Lung Cancer Screening, Diagnosis and Tests

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Lung cancer is the leading cause of cancer death worldwide. One of the challenges with diagnosing lung cancer is that symptoms often do not appear until the disease is at an advanced stage. Getting screened for lung cancer increases the chances of earlier diagnosis and more effective treatment. City of Hope’s lung cancer screening program is available at our main campus in Duarte, as well as in Antelope Valley, Newport Beach and Corona.

Getting Screened Early

As a comprehensive cancer center, City of Hope offers leading-edge cancer screening methods and a team whose sole focus is accurately diagnosing and successfully treating lung cancer. Early screening can also help detect other diseases, like emphysema or heart disease. 

Our most common screening method is a low-dose computed tomography (LDCT) scan. LDCT scans are safe, painless and cost-effective. They use the minimum dose of radiation possible to accurately detect lung cancer. 

  • For high-risk people, LDCT scans will discover early-stage lung cancer 64%-85% of the time.
  • This can reduce mortality by 20%. 
  • Currently, only 4.4% of people who meet the recommended criteria for a lung screening get one.

Depending on the results of your screening, your doctor may recommend other procedures, including a lung biopsy or testing for genetic markers. These procedures can help your team determine what kind of tumor you have, the stage it is at and whether there are any genetic problems or mutations driving the cancer. This information allows us to recommend the most specific and tailored treatments for you.

Who Should be Screened?

If you were — or currently are — a heavy smoker, then a lung cancer screening can help. Even if you do not have symptoms, you should get screened for lung cancer if you are:

  • Between the ages of 55 and 80
  • Have smoked the equivalent of one pack a day for 20 years (for example, you have smoked two packs a day for 15 years, or three packs a day for 10 years)
  • Still smoke or have quit within the last 15 years

Screening may also be an option for patients who smoked the equivalent of a pack0 a day for fewer than 20 years but have another serious risk factor for lung cancer. It is best to talk to your doctor to discuss your options. 

If you have questions about our screening program, call 626-218-9410 or email lungscreening@coh.org.

We also offer LDCT scans to screen for lung cancer at our Newport Beach location. Call us at 949-763-2204 for more information.

If you would like help quitting smoking, we are also here to help. Call 626-218-9410 or email us at smokingcessation@coh.org.

Diagnostic Tests and Tools for Lung Cancer

There are a variety of ways to accurately diagnose lung cancer, including several minimally invasive tests and procedures. Your cancer care team may recommend one or a combination of tests. 

Low-Dose Computed Tomography Scan

An LDCT scan is a first-line screening method at City of Hope. It uses low-dose X-rays to scan the body in a spiral path. The images produced by an LDCT scan appear as “slices” of the body from different points of view. LDCTs use a dose of radiation that is lower than that used by a standard CT scan (1mSv) and only a little higher than the dose used for mammograms. 

LDCT 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. It is worth remembering that 9 out of 10 nodules detected in lung cancer screenings are benign. LDCT scans are covered by many health insurance providers at a low cost or no cost. 

Nonsurgical Imaging Procedures

Your care team may recommend other types of imaging procedures — tests that do not require surgery — to screen for lung cancer. 

  • 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 their activity. PET may also be used to determine if the cancer has spread beyond the lungs.
  • Brain magnetic resonance imaging, or MRI, uses magnets and radio waves to create a series of pictures of the brain — a common site where lung cancer spreads. 
  • Bone scans 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.
Additional Tests
  • 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 process in which a thin, hollow needle 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 collects tissue and fluid samples and can find and fix 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 to find tumors in the smallest airways of the lungs with an ultrathin catheter (tube).
  • Pulmonary function testing is a group of tests that measure how well your lungs function. It 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 your team design a targeted therapy approach that is mostly likely to work against that tumor type

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.

Next Steps After a Positive Screening

Approximately 15% of all lung cancer screenings will identify a lung nodule, but 90% of those are benign. If the screening is positive, world-class City of Hope lung cancer specialists will work with you to determine the next steps and potential treatment options. Even if a screening is negative, you should repeat the screening process after one year. 

If you or a loved one have been recently diagnosed with lung cancer, call us to discuss the treatment options that may be available to you.