Lung Cancer Diagnosis and Staging

An X-ray of the chest can show many abnormal areas in the lungs.

A computed tomography (CT) scan rapidly generates X-ray images of a series of layers of your chest, which can be combined to create a 3-D view of your lungs and surrounding areas. Scripps offers the latest CT technology, including several low-dose CT scanners that reduce radiation exposure and its associated risks.

A positron emission tomography-computed tomography (PET-CT) scan of the chest helps provide an accurate assessment of lung tissue structure and function. A chest PET-CT scan allows a physician to determine if a patient with lung cancer is a candidate for specific surgeries or other types of treatment.

Magnetic resonance imaging (MRI) helps provide detailed images of soft tissues. A chest MRI is used to look for tumors in the chest, as well as to see blood vessels, lymph nodes and other structures. It can include the injection of contrast dye into a vein to capture more detailed pictures.

This interventional procedure allows physicians to view the chest wall and surrounding lymph nodes for potential cancer and remove a tissue sample for biopsy. During the EBUS procedure, an endoscope equipped with an ultrasound camera and biopsy instrument is inserted through the patient’s mouth into the trachea, esophagus or chest to biopsy the lung cancer or nearby lymph nodes.

Using a tube-like device inserted into the nose or mouth and through the patient’s windpipe (trachea), the physician can view the upper airways and lungs, perform biopsies and clean excess secretions from the lungs.

Electromagnetic navigational technology adds the advantage of enhanced ability to locate and reach smaller and more difficult-to-reach lesions using CT images and a 3-dimensional mapping system. This is a much less invasive alternative to surgery. 

Ultrasound guidance is another minimally invasive technique used to guide biopsies of lungs, pleural cavities or lymph nodes.

Also known as thorascopy, video-assisted thorascopic biopsy for lung cancer requires only small incisions made while the patient is under anesthesia. The instrument, inserted between the ribs, allows physicians to see inside the chest cavity and remove growths close to the outer areas of the lung for testing to determine if they are cancerous.

Using a small needle inserted into the tumor, the physician uses suction to remove a tissue sample, which is then examined under a microscope.

The American Joint Committee on Cancer (AJCC) uses the TNM system to stage non-small cell lung cancer. This complex system is based on three aspects of the cancer:

• T indicates the size of the main (primary) tumor and if it has grown into nearby areas.
• N indicates whether the cancer has spread to nearby (regional) lymph nodes. Cancers often spread to lymph nodes before they affect other parts of the body.
• M indicates whether the cancer has spread (metastasized) to other parts of the body. Non-small cell lung cancer most often spreads to the brain, bones, adrenal glands, liver, kidneys, and the other lung.

Numbers or letters following T, N and M provide more details about each factor. Higher numbers indicate more advanced cancer. 

When each category has been determined, the information is grouped and an overall stage is assigned.

The TNM staging system is complicated and can be challenging to understand. If you have questions about your lung cancer stage, talk with your physician.

Limited stage

Cancer is in one lung and possibly in lymph nodes on the same side of the chest.

Extensive stage

Cancer has spread to the other lung, to lymph nodes on the other side of the chest, to the fluid around the lung or to other parts of the body.

Staging for lung carcinoid tumors is the same as non-small cell lung cancer staging.