Lung Cancer - Diagnosis and Treatment

Diagnosis

Screening for Lung Cancer in People Without Symptoms

Doctors recommend yearly screening for adults at higher risk for lung cancer. People age 50 or older who have smoked heavily for many years often qualify for screening.

This may also include those who quit smoking within the past 15 years. Doctors use a low-dose CT scan as the main screening test. This test can help find lung cancer early, sometimes before symptoms appear.

Screening is not suitable for everyone. A healthcare professional will help decide if screening is needed by considering age, smoking history, and family risk factors.

Who May Be Offered Lung Cancer Screening

Risk Factor	Screening Advised?
Age 50 or older	Yes
Smoked for 20+ pack-years	Yes
Quit smoking less than 15 years ago	Yes
Never smoked	No
Under age 50	Usually No

Exams and Procedures Used to Find Lung Cancer

If someone shows lung cancer symptoms or if a screening test raises concern, doctors use several tests to confirm the diagnosis. These tests can also help rule out other causes of symptoms.

Imaging Tests: Chest X-rays, CT scans, MRIs, and PET scans create pictures of the inside of the body. These tests can show abnormal areas, the size of a tumor, or if it has spread.
Sputum Cytology: If a person coughs up mucus, doctors may check it under a microscope. This can sometimes show lung cancer cells.
Biopsies: Doctors remove a piece of tissue and study it in a lab to confirm lung cancer. There are several ways to get tissue:
- Bronchoscopy: Doctors insert a tube with a camera into the lungs through the mouth or nose. They look at the airways and take tissue samples.
- Needle Biopsy (Fine Needle Aspiration): A thin needle is guided into the lung using an X-ray or CT scan to remove cells.
- Mediastinoscopy: Doctors use special tools through a small cut near the neck to collect samples from lymph nodes.
- Surgical Biopsy/Pleuroscopy: Surgeons may perform surgery to get bigger tissue samples if other tests are unclear.
Other Tests:
- Thoracentesis: If fluid collects around the lungs, doctors take a sample and check it for cancer cells.
- Blood Tests and Molecular Testing: Doctors check blood and tissue for genetic changes. This helps them find the specific type of lung cancer, such as non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC), and guides treatment options.
- Endobronchial Ultrasound: Doctors attach an ultrasound probe to a bronchoscope to look at lymph nodes and get samples without surgery.
- Liquid Biopsy: This newer test checks a blood sample for cancer cells or DNA from the tumor.

Tests That Show How Far Lung Cancer Has Spread

After doctors find lung cancer, they use more tests to see if it has spread beyond the lungs. These tests help determine the stage of the cancer, which guides treatment.

Imaging Tests for Staging:

MRI: Checks the brain, spine, or other organs for cancer.
CT scan: Looks for spread within the chest or other body parts.
PET scan: Shows active cancer cells in the body.
Bone scan: Detects cancer that may have spread to bones.

Doctors choose tests based on symptoms and risk factors.

Lung Cancer Staging:

Stage 1: Cancer is in one small part of the lung.
Stage 2 & 3: Cancer is larger or in nearby lymph nodes.
Stage 4: Cancer has spread to other parts of the body.

For small cell lung cancer, doctors may use:

Limited: Cancer in one lung and area around it.
Extensive: Cancer in both lungs or distant parts of the body.

Treatment

Surgical Options

Doctors often use surgery when lung cancer is found early and has not spread. The goal is to remove the cancer and a small part of healthy lung tissue.

Surgeons may perform different procedures, such as:

Wedge Resection: Removes a small, wedge-shaped piece with the tumor and some healthy tissue.
Segmental Resection: Takes out a larger part of the lung but leaves much of the lung intact.
Lobectomy: Removes an entire lobe of the lung.
Pneumonectomy: Removes the whole lung when cancer is widespread.

Surgeons may also remove lymph nodes near the lungs to check for cancer. Doctors may use surgery alone or combine it with other treatments, depending on the cancer’s size and spread.

Sometimes, doctors give chemotherapy or radiation before surgery to shrink larger tumors, or after surgery to lower the risk of cancer returning.

Video-assisted thoracic surgery (VATS) is a less invasive method. Surgeons use small cuts and a camera to help remove the tumor. Recovery may be quicker with VATS, and people may have less pain afterward.

High-Energy Radiation Treatment

Doctors use radiation therapy to target and destroy cancer cells with focused beams, such as X-rays or protons. A large machine moves around the patient and aims energy at the tumor.

