Shamard Charles, MD, MPH is a public health physician and journalist. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.
Brian Bezack, DO, is board-certified in pediatric pulmonology and pediatrics. He is the sole practitioner and owner of Bezack Pediatric Pulmonology in Commack, NY.
Lung cancer is the number one cause of cancer death in the United States, taking more than 130,000 lives in 2021. Someone is diagnosed with lung cancer every two and a half minutes, roughly 646 people per day.
The symptoms of lung cancer—cough, shortness of breath, hemoptysis, pallor, and fatigue —are often insidious and non-specific, so they are easily confused with other medical conditions.
Treatment involves a multidisciplinary team, including:
Lung cancer is often insidious—producing no symptoms until the disease is in its advanced stages. This underscores the importance of routine check-ins with a healthcare provider, especially if you are at high risk.
You are considered at high risk of lung cancer if you are:
The first steps in investigating abnormal symptoms are:
On observation, your healthcare provider may note:
Low blood pressure and oxygen saturation (O2 Sat) levels are common in those with lung cancer.
An increased breathing rate (tachypnea) and an increased heart rate (tachycardia) may also be observed, but these signs are non-specific and, therefore, less meaningful in diagnosing lung cancer.
A chest X-ray is usually the first imaging modality that is ordered if there is any suspicion of lung cancer because it is quick and inexpensive to do. It is a painless scan that uses radiation to show tumors. CXRs usually pick up masses that are one centimeter wide or larger.
CT scans are an imaging technique that uses low-radiation X-ray beams to take pictures of the inside of your body. It is particularly helpful in diagnosing lung cancer because it can detect smaller lung cancers and provide more details than a CXR.
Also known as lung function tests and spirometry, PFTs are a series of tests that assess lung function by measuring how much air the lungs can hold and how quickly the lungs can be filled with air and then emptied.
A blood sample may be tested to check the number of red blood cells, white blood cells, and platelets (complete blood count) and to see how well your kidneys and liver are working.
Lung cancer can throw off these numbers, so comparing your baseline numbers to your current numbers can help provide details on potential changes resulting from your lung cancer.
A bronchoscopy is a specialized procedure where a healthcare provider places a scope with a built-in camera through a sedated person’s mouth, down the airway, and into the lungs to examine the lung tissue.
Lung masses with increased vascularization, irregular shape, or a hard, immovable nodule are concerning and will usually prompt your healthcare provider to remove a piece of tissue for biopsy.
A biopsy involves extracting a piece of tissue from the lung and then examining it under a microscope.
If your oncologist identifies tissue that looks concerning, they will send a piece of the tissue to a pathologist for examination. A biopsy is not only important for diagnosis but also staging and functional evaluation, all of which affect treatment planning and determination of prognosis.
In order to confirm your diagnosis, the below tests and procedures may occur.
Repeat CT scans and X-rays may be performed semi-routinely throughout the course of your treatment.
Positron emission tomography (PET) is a commonly used imaging modality that is used with CT to confirm the diagnosis of lung cancer and assess how your lung cancer is responding to treatment.
PET involves injecting a small amount of radioactive tracer, usually fluorodeoxyglucose (FDG), into a person's bloodstream. The body takes up the radiotracer and is taken up by the body like glucose. Active cancer cells will take up the glucose-like radiotracer giving off a red-orange color on the PET scanner, like simple sugar glucose.
A PET Scan is especially useful for restaging lung cancer following treatment and providing additional information on the histology of your lung cancer.
A biopsy is used to examine lung tissue for the presence of cancer cells. This can be done by taking a piece of tissue via bronchoscopy, fine need aspiration, or surgical incision.
Sometimes a repeat biopsy may be used to confirm a suspicion of lung cancer if the diagnosis is unclear.
A pulmonologist is a healthcare provider specializing in treating lung diseases.
A pulmonary oncologist specifically specializes in the treatment of lung cancer.
Your care team may also include:
Nurses, nurse practitioners, and physician’s assistants support these healthcare providers.
There is no one-size-fits-all approach to cancer treatment.
Comprehensive treatment of your lung cancer will require seeing multiple specialists and other healthcare providers. Input from a team of healthcare providers is often needed to develop an effective, detailed, and personalized treatment plan.
Shared decision-making is key to achieving patient-centered health care. This process, involving collaborative decision-making between clinicians and individuals, is the best way to meet your health goals. It’s also important to remember that while you have the final say on your treatment options, shared decision-making means that you don’t have to make crucial decisions alone and increases the likelihood that you will stick to your treatment plan even if you have setbacks.
A detailed physical exam is the first step in determining lung cancer diagnosis. Lung cancer may present with little to no symptoms, or non-specific symptoms such as cough, shortness of breath, hemoptysis, pallor, and fatigue.
The physical exam is one of the initial methods used to diagnose lung cancer. Even an experienced healthcare provider will need to use additional modalities like imaging, blood tests, and taking a detailed medical history to make a diagnosis. After diagnosis, your primary healthcare provider will help coordinate care from a multidisciplinary team of specialists who will help you develop a personalized treatment plan that is best for you.
A lung specialist will perform a lung biopsy if they identify any abnormal tissue that requires further investigation. The threshold for biopsy is much lower in those at high risk for lung cancer.
Early lung cancer may not cause any symptoms. Even if it presents symptoms, it may easily be confused with other medical conditions like asthma and pneumonia. Overt symptoms such as shortness of breath on exertion and coughing up blood (hemoptysis) usually appear after significant lung damage.
The following specialists work in a multidisciplinary team to treat lung cancer:
No physical exam is ever 100% accurate, but when combined with laboratory tests, imaging, and clinical experience, the physical exam can yield highly accurate results.
People who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke. Even more, roughly 40% of lung cancer cases occur in people who have quit smoking more than 15 years before their diagnosis. Therefore, the U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography in adults who currently smoke or have a long history of smoking and have quit in the past 15 years.
American Lung Association. Key statistics for lung cancer.
Kowalczyk A, Jassem J. Multidisciplinary team care in advanced lung cancer. Transl Lung Cancer Res. 2020;9(4):1690-1698. doi:10.21037/tlcr.2019.11.33
Hochhegger B, Alves GR, Irion KL, et al. PET/CT imaging in lung cancer: indications and findings. J Bras Pneumol. 2015;41(3):264-274. doi:10.1590/S1806-37132015000004479
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