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How do you diagnose it?
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Patients typically undergo a number of diagnostic tests before a definitive diagnosis of lung cancer can be made. As with any cancer, early detection is critical to improving chances for survival. John Muir Health offers the full spectrum of advanced technology used in diagnosing lung cancer. Our comprehensive capabilities include an exceptional team of radiologists and pathologists with a broad experience base in lung cancer, ensuring that patients receive an accurate and timely diagnosis.
When cancer is suspected, a number of imaging tests will be used to gather information about the tumor and any local or distant spread. A conventional chest x-ray is typically the first imaging test ordered to look for any mass or spot on the lungs. Physicians may also order a CT scan (computed tomography) to further assess any abnormalities observed on the chest x-ray. CT is a computer-enhanced x-ray procedure that provides a high level of structural detail by recording cross-sectional images from many different angles. Smaller tumors not visible on a chest x-ray, enlarged lymph nodes, and/or metastases to distant sites can be viewed on a CT scan.
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A new, state-of-the-art diagnostic tool now available at John Muir Health is an integrated CT and PET scanner. PET (positron emission tomography) scanning entails the injection of a special radionuclide glucose (radioactive sugar) that migrates to areas of high metabolic activity in the body, which are indicative of cancer. The integrated scanner enables the simultaneous assessment of suspicious areas. Patients benefit from the convenience of undergoing a single diagnostic procedure instead of separately administered scans. This important new technology brings together the capabilities of two key imaging modalities, and arms the physician with an unprecedented level of information as to the size, location, and any spread of the cancer.
MRI (magnetic resonance imaging) is another test that is sometimes used in the diagnosis of lung cancer. Using a powerful magnetic field to gather data, MRI provides a high level of precise detail, and is especially useful in finding cancer that has metastasized to other areas of the body.
Sputum cytology is a relatively simple test in which a sample of sputum (phlegm) coughed up from the lungs is examined under the microscope, using special stains that point out cancerous or precancerous cells.
Patients may also undergo a biopsy procedure, in which lung tissue samples are collected for examination under a microscope. Biopsy samples can be obtained via several different methods, depending on the location of the tumor.
Bronchoscopy is a procedure in which the lungs can be directly viewed through a flexible, lighted fiberoptic tube (the bronchoscope), which is passed through the nose and throat into the bronchi. Tissue samples from suspicious areas can be removed through the bronchoscope for microscopic analysis.
To evaluate areas of the lung not accessible with bronchoscopy, physicians may perform a needle biopsy, in which a needle is carefully guided through the chest into the lungs, under the guidance of fluoroscopy. (Fluoroscopy is similar to an x-ray, but the image is viewed on a screen rather than on film.) A tiny tissue sample is withdrawn through the needle, and examined under a microscope. A state-of-the art enhancement of this technology, known as core needle biopsy, is now available at John Muir Health, where using a higher-capacity needle, larger tissue samples are garnered, providing more reliable information to the oncologist.
Thoracoscopy is another important minimally invasive diagnostic procedure available at John Muir Health. During this procedure, the surgeon can visually examine the surface of the lung, and the space between the lung and the chest wall (pleural space), using a thin, lighted tube (thoracoscope) connected to a video camera. The thoracoscope is introduced into the pleural space through a small incision in the chest wall. Samples of tissues can be removed through the thoracoscope and examined under a microscope. Thoracoscopy can potentially be used to assist in the diagnosis of lung cancer, as well as the treatment of complications of lung cancer.
In certain cases, when adequate diagnostic information cannot be obtained using minimally invasive technology, surgeons may need to perform a surgical procedure known as a thoracotomy. Thoracotomy is a major "open" surgery, in which the chest wall is opened to view the lungs. Although this procedure allows excellent visualization of the lungs, it entails a lengthy recuperation for the patient and greater risk of complications, so less invasive procedures are preferred wherever possible.
Staging
Once a definitive diagnosis of lung cancer has been reached, your physician will need to "stage" your cancer - or determine how far the tumor has spread - to devise the best treatment plan. Staging is based on information gathered from the diagnostic tests described above, or any other tests that may have been ordered, including routine laboratory tests. Staging of non-small cell lung cancer is based on the TNM classification system, which assesses the extent of the primary tumor, lymph node involvement, and any distant metastases. Classification ranges from Stage 0 (early-stage cancer) to Stage IV (metastatic cancer). A detailed discussion of the various stages of lung cancer and the appropriate treatment options for each can be found at: www.cancer.gov/cancer_information/cancer_type/lung.
For small cell lung cancer, a different staging system is used. The cancer is classified as either limited or extensive, referring to the extent of cancer spread within the body, as determined by your physician.
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