As an expert in distinguishing lung cancer types, pathologist William Travis provides precise diagnoses. His work is essential to developing the most effective treatment strategy for each patient.
Lung cancer is difficult to detect early because symptoms usually do not appear until the disease is advanced. Symptoms depend on the location of the tumor and can include persistent cough, hoarseness or wheezing, shortness of breath, sputum streaked with blood, recurring bronchitis or pneumonia, loss of appetite accompanied by weight loss, and chest pain.
Physicians use several techniques to diagnose lung cancer, including the following:
Imaging Tests
Chest x-rays and computed tomography (CT) scans help locate abnormal areas in the lung. Positron emission tomography (PET) combined with CT scanning technology is also used.
Memorial Sloan-Kettering’s radiology department possesses the latest imaging equipment, including computed tomography (CT) and positron emission tomography (PET). CT scanning is often used to diagnose and stage lung cancer. A combined PET/CT scan is also used to detect metabolic activity of a tumor and identify lymph node involvement and sites of metastases. The highly sensitive PET scan picks up the metabolic signal of actively growing cancer cells in the body, and the CT scan provides a detailed picture of the internal anatomy that reveals the size and shape of abnormal cancerous growths. Alone, each test has its limitations, but a combined PET/CT scan provides the most complete information on cancer location and metabolism possible.
Pathology - Bronchoscopy & Biopsies
Doctors may perform a bronchoscopy, which allows them to examine the bronchial passages using an instrument called a bronchoscope. This is a small tube that is inserted through the nose or mouth, down the throat, and into the bronchi. During the procedure physicians may remove some tissue or take a sputum sample for analysis.
At Memorial-Sloan Kettering, we use a modified form of bronchoscopy called autofluorescence bronchoscopy, which can detect early invasive cancers not seen with standard x-rays or white-light bronchoscopy.
To examine areas of the lungs that are not accessible during a bronchoscopy, physicians may perform a needle biopsy, or fine needle aspiration, to remove a small sample of tissue for analysis. Our thoracic pathologists study the microscopic appearance of the tissue to make the most accurate diagnosis possible. Molecular pathologists will then study the genetic characteristics of the biopsy to determine the best treatment for each individual.
Memorial Sloan-Kettering was one of the first centers in the world to implement a personalized medicine approach for the treatment of patients with lung cancer. As part of that initiative, we perform molecular mutation tests on lung cancer biopsies whenever feasible in order to help determine the most effective treatment for each person. By incorporating the results of molecular tests for genetic mutations EGFR and K-ras from lung cancer biopsies into treatment decisions, our oncologists ensure that the patients most likely to benefit from new targeted therapies receive them promptly; conversely, the patients whose tumors are highly unlikely to respond to these drugs are immediately offered other treatment options.
