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How Is Non-Small Cell Lung Cancer Diagnosed?

Medically reviewed by Marla Anderson, MDMedically reviewed by Marla Anderson, MD

Non-small cell lung cancer (NSCLC) is a type of cancer that starts in the cells that line the surface of the lung airways. About 80-85% of people with lung cancer in the United States are diagnosed with NSCLC. While anybody can develop the cancer, people who smoke are at the highest risk of developing NSCLC.

An oncologist (a medical doctor specializing in diagnosing and treating cancer) usually diagnoses NSCLC with several tests and exams. Your medical team will also likely include a pulmonologist (a medical doctor specializing in diagnosing and treating lung conditions).

To diagnose NSCLC, your healthcare team will likely recommend a medical history, physical exam, blood tests, imaging studies, procedures, and a biopsy.  

Medical History

To determine if you have non-small cell lung cancer, your healthcare provider will likely begin by asking several questions about your health history, family history, and current symptoms.

The most common cause of non-small cell lung cancer is a history of smoking. Other risk factors include exposure to radon, asbestos, secondhand smoke, and other chemicals.

Your provider will also probably ask if you have any of the following common NSCLC symptoms:

  • Persistent cough

  • Shortness of breath

  • Chest pain

  • Wheezing

  • Blood when coughing

  • Hoarse voice

  • Trouble swallowing

  • As NSCLC progresses, it may cause a lack of appetite, unintended weight loss, and fatigue.

    Physical Exam

    The next step in diagnosing NSCLC is a physical exam. Your provider will likely conduct a thorough exam, paying special attention to your lungs and chest area.

    Your provider will listen to your lungs with a stethoscope and ask you to take deep breaths. The provider can hear your lungs by placing the stethoscope's metal disc on your body and listening with the tool's earpieces, which are connected to the disc by two tubes.

    Your provider will also examine your face and neck for signs of swelling or enlarged veins. 

    Imaging

    After conducting a medical history and physical exam, your healthcare provider will likely order a chest X-ray (CXR) to look for a tumor (masses) in the lungs. A chest X-ray is a painless test that can detect lung masses.

    Your provider may also recommend a chest computerized tomography (CT) scan because it can detect smaller growths in the lungs. 

    Lab Tests

    Your healthcare provider may request laboratory tests of your blood and urine to look for signs of cancer or infection. A complete blood count (CBC) measures the number of red blood cells, white blood cells, and platelets in your blood. People with cancer usually have abnormal values of these types of cells.

    Your healthcare team may also recommend pulmonary function tests (PFTs). These tests measure lung function and determine how much air the lungs can hold. If you have been coughing up mucus (sputum), your provider may take a sample to examine it under a microscope and look for cancer cells. 

    Procedures

    Several types of procedures can help your healthcare team get a closer look at your lungs and determine if cancer cells are present.

    Your healthcare provider may start with a bronchoscopy. This procedure involves placing a tube with a camera (scope) down your airway and into the lungs to examine the tissue and take samples. If your provider sees a concerning area or growth, they will take a tissue sample and send it to the lab for testing. This sample is known as a biopsy.

    Other procedures to inspect the lungs include thoracentesis (removing fluid from the space between the lungs and chest wall) and mediastinoscopy (placing a scope into the chest through an incision).

    Staging Tests

    Once you have been diagnosed with NSCLC, your healthcare team may recommend additional tests to determine how advanced the cancer is.

    A positron emission tomography (PET) scan is an imaging study used to detect fast-growing cells in the body. This test can help your team determine if and how far cancer has spread beyond the lungs.

    If your provider is concerned that cancer has spread, they may recommend a bone scan to look for cancer cells in the bones and a lymph node biopsy to learn if there are cancer cells in the lymph nodes. 

    Genetic Testing

    Certain gene mutations may raise the risk of NSCLC. Once you have been diagnosed, your healthcare provider may recommend genetic testing to determine your most effective treatment plan. You may benefit from targeted therapy if you have NSCLC and any mutations in the following genes:

  • CHEK2

  • ATM

  • TP53

  • BRCA1

  • EGFR

  • APC

  • PALB2

  • Stages of Non-Small Cell Lung Cancer

    Once a person has been diagnosed with cancer, their healthcare team conducts additional tests to determine the cancer stage. The stage describes how advanced the cancer is and how far it has spread. This helps to determine a person's treatment plan and prognosis.