Doctors may give radiation:

Before surgery to shrink tumors.
After surgery to destroy any cancer cells left behind.
At the same time as chemotherapy to boost effectiveness.

If the cancer has spread, radiation can help with symptoms like pain, coughing, or trouble breathing. Doctors often recommend radiation for people who cannot have surgery.

Treatments usually follow a schedule, such as daily sessions on weekdays for several weeks. Common side effects include tiredness and skin changes in the treated area.

Medicine-Based Cancer Treatment

Doctors use chemotherapy to kill cancer cells with strong drugs, often given through a vein or as pills. Treatments happen in cycles over several months, with breaks for recovery.

Doctors use chemotherapy to:

Shrink tumors before surgery (neoadjuvant therapy).
Attack leftover cancer cells after surgery (adjuvant therapy).
Work with radiation if surgery is not possible.
Reduce symptoms in advanced cancer (palliative chemotherapy).

Side effects may include hair loss, nausea, and tiredness. Many people manage these effects with help from their healthcare team.

Common chemotherapy medicines include platinum-based drugs, often combined with other agents.

Precision Radiation: Stereotactic Therapy

Doctors use stereotactic body radiotherapy, also called stereotactic radiosurgery, to target cancer with very focused, high doses of radiation from several angles. This approach often treats small tumors, especially when surgery is not possible.

Doctors also use this method to treat lung cancer that has spread to other organs, such as the brain. Treatment usually finishes in just a few sessions.

Advantage	Details
Short treatment time	Often finished in 1–5 visits
Focused approach	Less damage to healthy tissues
Used for small tumors	Good option if surgery is not safe
Multiple targets	Can treat tumors that have spread (metastases)

Medicines Targeting Cancer Genes

Doctors use targeted therapy medicines to find and block specific molecules in cancer cells. These drugs work differently than standard chemotherapy and are designed for people whose tumors have certain gene changes.

Doctors test a sample of the cancer in a lab to check for mutations that targeted medicines can attack. If they find a match, these medicines can block the cancer cell’s signals and stop them from growing.

Some gene mutations treated this way include changes in EGFR, ALK, and ROS1 genes. Not all lung cancers have these mutations, so testing is necessary.

Doctors often use targeted therapy for cancer that has come back or spread to other parts of the body.

Boosting the Body’s Defenses

Doctors use immunotherapy to help the immune system recognize and attack cancer cells. Some lung cancer cells hide from immune defenses, but immunotherapy removes these blockades so immune cells can work better.

Doctors often use medicines called checkpoint inhibitors for advanced lung cancer. These medicines are usually given through a vein.

Immunotherapy may be used alone or with other treatments, such as after surgery or with chemotherapy. People using immunotherapy might have side effects like tiredness, rash, or inflammation.

Helps immune cells find and kill cancer.
Can be used when other treatments are not working.
May bring different side effects than chemotherapy.

Comfort and Symptom Management

Palliative care helps people with cancer feel as comfortable as possible. A team of health professionals, including doctors, nurses, and therapists, supports both the person and their family.

Palliative treatment does not cure cancer, but it helps with:

Managing pain
Relieving symptoms like breathlessness or coughing
Providing emotional and practical support

People can get palliative care at the same time as treatments like surgery, chemotherapy, or radiation. It aims to improve quality of life and help families cope with serious illness.

Lifestyle and home remedies

Ways to Stay Calm

Feeling out of breath can cause stress and worry, which may make breathing harder. Taking steps to stay calm can help. People might listen to soft music, try meditation, imagine a peaceful place, or say a quiet prayer to relax.

Choosing Supportive Positions

Sitting or leaning forward slightly can help open the airways and make breathing easier. People can try different body positions to see what helps most. A comfortable chair or a pillow for support can also provide relief.

Paying Attention to Breathing

Breathing exercises can help manage shortness of breath. One technique is to breathe in slowly through the nose and out through pursed lips to slow each breath.

Matching breathing pace to activities like walking may also help reduce discomfort.

Saving Strength for Priorities

Daily tasks can feel overwhelming when energy is low. Making a list helps a person decide which activities matter most. Saving energy for important tasks, resting between activities, and asking family or friends for help can make a difference.

Alternative Medicine

Stimulation With Fine Needles

Acupuncture involves placing fine, sterile needles at certain points on the body. A skilled professional performs this procedure.

Some people with lung cancer use acupuncture to ease pain and reduce side effects from their main treatments, such as nausea or vomiting.

Guided Relaxation Therapy

A therapist guides patients through calming and relaxing thoughts during hypnosis. The person may focus on soothing images or ideas.

