A biopsy (tissue sample) is essential to the diagnosis. A specialist called a pathologist (a doctor who identifies disease by studying cells and tissues) should evaluate the tissue sample to determine whether and how the cells are cancerous.

Lung cancer specialists focus on the diagnosis and treatment of this disease. Thoracic surgeons tend to be considered the most expert surgeons for lung cancer. They are specifically trained in either cardiac (heart) or thoracic (lung) surgery. Also, consider scheduling a consultation with an oncologist (a doctor who specializes in cancer). Oncologists know about up-to-date, chemotherapy and non-chemotherapy treatments that may be appropriate.

Important Considerations in Choosing a Lung Cancer Specialist

In diagnosing lung cancer, a doctor obtains a detailed history of your health that includes:

Health History - Including information about smoking, exposure to environmental risk factors, and any significant symptoms such as nagging cough, shortness of breath, fatigue, back or chest pain. 

Genetic History - Including questions that may indicate a genetic predisposition to lung cancer.

Physical Exam -  During the physical exam, your doctor will listen to your lungs and the sounds of your breathing (and may request special breathing or pulmonary function tests to determine if breathing is impaired), check for swollen lymph nodes in the neck or the region above the collarbones and feel the liver to see if it is enlarged or if any masses are present in the abdomen.

Diagnostic Tests - Your doctor may use several diagnostic tests. The most common include CT and MRI scans. CT (computed tomography) and MRI (magnetic resonance imaging) use computers to produce detailed, three-dimensional images that help diagnose lung cancer and can determine the size, shape, and location of a tumor.

PET Scans (Positron Emission Tomography) - These scans identify rapidly dividing tumor cells. PET scans may give a more accurate picture of the stage of NSCLC, often as a follow-up to other tests or to diagnose recurrent disease. However, there is no conclusive evidence that PET scans can replace pathologically staging lymph nodes at the initial diagnosis.

Sputum Cytology - If cancer cells are in the bronchi, some are likely to be carried up the throat in mucus from the airways called sputum, which can be examined for signs of cancer. Sputum can be coughed up or collected through a tube called a bronchoscope. This technology can find cancer cells long before a tumor is evident on other tests, but it may not detect cancers deeper in the lungs and cannot determine a tumor's size or location.

Genetic Markers - A gene or DNA sequence has a known location on a chromosome and is associated with a particular gene or trait. Genetic markers are associated with certain diseases and cancers.

If any of the diagnostic tests find something suspicious, your doctor will request one or more follow-up tests for more information:

Biopsy - A biopsy is the only reliable way to confirm the presence of cancer and identify its type and stage. In this procedure, a small piece of tissue is removed either through a thin needle (needle aspiration) or surgery with anesthesia as appropriate. Biopsies of the chest lining, lymph nodes, bone, or liver also may be done.

Bronchoscopy - This procedure involves the use of a flexible tube-like instrument called a bronchoscope to view the airways into the lungs and to collect tissue samples.

In a newer technique known as auto-fluorescence bronchoscopy, chemical properties of tumor cells cause them to reflect light (fluoresce) differently than normal cells. If the cells do not fluoresce normally, a sample is taken to determine whether they are cancerous.

Endoscopic Bronchial Ultrasound (EBUS) - This procedure uses a bronchoscope with ultrasound that can visualize more distant airways and aid in diagnosis.

Mediastinoscopy - In this procedure, a rigid instrument called an endoscope is inserted through a small incision in the neck or chest into the area known as the mediastinum. This procedure determines whether cancer has spread to lymph nodes near the trachea—one of the first places lung cancer is likely to spread.

Thoracentesis - If fluid is collecting between the lungs and the chest wall, this procedure is used to extract some of the fluid through a needle to see if cancerous cells are present.

Thoracoscopy - An instrument called a thoracoscope is inserted through a small incision in the chest wall to allow examination of the lining of the chest wall and the surface of the lungs for tumors.

Video-Assisted Thoracic Surgery (VATS) - Sometimes used to diagnose lung cancer.

Endoscopic Ultrasound - A scope with an ultrasound is placed into the esophagus. Regional lymph nodes can be closely visualized and biopsied.

Once the results from the test or procedure are returned you will be able to make thoughtful decisions. Please see Newly Diagnosed  for information on being patient active, treatment decisions, partnering with your healthcare team and finding support. 

Receiving a cancer diagnosis is difficult. Please see Caregivers and/or Online Support for more information on how the Cancer Support Community can offer support.

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