Lung Cancer 101 Part II

Lung cancer is diagnosed using a series of diagnostic tests to help identify the type of lung cancer you may have and ways to treat cancer.

Once diagnosed, there are several treatment options to consider. Many treatment options can be very successful but the key to treating lung cancer is to catch it early.

Diagnosing Lung Cancer

There are many different ways to diagnose lung cancer. Sometimes lung cancer is diagnosed incidentally or accidentally after a regular chest X-Ray.

The most common way to diagnose is through a CT scan also known as a CAT Scan. There are two types of CAT scan’s used to help diagnose lung cancer.

Medicare now reimburses hospitals and imaging centers for Low Dose Lung Screening CT’s. The Low Dose Screening CT (LDSCT) is a lot like a screening mammogram except it is a screening test for lungs rather than a screening test for breasts. The criteria used to qualify for an LDSCTinclude:

  • No symptoms
  • Ages 55 – 77
  • Currently smoking or have quit smoking within the last 15 years
  • A 30 pack or greater years history of smoking (an average of one pack a day for 30 years)
  • An order from a physician or a qualified non-physician practitioner (NP, APRN, PA)

A diagnostic CT scan is performed when you experience symptoms related to your lungs. Symptoms include:

  • A Cough that won’t quit, does not go away or get worse
  • Coughing up blood or a rust-colored sputum, spit, or phlegm
  • Shortness of breath
  • Chest pain that is worse during deep breathing, coughing or even laughing
  • Hoarseness in your voice
  • Weight loss or loss of appetite
  • Feeling tired or weak
  • Wheezing

As with all cancers, lung cancer is diagnosed with a biopsy of the area where suspected cancer cells are seen on the imaging tests.

There are a couple of ways to access areas of the lungs with suspicious cells. For example, physicians use a bronchoscopy, a transthoracic biopsy, Endobronchoscopic Ultrasound (EBUS), Mediastinoscopy, and finally lung surgery.

A Bronchoscopy (pronounced bron-cos-scopeee) is a procedure where a pulmonologist, also known as a lung doctor, inserts a flexible scope through your nose and down into your lungs.

The lit scope is used as a periscope allowing the lung doctor to see into your airways which lets them navigate your air passages. Once the lung doctor reaches the suspicious area they can snake a needle through the scope and obtain a sample of suspected cancerous cells.

A transthoracic biopsy is a procedure where a specialized radiologist inserts a needle from the outside of your lung, through the skin, through the chest wall and into the area where the suspicious cells are located. Make sure that you ask the radiologist to numb the skin enough so you do not feel any pain.

An Endobronchoscopic ultrasound (EBUS) is similar to a bronchoscopy but it uses ultrasound waves to identify the location of the suspicious cells. Once the suspicious area is located, a needle can be inserted to get a sample of the suspected cancer cells.

A Mediastinoscopy is a procedure performed by a surgeon. The procedure starts with a small incision (cut) above the collarbone in between the first, second, or third rib. The surgeon then inserts a special tube into the mediastinum.

The mediastinum is the space in your chest which contains your heart, your aorta, and other great vessels, along with your esophagus, trachea, cardiac nerves, your thymus, and lymph nodes. During a mediastinoscopy, the surgeon can see your lymph nodes surrounding your heart and allows the surgeon to biopsy the lymph nodes.

Surgery is a way to remove the suspicious cancer cells from your lung where they can be analyzed by a pathologist. A surgical approach is common for patients with early-stage lung cancer.

During surgery, the surgeon has the opportunity to see the outside of the lung which helps them identify the suspicious area and remove suspected cancer cells.

Tumor Markers

Once the suspected cancer cells are removed, they can be analyzed to help the cancer care team to choose the correct treatment specific to your lung cancer. We already know that there are three types of lung cancer including non-small cell, small cell, and lung carcinoid carcinoma.

Cancer cells contain mutated genes which control how the cells work. Over time, the genes of normal cells can change or mutate. The genes change as a result of your exposure to carcinogens from our external environment. Some genes that change in lung cancer include:

  • epidermal growth factor receptor (EGFR)
  • anaplastic lymphoma receptor tyrosine kinase (ALK)
  • ROS proto-oncogene #1, receptor tyrosine kinase (ROS1)
  • Kirsten rat sarcoma viral oncogene homolog (KRAS)
  • B-Raf proto-oncogene, serine/threonine kinase (BRAF)

Additionally, some lung cancer tumors produce a protein called Programmed death-ligand 1 (PD-L1) which can bind to your normal immune cells turning on your immune system staying active and working to fight cancer.

While there are other tumor markers the ones mentioned above are common to lung cancer. The description of each tumor marker is complex and difficult to understand.

The best way to help you understand and the way your lung cancer care team will describe your tumors markers will be by its symbol. For example, EGFR, ALK, ROS1, BRAF, KRAS, along with PD-L1 are common to lung cancer.

Targeted Therapies

According to the “Targeted Therapy for Lung Cancer: A Guide for the Patient” sponsored by the Lung Cancer Alliance, targeted therapies are aimed at a particular “target” in the cancer cell with the primary goal of stopping the growth of cancer cells.

Targeted therapies spare the rest of the body from the toxic side effects experienced with many chemotherapy treatments. Most targeted therapies come in pill form and are specific to the genetic change of the lung cancer cell. While targeted therapies have fewer toxic side effects, they can cause a severe rash and diarrhea.


Stereotactic Body Radiotherapy (SBRT)

Joan Schiller M.D. Chief of Hematology and Oncology at the University of Texas explains that radiotherapy also called radiation therapy uses high-energy rays to stop cancer cells from growing or multiplying by damaging a cancer cells DNA.

Schiller goes on to state that, radiotherapy treatment is carefully planned to deliver as much radiation as possible while preventing as little damage to your normal surrounding cells. The combination of a physician (Radiation Oncologist), a physicist, and a dosimetrist works to maximize treatment and minimize side effects.

SBRT gives the Radiation Oncologist an ability to give an even higher dose, more accurately allowing for a focused treatment with minimal side effects.

SBRT also allows for less radiation being delivered to other surrounding organs like the heart, trachea, lymph nodes, or esophagus.



Lung cancer can be a complex chronic disease which is difficult to understand for many people.

Our next article will include questions you should ask your cancer care team along with tips for survival and how to cope with a lung cancer diagnosis.

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