Diagnosing Non-Small Cell Lung Cancer (NSCLC)

Overview

Non-small cell lung cancer (NSCLC) is a type of cancer where harmful cells grow in the lung tissues. It is often linked to smoking. Symptoms include a persistent cough and difficulty breathing. To diagnose NSCLC, doctors may conduct tests like lung examinations and biopsies. These tests help confirm the presence of cancer cells.

Specialists involved in diagnosing NSCLC may include:

• Pulmonologists: Specialist in diagnosing and treating lung diseases
• Oncologists: Specialist in diagnosis and treating cancer
• Radiologists: Specialist in analyzing imaging studies (such as X-rays, CT scans, MRI scans, PET scans) to identify abnormalities and possible causes of the abnormality
• Pathologists: Specialist in analyzing tissue and other samples to identify abnormalities and possible causes of the abnormality.

Steps are first taken to diagnose NSCLC, then to determine its stage. Diagnosis of NSCLC may include:

• Medical history: The healthcare professional will review a person's symptoms, medical history, medications, family health history, and health-related habits such as smoking habits.
• Physical exam: Doctors conduct a thorough physical examination to assess symptoms and overall health.
• Laboratory tests:
  • Blood tests: Blood tests may be conducted to check for general health of the kidneys, liver and other organs, and for signs of cancer, including NSCLC markers.
  • Sputum tests: Sputum cytology is a test that examines mucus coughed up by the patient over three consecutive mornings to detect cancer cells.
• Imaging tests:
  • Chest X-ray: This may be used to enable the doctor to see the structure of the organs in the chest, including signs of infection or other lung abnormalities
  • CT scans produce detailed 3D images of the lungs to identify tumors.
• Biopsy: A biopsy involves removing a small tissue sample for examination under a microscope, providing a definitive diagnosis. Tests can be done on the sample to help determine the type of cancer.

To determine the stage or severity of NSCLC, additional examinations and tests may include:

• PET scans, often performed alongside CT scans, use a mildly radioactive sugar injection to highlight areas where cancer cells may have spread.
• MRI scans may be used to detect if cancer has spread into the bones.
• Bronchoscopy: This procedure allows doctors to examine the airways and collect tissue samples for biopsy.
• Lymph node testing: If cancer spread to nearby lymph nodes or other parts of the body is suspected, further tests such as endobronchial ultrasound or mediastinoscopy may be performed.

Through the diagnosis process, the healthcare team will obtain information to help guide treatment recommendations, such as:

• Stage: The size of the tumor and whether it is only in the lung or has spread to other parts of the body.
• The type of lung cancer.
• Cancer cell gene mutations or other characteristics: Epidermal growth factor receptor (EGFR) gene, anaplastic lymphoma kinase (ALK) gene

The healthcare team will use this information along with other individual factors, such as a person’s overall health, symptoms from the condition, and individual preferences to determine treatment options.