” (bright areas) in the PET scan images.
• MRI (magnetic resonance imaging) creates detailed images of the body using magnetic fields and radio. A MRI scan can help determine whether a tumour has spread beyond its original location.
• BONE scans use a radioactive substance to look for cancer in the bones. Areas where there may be cancer appear darker in these images.

A biopsy is a procedure that involves removing tissue or fluid from the suspicious area in the body for testing. The tissue or fluid allows diagnosis of the type of cancer you have. It also provides specific information about your cancer to inform the appropriate course of treatment for you.

There are several types of biopsy procedures to obtain tissue or fluid from the tumour. The decision about which type of biopsy you will have is guided by the location and size of your tumour.

• CT-Guided Core Biopsy: is performed in a hospital or radiology clinic. A CT scan will be used to guide the needle through your chest wall and into position. A small piece of tumour can usually be removed with the needle.
• Bronchoscopy: a bronchoscope is a flexible tube with a camera attached. This is passed down your windpipe into your lungs. This allows a doctor to take a needle biopsy of the tumour. During this procedure, a doctor can also perform “brushings” and “washing”. Brushing uses a brush-like instrument to remove cells from the lungs. Washing consists of injecting fluid into the lungs and then withdrawing the fluid for testing.
• EBUS (endobronchial ultrasound biopsy) – is performed during bronchoscopy with an ultrasound probe attached to the video camera. This helps to locate very small areas seen on scans or xrays.
• Surgical Biopsies: there are a range of different surgical biopsy approaches. Surgical options are used if unable to obtain tissue during the procedures described above.

Non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancers. There are several sub-types of NSCLC but the most commonly diagnosed are:

Adenocarcinoma

Adenocarcinoma is the most common type of lung cancer, in men and women, regardless of their age. It is usually found near the edge of the lung. It can develop in the chest lining causing fluid to form in the chest cavity. This type of NSCLC tends to grow more slowly than other lung cancers and has a greater chance of being found before it has spread (or metastasised) to other body organs.

Squamous cell carcinoma

Squamous cell carcinoma can develop in the mucous membrane that lines the bronchial tubes. Coughing up blood is a common sign of squamous cell NSCLC.

Large cell undifferentiated carcinoma

This is a rare sub-type of NSCLC. Large cell undifferentiated carcinoma often begins in the central part of the lungs. It is known to grow and spread quickly into nearby lymph nodes as well as other organs.

Knowing the subtype of NSCLC allows the healthcare team to identify the best treatment options.

NSCLC is not the same in every person. Recently, the complexity of lung cancer has been identified through genome research. The different sub-types of NSCLC lung cancer can be grouped according to the type of DNA damage that causes the lung cancer. This type of genetic or molecular testing can help doctors identify if your lung cancer can be treated by medicines that target these DNA changes.

Small cell lung cancer (SCLC) accounts for around 15% of all lung cancers. Small cell lung cancer usually starts in the bronchi in the centre of the chest, although about 5% of the time it is found in the periphery of the lungs. Small cell lung cancer is a type of neuroendocrine tumour (ref Lungevity), which means that the neuroendocrine cells that form part of the lining of the airways experience uncontrolled growth and multiply.

Small cell lung cancer behaves very differently to non-small cell lung cancer. It is aggressive; it grows very quickly and spreads via the bloodstream to lymph nodes and other organs such as the brain early in the disease. It is quite common for tumour deposits to be found in other organs at the time of diagnosis. Due to the early spread of small cell lung cancer, surgery is not an option. Chemotherapy with or without  radiotherapy is used as treatment.