Early Diagnosis Is Key to Treating Lung Cancer

Printer-friendly versionSend to friend

Since you can have lung cancer and not even have any noticeable symptoms, it's imperative that you have routine checkups with a doctor. Depending on your personal and family health history and the results of your examinations, you may be advised to have additional tests performed.

The following exams are typically used to detect, diagnose and stage lung cancer:

• Physical exam and history: A detailed history that includes your past illnesses, habits, occupation, and family illnesses will be taken by your physician, followed by a thorough exam.
• Chest x-ray: A radiographic test that uses a small amount of radiation to take a "picture" that looks at your heart, lungs, bones, and lymph nodes.
• CT (Computed Tomography) Scan: Three-dimensional images are made of the chest using computerized x-rays. A dye is first injected into a vein or swallowed to help organs and tissues show up more clearly.
• MRI (Magnetic Resonance Imaging): An MRI uses magnetism, radio waves and a computer to generate images of body structures. An MRI covers many of the same regions as a CT scan but can perform additional studies.
• PET (Positron Emission Tomography) Scan: To find malignant tumor cells a small amount of radioactive glucose is injected into the vein. Since cancerous tumor cells are more active and use more glucose they appear as bright spots on the PET scanner.
• Sputum Cytology: The mucous coughed up from the lungs is viewed by a pathologist using a microscope to detect cancerous cells.
• Fine-needle aspiration (FNA) biopsy of the lung: A biopsy allows a small sample of the abnormal tissue or fluid in the lung to be harvested so it can be examined under a microscope to see if cancer cells are present. An FNA can also be obtained by bronchoscopy, EBUS, EUS, or by an Interventional Radiologist
• Bronchoscopy: A bronchoscope is a tube-like instrument with a light and camera that is inserted through the nose into the trachea (airway) and lungs to look for abnormalities. If abnormalities are gound, the pulmonologist may remove tissue smaples that are examined by a pathologist for signs of cancer.
• Thorascopy: A thorascopy is a surgical procedure where a small incision is made between the ribs and a thin instrument with a light and lens on it known as a thorascope is inserted.  The thorascope will allow the surgeon to look inside the chest cavity and to remove tissue or lymph node samples so they can be checked under a microscope.
• Thoracentesis: The fluid in the space between the lining of the chest and the lung can often yield signs of cancer cells. The cells are removed from this space using a needle so a pathologist can analyze it further under a microscope.
• Mediastinoscopy: A surgeon inserts a small tube with a light and lens attached into a small incision above the breastbone.  This procedure allows the surgeon to examine and biopsy the area between the lungs and the surrounding lymph nodes. 
• Endobronchial Ultrasound (EBUS): A bronchoscope in combination with ultrasound, is used by a trained pulmonologist to evaluate the airways and surrounding lymph nodes.  Any abnormal areas can be biopsied without surgical incision.  EBUS is an important tool in initial staging, as well as determining the effectiveness of therapy in thoracic cancer patients.
• Endoscopic Ultrasound (EUS): Just as EBUS can be used to help diagnose or stage lung cancer patients, EBUS can also be used.  A trained gastroenterologists inserts a thin, flexible tube into the mouth and down the esophagus.  With the use of the transducer (ultrasound) at the end of the tube, the surrounding lymph nodes can be biopsied. 

Lung Cancer Staging

If tests and examinations confirm the presence of lung cancer, experts at the Florida Hospital Cancer Institute's Lung Cancer Clinic will "stage" the lung cancer to determine how far it has progressed. The stage of lung cancer is determined so that the Thoracic Cancer Team can develop a thorough and highly individualized treatment plan designed just for you.

Lung cancer is staged in two different ways, depending whether the diagnosis involves small cell lung cancer or non-small cell lung cancer.

Small Cell Lung Cancer Staging

Limited Stage: The cancer is limited to one lung and the lymph nodes on the same side of the chest.

Extensive Stage: The cancer has spread to the other lung and lymph nodes on the other side of the chest and/or organs.

Non-small Cell Lung Cancer Staging

Stage I: The cancer has only been found in one lung and has not spread to any lymph nodes or the other lung. At this stage, the outlook is very good because it is such an early stage in the cancer's progression. Treatment usually involves surgical removal of the tumor by the highly trained specialists at FHCI. In some cases, additional treatment using chemotherapy may also be recommended. If surgery is not an option, radiation therapy such as Trilogy may be utilized.

Stage II: The cancer has spread to the lymph nodes in the chest near the lungs. Treatment at this stage may involve removal of the tumor as well as chemotherapy. Radiation therapy may also be used to address the cancer in the lymph nodes.

Stage III-A: The cancer has spread to the lymph nodes away from the lungs in the middle of the chest and the cancer in the lung itself is a single tumor. The Thoracic Cancer team may recommend starting with chemotherapy and/or drug therapy along with radiation to treat it. Depending on the effectiveness of the initial treatments, surgery may also be employed.

Stage III-B: As in Stage III-A, cancer has spread to the lymph nodes away from the lungs in the middle of the chest. Cancer has also spread to more than one area in the lung itself. Treatment options include chemotherapy and radiation.

Stage IV: The most advanced stage of lung cancer, the cancer has spread (metastasized) to distant parts of the body such as the brain, bones, liver or other organs. Treatment options may include chemotherapy and/or radiation.  If the cancer has spread to only one site outside the lungs, surgery may be considered to remove the metastatic tumor.  Other therapies may also be considered such as gamma knife surgery or radiofrequency ablation.

As with all types of cancer, the team at FHCI recommends regular checkups with your regular physician who knows your health history and can monitor changes that may signal the presence of cancer. Time is of the essence and an accurate diagnosis followed by the correct treatments utilizing the latest techniques, procedures and medical advances is essential. Fortunately, FHCI's Lung Cancer Clinic is one of the most respected centers in the nation for thoracic cancer treatment.

Contact us now to schedule an appointment with the Florida Hospital Cancer institute.