Diagnosis & staging
This information is about primary lung cancer. This is cancer that starts in the lungs.
The lungs are a common site for secondary lung cancer. This is cancer that starts somewhere else in your body and then spreads (metastasizes) to the lungs.
Mesothelioma is a type of lung cancer. For information:
Mesothelioma
The right lung has three lobes (sections) and the left lung has two lobes.
Other names for lung cancer are pulmonary cancer, bronchial cancer, small cell lung cancer (SCLC), oat cell carcinoma of the lung, non-small cell lung cancer (NSCLC), adenocarcinoma of the lung, and squamous cell lung carcinoma of the lung.
Lung cancer is the deadliest cancer. It causes about 26% (26 out of 100) of all cancer deaths.
B.C. has the lowest rate of lung cancer in Canada. B.C. also has the lowest mortality rate (death) from lung cancer.
There are often no symptoms with early stage lung cancer. Because of this, many people with lung cancer already have advanced disease when they are diagnosed.
More advanced lung cancer may have these symptoms:
- New, changing, or worsening cough, especially if the sputum (the stuff you cough up) has blood in it.
- Change in how well you can exercise (for example, sudden shortness of breath when walking).
- Blood in sputum (thick type of mucus that is made in your lungs), even small amounts.
- Wheezing (not related to asthma or infection).
- Hoarse voice.
- Repeated cases of pneumonia and/or bronchitis.
- Fever.
- Weakness.
- Weight loss.
- Pain in your chest.
- Difficulty swallowing.
- Lymph nodes in your neck get bigger.
- A sudden urge to quit smoking (rare).
- Clubbing (broadening) of your fingernails (rare)
Advanced lung cancer often spreads to the brain, liver, bone and lymph nodes. People with lung cancer may have symptoms from the spread of the cancer before they have symptoms from the lung cancer.
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Tests that may help diagnose lung cancer include:
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Imaging: to see the tumour and if the cancer has spread to other organs and tissues
- Chest X-ray.
- Computerized tomography (CT) scan.
- Magnetic Resonance Imaging (MRI).
- Positron Emission Tomography (PET) scan.
- To diagnose lung cancer, a specialist doctor (pathologist) needs to look at cells under a microscope. Cells from the lungs can be collected in many ways:
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Sputum sample.
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Thoracentesis: a needle is put into the chest to take out fluid between the lungs and chest wall.
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Bronchoscopy: a doctor puts a bronchoscope (thin, flexible tube with a light) down your throat to examine your lungs. The bronchoscope can also take small pieces of tissue for a biopsy. This sample can be called a brushing or a washing.
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Needle biopsy: a doctor uses a CT scan or X-rays to help guide a needle to the tumour. The needle is put through the chest wall into the tumour to take out a tissues sample.
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Mediastinoscopy: a mediastinoscope (a type of endoscope) is put through a small cut made at the bottom of your neck, just above your breastbone. You will be given general anesthetic (put under) for this procedure. This procedure allows your doctor to look at the lymph nodes near your trachea (windpipe). The doctor may also take a biopsy to see if cancer has spread to the lymph nodes.
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Mediastinotomy: a doctor makes a cut near your second rib so they can examine or take a biopsy of the lymph nodes near the aorta (major blood vessel).
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Diagnostic thoracotomy: a surgeon opens your chest to look at your lungs. This may be necessary if other tests cannot make a diagnosis.
There are two main types of lung cancer: non-small cell and small cell.
Non-small cell lung cancer (NSCLC)
- 80% (80 out of 100) of all lung cancers.
- This type of lung cancer includes different kinds of cancer.
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Squamous cell carcinoma (epidermoid): About 30% (30 out of 100) of NSCLC cases.
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Adenocarcinoma: About 40-50% (40-50 out of 100) of NSCLC cases. Most common lung cancer in women. Non-smokers often have this type of lung cancer.
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Large cell carcinoma: About 10% (10 out of 100) of NSCLC cases.
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Adenosquamous carcinoma and carcinoid: Less common.
- 10-15% (10-15 out of 100) of all lung cancers.
- Most aggressive and fast-growing of all lung cancer.
- In many people, the cancer will have already spread to other areas of the body at the time they are diagnosed.
- If the tumour is only in the chest, this is called limited stage. A long-term cure is possible in about 20% (20 out of 100) of these people.
- These cancer cells are small and round, or oval, or shaped like oat grains. An older term for this type of lung cancer is oat cell cancer.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
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Stage 0: Cancer cells are only in the lining of the airway or in the air sacs of the lung. Also called carcinoma in situ or adenocarcinoma in situ.
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Stage 1A: Tumour is only in the lung and is 3 cm or smaller.
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Stage 1B: Tumour in the lung is larger than 3 cm but not more than 4 cm. The tumour may also have:
- Grown into the main airway but where the trachea divides into the left and right bronchi.
- Grown into the inner membrane covering the lungs, called the visceral pleura.
- Caused a lung to collapse or has blocked a bronchus and caused an inflammation of the lung tissues (obstructive pneumonitis)
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Stage 2A: Tumour in the lung is larger than 4 cm but not more than 5 cm or the tumour has:
- Grown into the main airway but where the trachea divides into the left and right bronchi.
- Grown into the inner membrane covering the lungs, called the visceral pleura.
- Caused a lung to collapse or has blocked a bronchus and caused an inflammation of the lung tissues (obstructive pneumonitis)
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Stage 2B: Tumour in the lung is 5 cm or smaller and it has spread to lymph nodes near the bronchi
OR one of the following:
- Tumour is larger than 5 cm but not more than 7 cm.
- Tumour has grown into the outer membrane covering the lungs (called the parietal pleura), the chest wall, the main nerve that runs to the diaphragm (called the phrenic nerve) or the outer membrane covering the heart (called the parietal pericardium).
- There are 2 or more tumours in the same lobe of the lung.
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Stage 3A: Tumour in the lung is 5 cm or smaller and it has spread to lymph nodes beside the trachea on the same side of the body as the tumour, or to lymph nodes below the area where the trachea divides into the left and right bronchi, or both.
OR tumour is larger than 5cm and one of the following:
- Cancer has spread to lymph nodes near the bronchi.
- Tumour has grown into any of the following: the diaphragm, the mediastinum, the heart or large blood vessels near the heart, the trachea, a main nerve that runs to the larynx, the esophagus, a bone in the spine (vertebra) or the area where the trachea divides into the left and right bronchi.
- There are 1 or more other tumours in the same lung.
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Stage 3B: Tumour is 5 cm or smaller and the cancer has spread to the lymph nodes on the opposite side of the trachea or lung or to lymph nodes in the lower part of the neck OR
- Tumour is larger than 5 cm or there are 1 or more other tumours in the same lung. The cancer has also spread to lymph nodes beside the trachea on the same side of the body as the tumour, or to lymph nodes below the area where the trachea divides into the left and right bronchi, or both.
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Stage 3C: The tumour is larger than 5 cm or there is more than 1 tumour in a different lobe of the lung. Cancer has also spread to the lymph nodes on the opposite side of the trachea or lung or to lymph nodes in the lower part of the neck.
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Stage 4: Cancer has spread to other parts of the body (distant metastasis). This is also called metastatic non-small cell lung cancer.
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Limited stage: Cancer is only on one side of the chest. This can include cancer that has spread to lymph nodes on the same side of the chest as the tumour.
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Extensive stage: Cancer has spread in the lung with the tumour, to the other lung, to the lymph nodes on the other side of the chest or to other parts of the body.
Lung cancer is not given a grade. It is given a stage (see above).
