Lung Cancer Diagnosis

Lung Cancer Diagnosis Expertise at Piedmont Oncology

At Piedmont Oncology, establishing an accurate diagnosis is the first step in treating lung cancer. Our cancer specialists use advanced imaging capabilities, nationally accredited by the American College of Radiology, for the accurate and timely diagnosis of suspected cancers.

In addition, the Piedmont Lung Nodule Clinic provides special expertise needed for the follow-up of small lung nodules of uncertain significance. The radiology, pulmonology and thoracic specialists in this clinic review the patient’s history and risk factors for lung cancer and, after study of the CT scan, make a recommendation about how often follow-up studies should be obtained and when to plan for a biopsy.

For more information on the Lung Nodule Clinic, call 404-605-LUNG (5864).
 

Understanding Lung Cancer Risk Factors and Symptoms

Cigarette smoking and prolonged radon exposure are thought to be the two leading environmental causes of lung cancer. Lung cancer most commonly causes the following symptoms:

• Coughing up blood

• Fatigue

• Hoarseness

• Loss of appetite and weight

• Persistent or worsening cough

• Shortness of breath

It is also not uncommon for lung cancer to be discovered incidentally without any symptoms. Most often, this happens when a chest X-ray or CT scan of the chest is performed for some other reason, and a lung nodule or mass is detected.

At times, lung cancer is found because of symptoms caused by the spread of the primary tumor to other sites in the body. These symptoms can include problems such as bone pain, yellowing of the eyes, and enlarged lymph nodes such as bumps under the skin in the neck, armpits, or groin.

When chest imaging suggests the presence of a lung cancer, referral to a pulmonary medicine specialist or thoracic surgeon is the critical next step.
 

Comprehensive Lung Imaging Tests

Both imaging specialists and expert pathologists at Piedmont Oncology work together to review all imaging tests needed for an accurate diagnosis. For lung cancer-specific concerns, a range of imaging tests may be required.

• Tumor Detection Initiated with Chest X-ray

  • When symptoms that could suggest the presence of a lung cancer occur, a chest imaging study is usually ordered by a doctor.
    This test uses a low dose of X-rays to take a snapshot of the chest. A radiologist looks at the pictures to see if there are any signs of cancer. A chest X-ray gives a moderately good ability to detect small tumors.

• Computed Tomography (CT)

  • CT uses X-rays to produce high-quality images of the chest. The scan takes only a few minutes to perform and may be combined with intravenous contrast. CT is more sensitive than chest X-rays for detecting small cancers and enlarged lymph nodes in the center of the chest near the heart.

• Magnetic Resonance Imaging (MRI)

  • MRI uses magnetic fields to produce an image of the chest. MRI has more limited use in the test because the motion of the lungs and the beating heart lower the detail that can be seen. The test takes about 45 minutes and involves intravenous administration of a contrast agent called gadolinium. Gadolinium cannot be given to people with kidney failure or a past allergic reaction. About 10% of patients experience claustrophobia (anxiety from a small space inside the scanner, but there are several ways to reduce this problem). Patients with implanted devices (e.g., cardiac pacemakers) often cannot have an MRI study.

• Positron Emission Tomography (PET)

  • PET uses a low dose of radioactive glucose (FDG or fludeoxyglucose) to look for areas of high metabolism that could indicate the presence of a rapidly growing tumor. FDG is given by intravenous injection, and the images are obtained from a machine resembling a CT scanner. The PET images can be superimposed on images from routine CT (see above) to allow the radiologist to see precisely where the areas of increased glucose are in the body. This is known as PET-CT. A positive PET scan can occur with cancer and with infections or inflammation, so a thoracic oncology specialist must interpret the pictures with the knowledge of the patient’s overall situation.

Range of Biopsy Options to Identify Cancer

When chest imaging shows a suspected cancer in the chest, the next step is to determine the exact type of tumor. This involves a biopsy or the removal of tumor cells so that a pathologist can look at them under a microscope to determine whether cancer is present or not. A biopsy can be performed in many ways, including using a needle under CT scan guidance, through a small incision in the chest wall through minimally invasive endobronchial ultrasound or navigational bronchoscopy, or by passing a fiber optic endoscope down through the airways.

Contact a Piedmont Oncology specialist to discuss lung biopsy options.
 

Pathology Expertise Determines Tumor Type

The analysis of the biopsy tissue by the pathologist shows whether a cancer is present or not, and if present, determines the exact type of cancer. The experience and expertise of the Piedmont pathology team are critical parts of lung cancer diagnosis and treatment planning. 
 

Get More Information

For questions or more information about a lung cancer diagnosis or to find a lung cancer specialist near you, call 404-425-1800 or use our convenient Find a Doctor search.