Diagnosis & Types

Lung Cancer

Although lung cancer is a common disease, it can be difficult to diagnose. It is often diagnosed late because symptoms can be vague or there may be no symptoms experienced in the early stages of the disease.

Currently, there are no organised early screening programs for lung cancer in Australia. It is therefore important to discuss any symptoms or concerns with your doctor. Make sure you discuss all your symptoms with your doctor so that they can work with you to choose the best tests to confirm your diagnosis early and help to develop a treatment plan.

Diagnosis

There are many different types of diagnostic imaging and pathology tests used to accurately diagnose and stage lung cancer. The purpose of these tests is to identify the type of lung cancer you have and also to identify if the cancer has spread to other parts of your body. Unfortunately, all the tests are rarely located at one centre so some tests may need to be outsourced to other hospitals/centres. You’re likely to see many doctors and together this team of health professionals (called a multidisciplinary team) will determine which tests are relevant to your lung cancer. They will organise the tests for you as part of managing your treatment and care.

  • Imaging

    A number of 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) or not cancerous (benign). Some imaging tools include the following:

    • 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) scans show how areas of the body use or metabolise glucose (also known as sugar). Since tumours typically use more glucose than surrounding tissue, tumours can  appear as “hot spots” (bright areas) in these images.
    • MRI (magnetic resonance imaging) creates detailed images of the body using magnetic fields and radio waves. Similar to PET, MRI 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. This testing is more common in the case of SCLC.
  • Biopsies

    A biopsy is a procedure that involves removing tissue or fluid from the suspicious area in the body for testing. The tissue or fluid can help doctors diagnose cancer and provide specific information about the type of cancer and the appropriate course of treatment.

    There are several types of biopsy procedures:

    • FINE NEEDLE ASPIRATION (FNA): Tissue is removed using a thin hollow needle. Depending on the location of the suspicious area, FNA is done during a bronchoscopy procedure (in which a camera-equipped tube is used to view the windpipe and other airways) or through skin. This procedure may be guided by an ultrasound or a CT scan.
    • CORE NEEDLE BIOPSY: Tissue is removed using a wider needle. More tissue can be removed with this procedure than with fine needle aspiration.
    • SURGICAL BIOPSY: Tissue is removed during a surgical procedure. Smaller tissue samples may be removed surgically during a bronchoscopy procedure; larger samples may require traditional surgery.
    • THORACENTESIS: Fluid is removed from the space around the lungs (also called the pleural cavity) using a hollow needle inserted into the chest.

      Information about genetic testing in lung cancer will be provided here soon.

Understanding your diagnosis

It is important to understand your diagnosis. You may have many questions and may not know where to begin or what questions to ask. Try to get as much basic, useful information about your cancer diagnosis as you can in order to make decisions with your doctor about your care. Write down your questions and concerns beforehand and bring them with you to your doctor’s appointment.

Types

There are two main types of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), which is more common.

Small cell lung cancer and non-small cell lung cancer behave differently and as such they are treated differently. It is important to have as much information as possible about your individual lung cancer. To understand what type of lung cancer you have, samples of the tumour taken from a biopsy of tissue or fluid from your lungs will be tested by a pathologist.

Mesothelioma is a rare type of cancer that can develop after exposure to asbestos. Mesothelioma usually targets the outer membrane of the lungs. Find out more about mesothelioma.

  • Non-small cell lung cancer

    Non-small cell lung cancer (NSCLC) accounts for approximately 80% of all lung cancers. There are several sub-types of NSCLC but the most commonly diagnosed are:

    Adenocarcinoma (including bronchioloalveolar carcinoma)

    Adenocarcinoma is the most common type of lung cancer in smokers and non-smokers, in men and women, regardless of their age. It comprises around 40% of all lung cancers. 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 metastasized) to other body organs.

    Squamous cell carcinoma

    Squamous cell carcinoma comprises 25-30% of all lung cancers. It can develop in the mucous membrane that lines the bronchial tubes. Coughing up blood is a common sign of squamous cell NSCLC. This sub-type of NSCLC is strongly associated with smoking.

    Large cell undifferentiated carcinoma

    This is a rare sub-type of NSCLC accounting for approximately 5-10% of lung cancers. 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.

    Other sub-types of NSCLC include adenosquamous carcinoma and sarcomatoid carcinoma. These are much less common than those mentioned above.

    Knowing the subtype of NSCLC helps the healthcare team identify the best treatment options for you.

    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. Information about genetic testing in lung cancer will be provided soon.

    NB: Information about other types of NSCLC such as Epidermal Growth Factor Receptor (EGFR) mutations and Anaplastic Lymphoma Kinase (ALK) etc. will be added soon.

  • Small cell lung cancer

    Small cell lung cancer (SCLC) accounts for around 15-20% 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, 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 generally not an option. Chemotherapy combined with radiotherapy is most commonly used as treatment.