A lung cancer diagnosis requires a series of tests. If they show you have it, you’ll need additional tests to determine the type of lung cancer and how advanced it is. Together, the tests provide information that can help your doctor recommend how to treat the disease.
Chest x-rays are a preliminary test. They show tissue masses such as tumors, pus formations known as abscesses and other lung conditions. But x-rays are unable to differentiate many conditions, so if a mass show up, you’ll need additional tests.
X-ray machines use small amounts of radiation to take a two-dimensional picture of the chest cavity. Some lung tumors appear as a white-gray mass. Other tumors don’t show up because they’re too small or in a difficult-to-detect position, such as behind bones.
If a chest x-ray suggests lung cancer, specialists will perform tests to confirm the disease, to identify the type of lung cancer it is, and to see if it has spread.
Computerized tomography, or a CT scan, is usually the first test that confirms lung cancer. It uses a combination of x-rays and a computer to create more detailed images than x-rays alone.
Before someone has a CT scan, a medical specialist will inject a contrast medium into their bloodstream. The dye-containing liquid makes the scanned images clearer.
A CT scan can detect tiny tumors and provide three-dimensional imaging of them. It can also help determine whether a tumor has spread to the lymph nodes that surround the lungs. A CT scan takes between 10 and 30 minutes, is painless, and safe.
Magnetic resonance imaging
Magnetic resonance imaging, or MRI, is an imaging technique that uses magnetic fields to create clear images of any tumors a person has. MRI is the most sensitive test used to look for lung cancer that has spread to the brain.
Positron emission tomography
Positron emission tomography, or a PET scan, is an imaging technique that can detect whether lung cancer has spread to other parts of the body.
It is based on the notion that cancer cells use more glucose, or sugar, to generate energy than normal cells — due to their high level of activity. Before the test, a medical professional will inject a special sugar solution into a person’s bloodstream. The solution accumulates in areas with a lot of activity, lighting up the scan. These areas may indicate the presence of cancer.
As the name implies, a PET-CT scan combines PET and CT imaging. Positron emission tomography-computerized tomography provides a more accurate picture of what is going on in the body than either a PET or CT scan alone.
Doctors use a PET-CT scan to follow up on a CT scan that shows an early stage of lung cancer. A PET-CT scan detects active cancer cells, helping doctors both diagnose and treat the disease. A specialist will inject a radioactive material into a person’s bloodstream before a PET-CT scan. The scan takes 30 to 60 minutes and is painless.
Doctors may also ask a patient for a biopsy to confirm the presence of lung cancer and determine the type. A specialized doctor called a pathologist removes tissue samples or fluids suspected of harboring cancer. The samples are then examined under a microscope.
Depending on the size and position of a tumor, there are several ways to obtain tissue or fluid for the biopsy. They include bronchoscopy, percutaneous needle biopsy, autofluorescence bronchoscopy, endobronchial ultrasound, mediatinoscopy, thoracentesis, thoracoscopy, and electromagnetic navigation.
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