    The staging of NSCLC is complex and detailed. A brief summary of staging includes:

  • Occult (hidden) stage: Cancer cells cannot be detected with imaging or bronchoscopy but can be found in the mucus.

  • Stage 0: Cancer cells are present in the lining of the airways but have not spread deeper in the lung tissue.

  • Stage IA: The cancerous tumor is no larger than 3 centimeters (cm) and has not spread to the lymph nodes.

  • Stage IB: The tumor is larger than 3 cm but not larger than 4 cm and has not spread to the lymph nodes.

  • Stage IIA: The tumor is larger than 4 cm but not larger than 5 cm and has not spread to the lymph nodes.

  • Stage IIB: The tumor is not larger than 5 cm but has spread to the lymph nodes.

  • Stage III: Cancer cells have spread to areas on the same side of the chest as the primary tumor.

  • Stage IV: Cancer cells have spread to distant areas of the body, such as the bones or the brain.  

  • Diagnosing the Type of NSCLC

    There are different types of non-small cell lung cancer, and your healthcare team will use several diagnostic tests to determine your type. The most common types of NSCLC include:

  • Squamous cell carcinoma: Affects the thin, flat squamous cells in the lungs

  • Large cell carcinoma: Affects the large cells in the lungs

  • Adenocarcinoma: Affects the cells that line the small air sacs in the lungs (alveoli)

  • Screening for Related Conditions

    There are benign (non-cancerous) conditions and infections that may cause symptoms similar to NSCLC. When you develop symptoms of lung cancer such as a persistent cough, your healthcare provider may perform exams and tests to rule out a lung infection like pneumonia (inflammation in the lungs). They may also look for signs of thrombosis, a blood clot in the lungs.

    A Quick Review

    Non-small cell lung cancer (NSCLC) is a type of lung cancer that begins in the cells that line the airways. NSCLC is the most common type of lung cancer in the United States. To determine if you have NSCLC, your primary healthcare provider will likely refer you to an oncologist or pulmonologist.

    Your healthcare team will likely start the diagnostic process with a medical history and physical exam to understand your risk and look for signs of cancer. They may also order imaging studies, blood tests, pulmonary function tests, and procedures such as a lung biopsy.

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    Warning Signs Of Lung Disease Every Smoker Should Know

    The earlier lung disease is detected, the better the chances of controlling it and maintaining a good quality of life

    Lung disease is a silent and often deadly threat that lurks in the lives of smokers. For many, smoking is a habit formed over years, becoming a part of their daily routine. However, the consequences of this habit can be dire, leading to severe health issues that may manifest as lung disease. Understanding the early warning signs of lung disease is crucial for smokers, as early detection can make a significant difference in treatment outcomes and quality of life.

    In this article, we will explore the key warning signs of lung disease that every smoker should know. These signs, often subtle and easily overlooked, can indicate the onset of serious conditions such as chronic obstructive pulmonary disease (COPD), lung cancer, or emphysema. By recognizing these symptoms early, smokers can take proactive steps to seek medical advice and potentially prevent the progression of life-threatening illnesses.

    The link between smoking and lung disease

    Smoking is the leading cause of lung disease, with a well-established link between tobacco use and conditions such as COPD, lung cancer, and chronic bronchitis. The harmful chemicals in cigarettes damage the lungs over time, leading to inflammation, scarring, and reduced lung function. As lung tissue deteriorates, the risk of developing lung disease increases, often with devastating consequences.

    For many smokers, the signs of lung disease may appear gradually, making it easy to dismiss them as minor issues. However, these seemingly minor symptoms can be early indicators of serious health problems. It is essential for smokers to remain vigilant and aware of the changes in their bodies, particularly when it comes to lung health.

    Common warning signs of lung disease Persistent cough

    A persistent cough is one of the most common and early signs of lung disease. While occasional coughing is normal, a cough that lingers for weeks or months could indicate an underlying issue. Smokers often develop a chronic cough, commonly known as "smoker's cough," which can be a sign of damaged lung tissue. If the cough becomes more frequent or produces blood, it is a clear warning sign that should not be ignored.

