How Is Lung Cancer Diagnosed? (podcast)

The number one cause of lung cancer still remains cigarette smoking; 90% of lung cancers are related to smoking, either currently or previously.

There are other risk factors, including diesel exposure at work, other occupational exposures, home exposures, such as radon. But primarily, the number one cause of lung cancer is still smoking.

Cancer can be caused by other risk factors too, including genetics. Following up with your primary care physician for any lingering cough and making sure you’re seen sooner rather than later are important. We know early detection is extremely important to decrease the risk of spread of cancer and also increase your survival if you are diagnosed with cancer.

The most prominent symptom is cough. Cough, coughing up blood, shortness of breath, and chest pain are the four most common symptoms.

That’s a great question because we all get sick during the year. Especially during the wintertime, we get a cough, a cold, congestion. The biggest thing is if it’s lingering and if it just doesn’t feel right to you. If it’s been persistent for weeks or even longer and you’ve been putting it off and blowing it off to sinuses, it’s a good thing to get checked out.

Lung nodules are spots we see in the lung. They’re white little dots or areas of haziness that we find on either a chest X-ray or a CAT scan. They’re very vague, and so they can range from anything from a scar from an old pneumonia to some type of other exposure, to a current infection or, unfortunately, sometimes also related to cancer.

Bronchoscopy has been around since the late 1960s and early 1970s. We’ve had our challenges just because how intricate the lung is to get a diagnosis on these spots. Over the years, we’ve had iterations of different tools that allow us to reach into the depths of the lung with more precision and, as of 2018 and 2019, we’ve come with newer platforms that are robotic assisted. What that allows us to do is to get into the depths of the lung with better accuracy.

Robotic bronchoscopy is very similar to you wanting to travel somewhere with your car. There are different phases of the procedure.

The first part is taking the imaging or the CAT scan of our patient and loading it into a system to generate a 3D map. This also shows the intricacy of the lung tissue with all the various air passages and different turns of it.

The computer and the program will generate a pathway for me to get to the actual tumor. Once the endoscope or bronchoscope is inserted into the air passage, we guide that into the lung tissue based upon the robot. I’m essentially holding a game controller like an Xbox controller in my hand, which allows us to navigate and control with extreme precise accuracy to where we want to go and navigate up through the lung tissue to the spot.

Once we get to that spot, we’re able to keep the tip of that scope in position and then pass other tools in there and either take snippets or push a needle into it to take a biopsy that way. It’s really improved our accuracy in terms of reaching these smaller spots. We always say finding a needle in a haystack, so this is like finding that golf ball in the haystack. With this computer-generated system, it makes it very accurate.

We get to within millimeters of the lesion. We’re talking about trying to find something sometimes the size of a pea within our chest. On a scale of things, getting to within a millimeter or two, or within even five millimeters makes a big difference. It becomes a challenge to do that with standard techniques. With the use of robotics, it allows those bends and turns to be manipulated with better accuracy and little fine movements with your hand on the controller makes these fine movements inside the air passage available.

The procedure is done under general anesthesia. You’re completely asleep and comfortable for the entire procedure. The procedure takes roughly about an hour to perform and it’s very safe.

It’s important that if you have any lingering complaint, such as cough or you cough up blood or you’re short of breath or you’re losing weight, that you be evaluated. As soon as we see that evaluation, you’ll get a general sense from your physician if this is something we’re going to treat or watch.

The first step is recognizing that there is something lingering and not blowing it off and being seen by your primary care doctor.

The biggest take home message is, do not start smoking and, if you are smoking, please visit your primary care doctor and come up with a plan to discontinue smoking.

If you do have lingering symptoms, it’s important to be seen by your primary care doctor. Here at Scripps MD Anderson, we have the most innovative treatment available for the management of lung cancer. We’re cutting edge and we’re going to take great care of you.