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Lung Cancer; Diagnosis.

Lung cancer can cause a number of symptoms, including:

nagging cough

chest, shoulder or back pain, which feels like a constant ache that may or may not be related to coughing

shortness of breath

fatigue and weakness

weight loss

repeated episodes of pneumonia or bronchitis

coughing up blood

hoarseness from left-sided tumors if the nerve that controls the left vocal cord becomes injured

swelling of the neck and face due to a right-sided tumor compressing the superior vena cava, the main vein that drains the upper body

symptoms related to a metastasis, such as headache or weakness from the spread of the tumor to the brain, or back pain related to its spread to the spine.

Symptoms from paraneoplastic syndromes, disorders caused by a hormonal or an immune response of the body to the presence of the cancer, but not due to direct effects of the cancer itself. Examples include certain hormone imbalances, neurologic complications and kidney problems.

A lung cancer may sometimes grow undetected for more than a year without producing symptoms. In fact, lung cancer usually spreads outside the lungs without initially causing any symptoms.

It is difficult to diagnose lung cancer at an early stage. Frequently, people don't have symptoms, or symptoms are vague or attributed to other ailments, such as stress, bronchitis, pulled muscles or pneumonia.

When lung cancer is suspected, a series of tests are conducted to confirm the disease and to determine how widely the cancer has spread (staging). The major tests include:

X-rays: A chest x-ray is frequently ordered as a first step in diagnosis. An x-ray is a two-dimensional picture that can help to locate a tumor. Chest x-rays have some potential as a screening tool, but in comparison to new imaging technologies that achieve a higher resolution, the effectiveness is somewhat limited. Once a tumor can be seen on x-ray, however, it may have already spread into the lymph nodes or elsewhere in the body.

Computed tomography imaging (CT scan) or, on occasion, magnetic resonance imaging (MRI): These tests may help your health care professional confirm a diagnosis suspected from a chest x-ray. CT scans and MRIs use computerized pictures to show very detailed three-dimensional and cross-sectional images of the body. They can depict the size, shape, and location of a tumor. These tools are also used to find out if the tumor has spread from the lung to lymph nodes or other organs in the chest, or to other parts of the body.

Some studies suggest that a new kind of CT scan, called spiral CT, can detect small nodules (early-stage disease) that are not very visible on chest x-rays. An advantage of spiral CT is that an entire scan can be completed in about 15 seconds, much quicker than with a traditional CT. The disadvantage of spiral CT is that it often finds tiny nodules that are not cancerous, yet require additional testing or even major surgery to prove they are benign. Spiral CT scans are also expensive. This technology is still being tested as a screening tool and is not yet widely available. Whether it will affect survival rates by finding cancers earlier remains to be seen.

Positron emission tomography (PET): In this procedure, the patient is injected intravenously with a small amount of radioactive sugar that cancer cells absorb, enabling the cells to be seen by a special camera. The technique is very sensitive and even very small malignant tumors can show up easily. The test is used to determine if the cancer has spread to lymph nodes or other distant places. It is also used to tell if a shadow on your chest x-ray is cancer. Most insurance companies cover expenses for PET imaging, including Medicare. Both false-positive and false-negative PET findings may occur, however (in which the scan shows what looks like cancer, but really isn't, or doesn't show the cancer when it really exists), so it's important that the scans be interpreted very carefully.

Bone scan: During this test, a small amount of radioactive dye is injected into a vein. It accumulates in areas of bone that may be cancerous. Then a gamma camera scans your body to detect where bone formation is occurring faster than the surrounding bone. This is a sign that the cancer has infiltrated and is destroying the bone. Bone scans are frequently done in patients with small cell lung cancer and are usually only performed in patients with non-small cell lung cancer when symptoms or other test results suggest the cancer has spread to the bones.

Lung biopsy: A biopsy is a test in which tissue is removed from the suspected tumor and examined under a microscope to see if cancer cells are present. A biopsy is necessary for your health care professional to confirm a cancer diagnosis and to identify the specific type of cancer and its stage.

There are two types of biopsy.

Needle biopsy is just like it sounds: a needle is inserted through the chest wall to take a sample of tissue from a known tumor after it's been located by chest x-ray, CT scan or fluoroscopy (fluoroscopy is like an x-ray, but the image is viewed on a screen in real time rather than on film).

Surgical biopsy. In this test, the chest wall is opened to remove a part or all of the tumor. A pathologist examines tissue samples and provides information about the type of cancer present and the stage of the cancer.

Bronchoscopy. A procedure in which a flexible lighted tube (bronchoscope) is inserted through the nose or mouth and into the airways to collect bronchial and/or lung secretions or to biopsy for tissue specimens. Sedation is required because the procedure can be uncomfortable.

Mediastinoscopy: While you're under general anesthesia, the surgeon makes a small cut in your neck and inserts a hollow lighted tube behind the sternum (breast bone). The surgeon then uses the tube to guide instruments into the chest to sample tissue from the mediastinal lymph nodes along the windpipe and major bronchial tube areas. The samples are then evaluated under a microscope.