    Shortness of breath

    Shortness of breath, or dyspnea, is another key indicator of lung disease. Smokers may notice that they become easily winded during activities that previously posed no challenge, such as climbing stairs or walking short distances. This symptom occurs when the lungs struggle to supply enough oxygen to the body, a condition often associated with COPD or emphysema. Persistent shortness of breath warrants immediate medical attention, as it may indicate the progression of lung disease.

    Chest pain

    Chest pain can be a frightening symptom and is often associated with heart problems. However, in smokers, chest pain can also be a sign of lung disease. The pain may be sharp or dull and can worsen with deep breaths, coughing, or physical activity. It may be a result of inflammation in the lung tissue or the presence of a lung infection. Regardless of its cause, chest pain should never be ignored, especially in smokers, as it could signal a serious underlying condition.

    Wheezing

    Wheezing is a high-pitched whistling sound that occurs when breathing, often caused by narrowed airways. For smokers, wheezing can be a sign of obstructive lung disease, such as asthma or COPD. This symptom indicates that the airways are becoming inflamed and constricted, making it difficult for air to flow in and out of the lungs. Wheezing, particularly if it is a new symptom, should prompt a visit to a health care provider for evaluation.

    Unexplained weight loss

    Unexplained weight loss can be a symptom of advanced lung disease, including lung cancer. Smokers who experience significant weight loss without changing their diet or exercise routine should be concerned. This type of weight loss often occurs because the body is expending more energy to breathe and maintain lung function, or because the disease is affecting appetite and metabolism. Unexplained weight loss should always be investigated by a health care professional.

    Fatigue and weakness

    Chronic fatigue and weakness are common in individuals with lung disease. Smokers may find themselves feeling constantly tired, even after a full night's sleep. This fatigue can result from reduced oxygen levels in the blood, making it difficult for the body to function optimally. Fatigue may also be accompanied by weakness, particularly in the muscles, as the body struggles to maintain energy levels. These symptoms can significantly impact daily life and should not be overlooked.

    Coughing up blood

    Coughing up blood, known as hemoptysis, is a serious symptom that requires immediate medical attention. For smokers, this can be a sign of lung cancer, bronchitis, or other severe lung conditions. Even a small amount of blood in the sputum should not be dismissed, as it may indicate that the lung tissue is damaged or an infection present. Early intervention is crucial to addressing the underlying cause of hemoptysis.

    Frequent respiratory infections

    Smokers are more susceptible to respiratory infections, such as bronchitis and pneumonia. Frequent infections that require antibiotics or last longer than usual can be a warning sign of underlying lung disease. Smokers' lungs are often weakened, making it difficult for the body to fight off infections. If respiratory infections become a recurring issue, it may indicate that the lungs are no longer functioning properly and that lung disease is present.

    The importance of early detection

    Early detection of lung disease is vital for improving outcomes and quality of life. Many of the symptoms mentioned above may be subtle at first, but they can quickly progress if left untreated. Smokers who notice any of these warning signs should seek medical advice promptly. Early intervention can slow the progression of lung disease, reduce symptoms, and improve overall health.

    Lung function tests, imaging studies, and other diagnostic tools are available to help identify lung disease in its early stages. By taking action as soon as symptoms appear, smokers can increase their chances of managing the disease effectively and avoiding more severe complications.

    How to reduce the risk of lung disease

    While the best way to prevent lung disease is to quit smoking, there are other steps smokers can take to reduce their risk:

  • Regular health check-ups: Regular visits to a health care provider can help detect lung disease early, even before symptoms become severe. Routine check-ups should include lung function tests and imaging studies for smokers.
  • Vaccinations: Staying up-to-date with vaccinations, such as flu shots and pneumonia vaccines, can help protect the lungs from infections that could exacerbate lung disease.
  • Healthy diet and exercise: Maintaining a healthy diet and engaging in regular physical activity can strengthen the lungs and improve overall health. Foods rich in antioxidants, such as fruits and vegetables, can help protect lung tissue from damage.
  • Avoiding secondhand smoke: Exposure to secondhand smoke can increase the risk of lung disease. Smokers should avoid environments where they may be exposed to additional smoke, as this can compound the damage to their lungs.
  • Seeking support for quitting: Quitting smoking is the most effective way to reduce the risk of lung disease. Smokers who are ready to quit should seek support from health care providers, smoking cessation programs, or support groups.
  • Conclusion

    Lung disease is a serious and often life-threatening condition that affects millions of smokers worldwide. By understanding the warning signs and taking proactive steps to address them, smokers can improve their chances of detecting lung disease early and managing it effectively. The symptoms discussed in this article are not to be taken lightly; they are the body's way of signaling that something is wrong.

