Lung Cancer Screening, Diagnosis and Tests

To accurately diagnose lung cancer, City of Hope uses a combination of leading-edge screening methods and a team of doctors whose sole focus is treating lung cancer. Our team of thoracic specialists combines its deep expertise with advanced technology to provide you with the most accurate diagnosis — leading to the most effective treatment.

Screening increases your chances of catching lung cancer at an early stage when it is easier to treat and may find other diseases like emphysema or heart disease. Getting screened at a comprehensive cancer center is one way to ensure you get the best and lowest-dose scan.

At City of Hope we do low dose spiral computed tomography scanning, which uses the minimum dose of radiation possible to accurately detect lung cancer. Our screening methods are proven to decrease what are called false positives — test results that say you have cancer when you don’t — and help you avoid unnecessary or invasive procedures.

If screening shows lung cancer is possible, a tiny piece of tissue from the lung (a biopsy) may be removed and examined under a microscope to find cancer cells. Cancer cells also are tested for genetic markers, since tumors with specific markers may respond better to certain treatments.

Your team is looking for the type of tumor, the stage it is in and whether certain genetic problems or mutations (abnormal changes inside a cell) are driving the cancer. All of this information can help give you the most specific and tailored treatment possible.

Who Should be Screened?

If you were--or currently are--a heavy smoker, then a lung cancer screening will benefit you. Even if you do not have symptoms, you should get a lung cancer screening if you are:

  • between the ages of 55 and 77 and
  • have smoked the equivalent of one pack a day for 30 years (for example, you have smoked two packs a day for 15 years, or three packs a day for 10 years), and
  • still are smoking or have quit sometime in the last 15 years

Screening may be an option for patients who smoked the equivalent of a pack a day for fewer than 30 years, but also have a serious risk factor for lung cancer. Speak with your doctor to discuss your options. Read more about screening for lung cancer. 

Do You Have Questions About our Screening Program?

Please call 626-218-9410 or email us at

We are pleased to offer the Orange County community low dosage CT scanning to screen for lung cancer at our Newport Beach locations. To find out if you are a candidate, call  949-763-2204.

Do You Feel Ready to Quit Smoking? 

Please call  626-218-9410  or email us at  for assistance. 

Testing for Lung Cancer

One or a combination of tests may be used to diagnose lung cancer including several minimally-invasive procedures:

  • Sputum cytology is mucus or phlegm (also called sputum) you cough up from your lungs that is examined under a microscope to check for cancer cells.
  • Needle biopsy is a thin, hollow needle that is guided to a mass in the lung. A pathologist looks at the sample under a microscope to check for cancer.
  • Bronchoscopy uses a flexible tube called a bronchoscope that is guided through the mouth or nose into the airways of the lungs. This procedure gets samples of lung tissue and fluid, and locates and fixes things like lung blockages.
  • Endobronchial ultrasound uses a narrow, flexible camera that is guided into the airways. This allows the surgeon to see lymph nodes through the windpipe and take a sample with a needle.
  • Electromagnetic navigation bronchoscopy uses technology similar to a car’s GPS (global positioning system) to find tumors in the smallest airways of the lungs using an ultrathin catheter (tube).
  • Pulmonary function testing is a group of tests that measure how well your lungs function. These tests typically measure things such as breathing rate, lung volume, inflammation in the lungs and how well gases such as oxygen move back and forth between the lungs and the bloodstream. Pulmonary function testing is usually done after lung cancer is diagnosed to determine how well the lungs are working prior to surgery.
  • Molecular testing analyzes tumor tissues to look for certain proteins or genetic changes that are commonly associated with lung cancer. Identifying the genetic changes present in a tumor helps the medical team design a targeted therapy approach that is mostly likely to work against that tumor type.


Imaging and other tests of the lungs involves looking at them without having to do surgery.

  • Low-dose spiral computed tomography (CT) scan is a first-line screening method at City of Hope that uses low-dose X-rays to scan the body in a spiral path. The images that come out of this scan appear as “slices” of the body from different points of view. Low-dose CT is sensitive enough to detect pulmonary nodules caused by secondhand smoke and is a cost-effective technology that can detect cancer earlier and help save lives.
  • Chest X-ray for lung cancer looks for any mass or spot on the lungs.
  • Positron emission tomography (PET) uses a radioactive tracer to locate cancer cells and measure cancer their activity. PET also may be used to determine if the cancer has spread from the lungs to other areas of the body.
  • Brain MRI (magnetic resonance imaging) uses magnets and radio waves to create a series of pictures of the brain — a common site where lung cancer spreads.
  • Bone scan is a test that can determine whether lung cancer has spread to the bones. A small amount of radioactive material is injected into the blood. This material collects in areas of the skeleton where the bone has been affected by cancer, which can be detected with a special camera.

Other tests that may be used to figure out if lung cancer has spread include:

  • Thoracentesis, a procedure that involves inserting a hollow needle through the chest wall, removing fluid and sending it to a lab to check for cancer cells
  • Cervical mediastinoscopy, which involves first making a small cut to the neck, then guiding a scope with a camera on it through the middle part of the chest to remove samples from lymph nodes
  • Thoracoscopy, when a small tube with a video camera at the tip is used to look at the outer part of the lungs and chest wall to locate and sample any abnormal tissue

Lung Cancer Stages

What stage lung cancer is in depends on things like the size of the tumor and whether it has spread to other areas of the body.

Stage 1 cancer

Lung cancer is confined to the lung, meaning it has not spread to any other part of the body — like the chest wall. This tumor is in deeper lung tissue but still surrounded by normal tissue.

Stage 2 cancer

This tumor tends to be larger than those found in Stage 1 and will have either spread to nearby lymph nodes or other tissues nearby like the chest wall, diaphragm, pleura (membranes that surround the lungs), bronchus or heart tissue.

Stage 3 cancer

In most cases, tumors in this stage have spread to lymph nodes near the windpipe and middle chest area. Stage 3 disease may also involve more than one malignant tumor in the lung that has spread to other organs like the heart, esophagus or trachea.

Stage 4 cancer

Tumors are in both lungs or in the fluid between the pleura — the protective membranes that surround the lungs. In this stage, lung cancer may have spread to other parts of the body like the bones, liver, brain or adrenal glands.