Diagnosis

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.