This practice can help reduce anxiety, manage pain, and lessen nausea during cancer treatments.

Manual Tissue Manipulation

A trained therapist uses gentle pressure on muscles and soft tissues during massage therapy. People with lung cancer may feel less pain, experience less stress, and find comfort from this technique.

Some therapists focus on working with cancer patients to keep massages safe and personalized.

Quiet Mindfulness Practice

Someone practicing meditation spends quiet time focusing on a thought, image, or sound. This activity can lower stress and improve quality of life during cancer care.

Many styles exist, and a simple daily routine can help people feel calmer.

Gentle Movement and Breathing

Yoga includes easy stretches, slow breathing, and moments of meditation. People with lung cancer often use yoga to sleep better, relax, and support overall well-being.

Yoga routines can be changed to fit different physical abilities. This makes yoga accessible for most people.

Guidance and Support

Understanding Lung Cancer and Making Care Choices

Learning about lung cancer and treatment choices helps people make informed decisions about their care.

Asking the healthcare team for details, such as test results and treatment plans, gives a clearer picture of what to expect.

Request easy-to-read materials from doctors.
Write down questions before appointments.

Staying Connected with Loved Ones

Friends and family provide both emotional and practical help. Support may include help at home, childcare, or rides to appointments.

Close connections can bring comfort during stressful times.

Ways Friends or Family Can Help	How It Supports Well-being
Doing chores	Reduces daily stress
Listening	Eases emotional burdens
Giving rides	Makes trips less tiring

Reaching Out for Emotional Support

Talking to someone about fears and hopes can make it easier to handle the emotional side of cancer. This could be a relative, a close friend, or a professional.

Support groups, counselors, and faith leaders also offer understanding and advice.

Ask healthcare providers about local or online groups.
Consider joining a cancer support group.
Look for information from the National Cancer Institute or the American Cancer Society.

Getting Ready for Your Medical Visit

Steps You Can Take Before Your Visit

Getting organized before meeting with a healthcare provider makes the appointment more useful. Here are some practical steps:

Check for any special instructions. When booking, ask if you need to do anything before the visit, such as fasting or avoiding certain foods.
List your symptoms. Write down any health changes you’ve noticed, even if they don’t seem related to your main concern.
Record personal details. List any stressful events and recent changes in your daily life.
Bring current medication information. Make a list or bring all prescription and over-the-counter drugs, vitamins, and supplements you use.
Collect your health records. If you have had chest X-rays or scans at other clinics, get copies to share during your visit.
Ask someone to come with you. A friend or family member can help you remember details from the appointment.
Prepare your questions. Write your questions in order of importance.

A sample checklist to bring:

Item	Done (✔)
Asked about restrictions.
Listed all symptoms.
Noted major life events.
Brought medications or a list.
Gathered medical records.
Invited a support person.
Written down key questions.

Important Topics to Discuss if Diagnosed with Lung Cancer

If you learn you have lung cancer, being ready with questions for the care team helps you use your time well.

Suggested questions in order of usefulness:

What type of lung cancer is this?
Can I see my X-ray or scan?
What could be causing my current symptoms?
What is the cancer stage?
Will I need further testing?
Should my cancer cells be checked for gene changes to find the best treatment?
Has the cancer spread elsewhere?
What treatment options are available?
Could any treatments possibly cure the cancer?
What side effects might I experience from each treatment?
Is there a preferred treatment option in my case?
Would quitting smoking now improve my health or outcomes?
What would you recommend if someone you care about was in my position?
What happens if I decide against treatment?
What can help with the symptoms I have?
Are clinical trials an option for me?
Should I meet with a specialist? How much does that cost, and what does insurance cover?
Can I have printed information or resources to review at home?

Bring your list of questions. Mark the most urgent ones. Write down answers for future reference.

What Questions the Healthcare Provider May Ask

Doctors often ask for more details to better understand symptoms and medical history.

Knowing what questions a doctor may ask helps you get ready with the necessary information.

They might ask:

When did symptoms first start?
Are symptoms present all the time or do they come and go?
How bad are the symptoms on a typical day?
Do you wheeze when breathing?
Is there a cough that feels like clearing the throat?
Have you ever received a diagnosis of emphysema or COPD?
Do you use any medications for breathing trouble? If so, which ones?
What makes the symptoms feel better?
What seems to make them worse?

How to prepare for these questions:

Keep a simple diary of symptoms and triggers.
Note how symptoms change during the day.
List any patterns or new observations.

Lung Cancer – Diagnosis and Treatment