Mediastinotomy: A surgical procedure that opens the chest cavity to remove samples of mediastinal lymph nodes while you're under general anesthesia. More lymph nodes can be sampled in this way than with the mediastinoscopy procedure, particularly those on the left side.

Thoracentesis: During this procedure, the doctor places a needle between your ribs to drain accumulated fluid around the lungs (called pleural effusion) and examine it microscopically for the presence of cancer cells. Malignant pleural fluid can indicate that cancer has spread to the delicate membranes that cover the lungs (called pleural membranes). Fluid accumulation can also prevent the lungs from filling with air, so thoracentesis can also improve your breathing.

Thoracoscopy: During this procedure, the surgeon uses a thin, lighted tube connected to a video camera and monitor to view the space between the lungs and chest wall. Like thoracentesis, this examination checks whether a pleural effusion is the result of cancer metastasis to the pleural membranes or related to some other condition such as heart failure or an infection.

Blood counts and blood chemistry: Blood chemistry tests can spot abnormalities in some of your organs that may signal cancer. If cancer has spread to the liver and bones, for instance, it may cause certain chemical abnormalities in the blood. If one of these abnormalities in particular, called the LDH, is significantly elevated, it usually means that the outlook for cure or long-term survival isn't good. A complete blood count (CBC) may also be performed and repeated regularly if you are being treated with chemotherapy to make sure you're not becoming anemic as a result of the treatment.

The stages of non-small cell cancer are:

Occult stage: Cancer cells are found in sputum (mucus), but no tumor can be found on x-rays.

Stage 0: Cancer is only found in a local area and only in a few layers of cells. It has not grown through the top lining of the lung. Another term for this type of lung cancer is carcinoma in situ.

Stage I: The cancer is only in the lung, and normal tissue is around it.

Stage II: The cancer has spread to nearby lymph nodes within the lung or to the surrounding chest wall.

Stage III: The cancer has spread to the lymph nodes in the area that separates the two lungs (mediastinum); or to the lymph nodes on the other side of the chest or in the lower neck. Stage III is further divided into stage IIIA (occasionally can be operated on) and stage IIIB (cannot be operated on). Cancer with pleural space involvement (pleural effusion) is considered stage IIIB.

Stage IV: Cancer has spread to other parts of the body.

Recurrent: Cancer has come back (recurred) after previous treatment.

The following stages are used for small-cell lung cancer:

Limited stage: Cancer is found only in one lung and in nearby lymph nodes.

Extensive stage: Cancer has spread outside of the lung to other tissues in the chest or other parts of the body.

Recurrent stage: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lungs or in another part of the body.

References

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"Vaccine Shows Promise in Lung Cancer." Raez L, et al. Journal of Clinical Oncology, Julty 15, 2004, Vol 22, pgs 2800-2807. Summary available at cancerpage.com. http://www.cancerpage.com. Accessed September 9, 2004.

"Location of Potential Familial Lung Cancer Gene Discovered." National Institutes of Health News Release, July 26, 2004. http://www.nih.gov. Accessed September 9, 2004.

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"Learn About Lung Cancer" The American Cancer Society. 2004. http://www.cancer.org. Accessed September 9, 2004.

"Lung Cancer" Veritas Medicine for Patients. 2004. http://www.veritasmedicine.com Accessed September 9, 2004.

"A Patient's Guide: Advanced Lung Cancer Treatment" The American Society of Clinical Oncology (ASCO). August 2003. http://www.asco.org. Accessed September 9, 2004. .

"Medicare Expands Coverage of PET Scans." Health Care Financing Administration (HCFA). Dec. 15, 2000. http://www.cms.hhs.gov. Accessed September 9, 2004.

"Education : Early Detection & Diagnostic Imaging: PET Imaging" Alliance for Lung Cancer. http://www.alcase.org. Accessed September 9, 2004.

"What are the key statistics for lung cancer?"AmericanSociety. October 2005. http://www.cancer.org. Accessed May 2006.

"Women and smoking fact sheet." The American Lung Association. March 2006. http://www.lungusa.org. Accessed May 2006.

"Questions about smoking, tobacco and health." The American Cancer Society. February 2006.

"Surgery: Lung Cancer." The American Cancer Society. October 2005. http://www.cancer.org. Accessed May 2006.

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"Lung Cancer: Non-small cell." The American Cancer Society. February 2006. http://www.cancer.org. Accessed May 2006.

"Lung Cancer Fact Sheet." The American Lung Association. April 2005. http://www.lungusa.org. Accessed May 2006.

Keywords: lung cancer, cancer, symptoms, metastasis, spiral ct, tumor, tumors, ct scan, ct scans, pet, bone scans, biopsy, stages
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Publication:NWHRC Health Center - Lung Cancer
Date:Sep 8, 2006
Words:2006
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