Lung Cancer Diagnosis and Staging


If you have lung cancer, it is important to get an accurate diagnosis as early as possible. It’s also important to determine if the disease has spread – information key to helping your medical team develop the best treatment options for you.

The process starts with a thorough physical examination, during which your doctor will ask about your general health, symptoms, family history, lifestyle – including smoking habits, and possible exposure to cancer-causing substances.
If lung cancer is suspected following the physical exam, your doctor will order additional tests to determine definitively if you have the disease and if it has spread. (These tests also may be used with cancer patients to find out if treatment is working.)

Our team of highly skilled pathologists, diagnostic radiologists and specially trained technicians use the most advanced and accurate equipment available to diagnose and determine the extent (stage) of lung cancer. Diagnosing lung cancer requires examine of cancerous tissue. 

Diagnostic tests for lung cancer include:

Needle biopsy: CT scan images guide a needle through the skin into the lung tissue to collect cells. A biopsy sample may also be taken from lymph nodes or other areas in the body where cancer has spread.

Endobronchial Ultrasound (EBUS): This minimally invasive technique uses a thin, flexible camera with an ultrasound probe to examine and biopsy structures near the windpipe and its branches. At City of Hope, this has largely replaced mediastinoscopy, which is a procedure that gives the same information but requires an incision in the neck and passage of surgical tools to take tissue samples from lymph nodes.

Navigational Bronchoscopy: A special computer creates a three-dimensional map of the lungs and helps guide a thin, flexible tube down the mouth, through the windpipe, and directly to the tumor. This allows the doctor to take biopsies or place markers for other treatments much more accurately than with traditional methods. 
Thoracentesis: Fluid from around the lungs is drawn out with a needle and looked at under a microscope.

Imaging tests:
  • CT or CAT (computed axial tomography)
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans

Genomic Testing

Genomic testing for the diagnosis and treatment of lung cancer is one of the most significant breakthroughs in recent medical history. City of Hope is at the forefront of this still-evolving, revolutionary diagnostic tool that represents a major shift from methods based solely on physical and histological findings to protocols that assess and treat tumors based on the presence of distinct, targetable genetic alterations.
A disease long viewed as monolithic, with few treatment options, lung cancer now is known to have many molecular subtypes and genetic tests that can match patients with those subtypes to treatments. Our early adoption of genomic testing is another example of how City of Hope is committed to staying at the forefront of significant medical advancements to deliver the best standard of care possible to our patients.

If you are diagnosed with lung cancer, your doctor will determine the stage (or extent) of the disease. This is a way to classify the cancer by how far and to which parts of the body it has spread. Staging helps your medical team plan the best treatment for you.

Staging tests may include imaging procedures that reveal whether the cancer has spread beyond your lungs. These tests include CT scans, magnetic resonance imaging (MRI), positron emission tomography (PET), bone scans, and endobronchial ultrasound (EBUS). Not every test is appropriate for every person, so talk with your doctor about which procedures are right for you.
Getting a Second Opinion at City of Hope

City of Hope’s pathologists are expert in diagnosing and staging lung cancer of every type. We have advanced expertise in developing personalized plans to target genetic changes that affect lung cancer, including cancers involving epidermal growth factor (EGFR), Anaplastic Lymphoma Kinase (ALK) and other gene mutations. We welcome the opportunity to provide second opinions for lung cancer.
City of Hope is here to help. We are committed to making the process of becoming a patient here as easy as possible. Call 800-826-HOPE (4673) or complete the online appointment form.