Diseases & Conditions
Lung Cancer - Diagnostic Procedures
Your multidisciplinary medical team, including thoracic surgeons, at Boston Medical Center’s Center for Thoracic Oncology will work with you and your primary care physician to diagnose lung cancer and determine its severity.
Tests your doctor might recommend to diagnose lung cancer include:
- Blood Tests
- Computed Tomography (CT) Scan
- Endobronchial Ultrasound (EBUS)
- Endoscopic Ultrasound (EUS)
- Magnetic Resonance Imaging (MRI) Scan
- MRI of the Brain
- Needle Biopsy
- Positron Emission Tomography (PET) Scan
- Pulmonary Function Tests (PFT)
- Stress Test
- Ventilation Scan or Perfusion Scan
- Video-Assisted Thorascopic Surgery (VATS)
A common tool for disease screening, blood tests provide information about many substances in the body, such as blood cells, hormones, minerals and proteins.
During bronchoscopy, a small, hollow tube (bronchoscope) is inserted through your nose and throat into the main airway of your lungs. He or she can then see any abnormal areas and extract a tissue sample for analysis.
CT scans use x-rays to create 2-dimensional images of your body, including your lymph nodes. If contrast dye is used to improve the computer image, you may need to avoid eating or drinking for 4 to 6 hours before the test. Be sure to tell your provider prior to the test if you have any allergies or if you have kidney problems.
EBUS is a minimally invasive procedure to assess lymph nodes along the bronchial tubes and frequently complements mediastinoscopy. Your physician will give you a sedative and then insert a bronchoscope through your mouth and trachea and into the lungs and surrounding tissues so that samples can be taken from lymph nodes. EBUS does not require any incisions.
Your physician uses an endoscope (a long, flexible tube) with a small ultrasound transducer on the tip to obtain images of the lymph nodes deep in the chest. This instrument is passed into your esophagus. The transducer sends high-frequency sound waves to the organs to create detailed images of them. You should avoid food and drink for at least 6 hours before the procedure, and you will be sedated, so you should not drive or return to work for 24 hours.
This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be asked to drink a contrast solution for better imaging, and you will most likely lie on a moving table as pictures are taken. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT. MRI may not be recommended if you have a pacemaker or other metal implant.
A MRI of the brain allows the physician to see if lung cancer has spread to the brain. It creates cross-sectional views (slices) of both healthy and unhealthy tissue using powerful magnet and radio signals. Inform your physician if you have a pacemaker or other metal implant.
Your physician makes an incision into or through the middle of the chest bone (sternum) to gain access to the lungs for diagnostic purposes. You should refrain from eating or drinking after midnight prior to surgery, and arrange for a ride home, as you will be given sedatives.
When performing mediastinoscropy, your physician inserts a lighted instrument (mediastinoscope) through a small incision in the neck. He or she is then able to see into the chest cavity where the lymph nodes surround your windpipe and trachea and take a tissue sample if necessary. You should refrain from eating or drinking after midnight prior to surgery, and arrange for a ride home, as you will be given sedatives.
Your physician will apply an anesthetic (numbing agent) and will insert a needle between the ribs and into the chest, guided by CT scan or x-ray. A sample of tissue is obtained and then examined under a microscope in a laboratory.
A PET scan is used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, thus helping physicians diagnose a variety of conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your blood stream. Once it has had time to move through your body, you will lie on a table while a scanner follows the radiotracer and sends 3-D images to a computer screen. Patients are generally asked to wear comfortable clothing and refrain from eating for 4 hours before the scan. Tell your doctor if you are pregnant or breastfeeding. Patients with diabetes should discuss diet guidelines with their physician for the hours leading up to the scan.
A pulmonary function test is used to understand how well your lungs are working. With each breath you take in and breathe out, information is captured about how much air your lungs take in, how the air moves through your lungs, and the how well your lungs deliver oxygen to your bloodstream.
A stress test will provide information about how your heart functions during exercise. Your physician will monitor your heartbeat and blood flow as you walk on a treadmill and will image your heart using a radioactive tracer. This will be used to diagnose any problems as well as plan treatment.
This is a pair of tests used to assess breathing and circulation in the lungs. For the ventilation scan, you inhale a harmless radioactive gas through a mask as your lungs are monitored; in perfusion scanning, you receive an injection of radioactive material in your arm while lying on a table, and then your lungs are scanned as the blood flows through them. Both tests are relatively painless and preparation is generally not necessary. Tell your doctor if you are pregnant or breastfeeding.
VATS is a minimally invasive alternative to open chest surgery that involves less pain and recovery time. After giving you a sedative, the physician will make tiny incisions in your chest and then insert a fiber-optic camera called a thorascope as well as surgical instruments. As the physician moves the thorascope around, images that provide important information are projected on a video monitor. VATS is not appropriate for all patients; you should have a thorough discussion with your provider before making a decision. It is often not recommended in people who have had chest surgery in the past, because remaining scar tissue can make accessing the chest cavity more challenging and thus riskier.
Once the physician has diagnosed lung cancer, he or she will then stage the condition to determine its severity. Cancer spreads (metastasizes) when cancer cells break away from the original tumor and enter the blood stream or the lymph system. Staging indicates how advanced the cancer is, that is, how far it has spread, if at all. The stages are:
- Stage I, the cancer has invaded the underlying lung tissue but has not spread to the lymph nodes.
- Stage II, the cancer has spread to neighboring lymph nodes, and invaded the chest wall.
- Stage IIIA, the cancer has spread from the lung to the lymph nodes, in the center of the chest.
- Stage IIIB, the cancer has spread to local areas, such as the heart, blood vessels, esophagus, or trachea, or to the lymph nodes in the collarbone or to the pleura, tissue that surrounds the lungs.
- Stage IV, the cancer has spread to other parts of the body, such as the liver, brain, or bones.
Based on this evaluation of the cancer, your physician will recommend the appropriate treatments.