    For smokers, the decision to prioritize their health can be life-changing. Whether through regular health check-ups, lifestyle changes, or seeking support to quit smoking, taking action today can lead to a healthier, longer life. Remember, the earlier lung disease is detected, the better the chances of controlling it and maintaining a good quality of life. Don't wait until it's too late—pay attention to your body and seek medical advice if you notice any of these warning signs.

    This story was created using AI technology.


    What Causes Difficulty Breathing?

    Difficulty breathing is a symptom of many conditions, including colds and flu, anxiety, asthma, COPD, emphysema, heart attacks, and more. Physical exertion and obstructions are also possible causes.

    People may experience physical difficulty inhaling or exhaling or feeling like they cannot get enough oxygen from each breath. Difficulty breathing can be mild or severe.

    Difficulty breathing may have an obvious cause, such as physical exertion or choking, but in other instances, the root of the problem may not be clear. A shortness of breath that comes on suddenly, progressively worsens and has no clear cause is a medical emergency and requires professional assistance.

    In this article, we examine the possible reasons people might experience difficulty breathing and discuss the diagnosis, treatment, and prevention of this symptom.

    There are several different reasons a person may feel short of breath.

    While many of these may be short-lived or mild, a person should seek immediate medical assistance if they, or someone around them, is having serious difficulty breathing or shortness of breath is accompanied by other symptoms such as dizziness, chest pain, and fever.

    Respiratory infections

    People with a common cold, the flu, and other respiratory infections may have difficulty breathing. These illnesses cause the following symptoms, which can make breathing more difficult:

    The severity of respiratory infection symptoms can vary from mild to severe. It is abnormal for a cold or flu to cause difficulty breathing; anyone experiencing this should seek immediate medical assistance.

    Infections can affect different parts of the lungs. For example, bronchitis is inflammation in the main lung airways (bronchi), while pneumonia can cause inflammation and fluid or pus buildup in the lungs' air sacs (alveoli).

    Learn how to ease the symptoms of a cold here.

    Chronic obstructive pulmonary disease (COPD)

    COPD is a term that describes several lung disorders, including chronic asthma, emphysema, and chronic bronchitis. COPD symptoms may worsen at night or after exertion.

    COPD can cause a range of symptoms, such as:

  • shortness of breath
  • chest pain
  • coughing
  • fatigue as a result of reduced oxygen in the blood
  • Other lung disorders

    Other lung conditions that may cause shortness of breath include:

    Lung cancer

    Certain types of lung cancer and cancer treatments can cause shortness of breath.

    Cancerous growths in the airways specifically can restrict airflow, while tumor surgery, chemotherapy drugs, and radiation therapy can affect breathing in different ways.

    For example, radiotherapy can cause inflammation in the lungs, while people undergoing cancer treatment are at a higher risk of anemia, pleural effusion, and other conditions that affect respiratory function.

    Choking and physical obstruction

    Choking occurs when an object becomes lodged in a person's throat. The object could be a larger piece of food, a toy, or another non-edible item that a child may typically put in their mouth.

    Choking can be life threatening if the object remains in the person's mouth and restricts breathing.

    Obesity

    People who are obese or overweight may experience periods during which they have difficulty breathing. This may occur after exertion, eating, or other activities.

    Extra fat around the neck, chest, and abdomen can put pressure on the muscles surrounding the lungs, making deep breaths more difficult.

    Physical exertion

    If weight or a lack of exercise is causing breathing difficulty, starting an exercise regimen and following a healthful diet can significantly reduce or eliminate the problem.

    Anxiety

    Anxiety can cause physical symptoms, including shortness of breath or breathing difficulties. A person's breath is likely to return to normal once their anxiety eases.

    Other symptoms of anxiety include:

  • feeling nervous or on edge
  • raised heart rate
  • fatigue
  • Panic attacks

    People may sometimes experience extreme anxiety or panic attacks that resemble a heart attack. Other symptoms of a panic attack can include:

  • a raised or pounding heartbeat
  • a feeling of choking
  • sweating
  • Learn about the differences between a panic attack and a heart attack here.

