Lung Cancer

Diagnosis

Lung cancer diagnosis often begins with an imaging test to examine the lungs. If you have concerning symptoms, a healthcare professional may start with an X-ray. People who smoke or have smoked may undergo screening even before symptoms appear.

Testing healthy people for lung cancer

Individuals at increased risk may consider yearly lung cancer screening with low-dose CT scans. Screening is generally recommended for people 50 and older who have smoked heavily for many years, or who quit within the past 15 years. Discuss your risk factors with your healthcare professional to decide if screening is appropriate.

Tests to diagnose lung cancer

If lung cancer is suspected, various tests can confirm its presence and rule out other conditions:

• Imaging tests such as X-ray, CT, MRI, or PET scans to determine the size and location of cancer
• Sputum cytology, examining mucus coughed up from the lungs for cancer cells
• Biopsy, removing tissue samples for lab testing

Biopsy methods include:
• Bronchoscopy, passing a lighted tube with a camera into the lungs to collect tissue
• Mediastinoscopy, making an incision at the base of the neck to take samples from lymph nodes
• Needle biopsy, guided by imaging to collect lung tissue through the chest
• Biopsy from lymph nodes or other areas where cancer may have spread

Lab testing of biopsy samples determines the type of lung cancer and helps guide prognosis and treatment.

Tests to determine the extent of the cancer

Once diagnosed, further tests determine if the cancer has spread and help stage the disease. Staging often involves imaging such as MRI, CT, PET scans, or bone scans.

Lung cancer stages range from 1 to 4:
• Stage 1 indicates small cancer localized to the lung
• Stage 4 means cancer has spread to other parts of the body

In small cell lung cancer, stages may be called limited or extensive. Limited stage affects one lung and nearby areas, while extensive stage has spread to the other lung or distant sites.

More Information
Lung cancer care at Mayo Clinic
Bone scan
Bronchoscopy

Treatment

Lung cancer treatment usually starts with surgery to remove the cancer. If the cancer is large or has spread, treatment may begin with chemotherapy or radiation instead. Treatment planning considers overall health, cancer type and stage, and patient preferences. Some individuals may choose comfort care instead of active treatment.

Surgery

Surgical options include:
• Wedge resection, removing a small lung section with the tumor
• Segmental resection, removing a larger portion of the lung
• Lobectomy, removing an entire lobe
• Pneumonectomy, removing an entire lung

Lymph nodes may also be removed for testing. Surgery may be preceded or followed by chemotherapy or radiation to shrink cancer or target remaining cells.

Radiation therapy

Radiation therapy uses high-energy beams to target cancer. It may be used before or after surgery, often combined with chemotherapy. Radiation can also relieve symptoms in advanced cases.

Chemotherapy

Chemotherapy uses strong medicines to kill cancer cells. It may be given intravenously or orally in cycles with recovery periods. Chemotherapy can be used before surgery to shrink tumors, after surgery to eliminate remaining cancer cells, alone, or with radiation therapy. In advanced cancer, it helps manage symptoms.

Stereotactic body radiotherapy

This intense, precise radiation treatment targets cancer from multiple angles, usually completed in one or a few sessions. It may be an option for small lung cancers or cancers that have spread, including to the brain.

Targeted therapy

Targeted therapy uses medicines that attack specific chemicals in cancer cells, causing cell death. It is used for cancers that spread or recur and is effective for patients with specific DNA changes in their cancer cells.

Immunotherapy

Immunotherapy helps the immune system recognize and kill cancer cells. It may be used after surgery or when surgery is not an option to control the cancer.

Palliative care

Palliative care focuses on relieving symptoms and improving quality of life. A care team including doctors and nurses provides support during treatment. Palliative care can be provided alongside surgery, chemotherapy, or radiation, helping patients feel better and potentially live longer.