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Symptoms and Diagnosis

Lung Cancer Symptoms

Diagnosing lung cancer early is important but it is not necessarily easy. The early beginnings of the disease may not have clearly recognizable symptoms. If you have early lung cancer symptoms, they may include:

  • A cough that does not go away and gets worse over time
  • Constant chest pain, often made worse by deep breathing, coughing or laughing
  • Coughing up blood or rust-colored spit
  • Shortness of breath, wheezing

Other symptoms that may occur, depending on whether the disease spreads, include:

  • Arm or shoulder pain, tingling in arms, hands or feet
  • Pain in others parts of body – hips, back
  • Hoarseness
  • Repeated episodes of pneumonia or bronchitis or an infection that will not go away
  • Swelling of the neck or face
  • Loss of appetite and/or unexplained weight loss
  • Feeling weak or very tired all the time
  • Irritability and/or mood swings
  • Clubbing of fingers

Should cancer spread to others parts of the body, it may cause other symptoms:

  • Bone pain
  • Arm or leg weakness or numbness
  • Headache dizziness or seizure; difficulty remembering
  • Jaundice (yellow coloring) of skin or eyes
  • Swollen lymph nodes in the neck and shoulder

Experiencing these symptoms does not always mean that you have lung cancer. Other health problems can cause the same symptoms. It is important that you discuss any symptoms you have with your doctor as they may signal other health concerns.

Lung Cancer Diagnosis

If there is a suspicion of lung cancer, the doctor will order tests to look for cancerous cells or to rule out other conditions. There are many tests and exams that are used to diagnose lung cancer. Your doctor may use some of them. Not all are necessary or appropriate for every person.

  • Your medical history: your doctor may ask questions about any medical problems you have experienced, about smoking, about where you live and work, family history of cancer, and symptoms you have noticed.
  • Physical examination
  • Chest X-ray
  • Sputum analysis (cytology): the phlegm you cough up is analyzed for cancerous cells

If these tests indicate an abnormal area, further testing may be done with the following procedures:

  • Bronchoscopy: a thin, flexible tube (bronchoscope) with a tiny light and camera is inserted through your mouth or nose and into your lungs while you are sedated; this helps to find tumors and can break a piece of tumor off for examination under a microscope
  • Needle biopsy (fine needle aspiration): a thin needle is inserted into your chest after you receive a local anesthetic for pain; the needle collects a small piece of the tumor for examination under a microscope
  • Thoracentesis: fluid from around the lungs is drawn out with a needle and looked at under the microscope
  • Endobrinchial ultrasound (EBUS): this is a procedure in which the bronchoscope with an ultrasound is inserted into the airways and images are then sent to a monitor. Biopsies can be taken if lesions are identified.
  • Mediastinoscopy or thoracoscopy: this test helps to identify if there is spread of the tumor cells to the lymph nodes. It is done after you are given a general anesthetic. The doctor makes a small cut at the base of your neck and inserts a thin tube. The tube collects fluid samples and small pieces of tissue from the lymph nodes near your throat and lungs behind your breastbone. These samples are tested for cancerous cells.
  • Thoracotomy: for this procedure you will need a general anesthetic. The surgeon opens your chest and takes samples of lung tissue and lymph nodes. Usually this procedure would be done if previous testing had not confirmed a diagnosis.
  • CT scan: This scan takes detailed x-rays that are blended together in a computer. You lie on a table and stay very still while the scans are being done. Before the first scan you receive an injection of dye to help the CT scan take a better picture. The scan is painless but you may find lying still is uncomfortable.

What does staging of lung cancer mean?

Part of the diagnosis process is to determine the stage or extent of your cancer. This is important because it helps you and your doctor decide about the most appropriate treatment approach for you.

There are a number of tests that are completed to determine how large the tumor is, and whether the lung cancer has spread to the lymph nodes or other parts of your body. These imaging tests include CT scan, MRI (magnetic resonance imaging), positron emission tomography (PET) and bone scans. They provide a more detailed picture of the tumor and whether there is abnormal fluid buildup or swollen lymph nodes. The tests are usually painless and do not require an anesthetic.

However, not every test is appropriate for every person. It is important to talk about the plans for these procedures with your doctor.

Based on all the test results, the doctor will identify the stage of the lung cancer. Staging is a way to classify the cancer by how far and to which parts of the body it has spread. Staging helps the doctor and you plan the best treatment for you. The stages of lung cancer are as follows:

  • Stage I: Cancer is limited to the lung and has not spread to the lymph nodes. The tumor is generally smaller than 2 inches (5 centimeters) across.
  • Stage II: The tumor is larger than 2 inches or it may be a smaller tumor that involves nearby structures such as the chest wall the diaphragm or the lining around the lungs (pleura). Cancer may also have spread to the nearby lymph nodes.
  • Stage III: The tumor has grown very large and invaded other organs near the lungs. Or a smaller tumor is accompanied by cancer cells in lymph nodes farther way from the lungs.
  • Stage IV: Cancer has spread beyond the affected lung to the other lung or to distant areas of the body.

What is tumor testing?

Tumor testing is a promising new field in the diagnosis and treatment of lung cancer. It is referred to as molecular, biomarker or genomic testing and is a procedure to look for changes (mutations) in the tumor DNA. A piece of the lung cancer tissue is taken during a biopsy procedure and it is sent to a special laboratory that can identify the genomic profile of the tumor. Based on the result, a specific treatment may be available to target the specific mutation that exists in the tumor cells.