    Pregnancy

    As pregnancy progresses, the fetus becomes bigger and can start to push on surrounding organs and muscles. These include the diaphragm, a muscle directly below the lungs that helps a person take deep breaths.

    If the uterus pushes against the diaphragm, this can make it more difficult for the person to take deep breaths.

    Anemia

    Anemia occurs when the body produces less healthy red blood cells than it requires–leading to a lack of oxygen-rich blood circulating. This can lead to shortness of breath in addition to fatigue and weakness.

    Asthma

    Asthma is a chronic disease that causes the airways leading to the lungs to become inflamed.

    As with other chronic conditions, a person's asthma will flare from time to time, usually as a result of exposure to a trigger. Triggers can vary between people but include exercise, smoke, or allergens.

    Anaphylaxis

    Anaphylaxis is a severe allergic reaction. It is a life threatening condition that requires immediate medical attention. Anaphylaxis progresses quickly, but it has some early warning signs and symptoms, such as tightness in the throat, difficulty breathing, and hives.

    Heart attack

    Difficulty breathing is one of the common warning signs of a heart attack. Therefore, anyone experiencing this symptom should pay attention to any other symptoms that occur.

    If a person experiences the following symptoms, they should get medical attention immediately:

  • chest discomfort
  • trouble breathing
  • discomfort in the back, jaw, neck, stomach, or one or both arms
  • lightheadedness
  • cold sweats
  • nausea
  • pulmonary embolism
  • pleural effusion
  • pneumothorax
  • pericarditis
  • cardiac tamponade
  • There are many possible causes of breathing difficulties. People should see their doctor whenever they have trouble breathing for unknown reasons.

    At an appointment, the doctor will ask about the other symptoms that a person is experiencing. In some cases, this may be enough for the doctor to determine the cause.

    In other cases, a doctor may want to run tests to help diagnose the problem. These tests may include:

    A person should seek immediate medical attention if they experience difficulty breathing that causes them to feel faint or occurs alongside other symptoms of a heart attack.

    Otherwise, a person with unexplained shortness of breath or other breathing problems should speak to their doctor to determine what is causing the issue.

    The cause of the breathing difficulty will determine the treatment. Some common treatments could include:

  • removal of an object in the throat, in cases of choking
  • medications
  • inhalers for asthma and other upper respiratory conditions
  • an epinephrine autoinjector (EpiPen) for anaphylaxis
  • eating smaller meals for acid reflux and COPD
  • antacids for acid reflux
  • In some cases, people can improve their breathing by using specific breathing exercises to increase their lung capacity.

    Learn about these exercises here.

    Prevention

    There are many potential ways to prevent the development of breathing difficulties. Some steps to consider include:

  • taking smaller bites of food and avoiding placing loose objects in the mouth
  • avoiding smoking and breathing in secondhand smoke
  • taking allergy medications and avoiding known allergens
  • eating healthful meals and exercising regularly
  • eating smaller meals
  • taking prescribed medications for chronic conditions and avoiding triggers
  • Below are frequently asked questions relating to shortness of breath.

    Why do I feel like I'm not getting enough air in my lungs?

    There are various reasons why a person may have difficulty breathing deeply, including:

  • obstruction
  • asthma
  • anxiety
  • colds
  • lack of fitness
  • How do I know if my shortness of breath is serious?

    If a person's shortness of breath is sudden, without a clear cause, and progressively worsens they should seek medical assistance immediately.

    If someone experiences shortness of breath with chest pain, dizziness, and nausea, they should also seek immediate help.

    What to do when you feel like you can't breathe?

    Remedying shortness of breath will depend on the cause. In the case of exercise-induced shortness of breath, resting can typically improve symptoms; likewise, if anxiety is causing symptoms, relaxation techniques may help.

    Ensuring the airways are clear, avoiding irritants, and breathing in controlled, steady breaths can also be beneficial.

    If shortness of breath is sudden or severe, a person should seek medical assistance.

    There are several different causes of breathing difficulty. Anyone with concerns about this symptom should see their doctor. Some causes are chronic, such as COPD, while others are temporary, for example, the common cold.

    If symptoms are severe, the person will need immediate medical attention.

    A person can typically avoid having difficulty breathing by avoiding triggers and living a healthful lifestyle that includes eating well and exercising regularly.V






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