You may be reading this because you’re thinking about getting screened for lung cancer. Maybe you’re waiting for test results. Or, perhaps you or someone you care about just learned they have lung cancer.
This guide will help you understand how lung cancer is diagnosed and what your diagnosis means. Learning as much as you can may help you feel ready to talk with doctors about your care.
If your doctor suspects you have lung cancer, they may do a biopsy. A lung cancer biopsy is a procedure to remove cells or tissue from the growth in your chest. They will test the sample for cancer. A biopsy is the best way to confirm if you have lung cancer.
A lung cancer diagnosis most often will describe where the cancer started, its type, and if it has spread. We use this information to create a care plan just for you.
Most people diagnosed with lung cancer have no symptoms.
For many people, the first sign of lung cancer shows up on a chest X-ray or a CT scan. It’s a spot that looks abnormal (not normal). If something does not look right, you’ll need other tests. These tests could confirm if it’s cancer, and what type of cancer it is.
Most people who come to MSK for a lung cancer diagnosis first meet with a surgeon. MSK surgeons work closely with pathologists, radiologists, and other lung cancer experts. They’ll learn more about the type of lung cancer, and how advanced it is. This information helps your team make a treatment plan that’s best for you.
Your imaging results may show something that’s not normal. Call 800-525-2225 to get a second opinion from MSK experts.
MSK experts are exploring ways to find lung cancer early, other than imaging tests of the tumor. We’re looking for lung cancer markers in a person’s breath. We’re also looking at small pieces of tumor DNA in the blood, using a liquid biopsy test called MSK-ACCESS®.
A lung biopsy is the best way to know for sure if you have lung cancer.
During a lung biopsy, your doctor removes a small sample of tissue from the growth in your lung. The sample is from the area we’re worried about. A pathologist will use a microscope to examine the sample. A pathologist is a doctor who uses a microscope to diagnose disease.
A biopsy provides information about the type of cancer cells. This helps doctors choose which treatment is best for you. Not all lung cancers are the same. They have different treatments.
It’s important for your care team to have this information so they make a care plan just for you.
There are a few types of lung biopsies. Your doctor will recommend the best biopsy method for you. They can explain why they chose that type of lung biopsy, if you have questions.
A bronchoscopy (bron-KOS-koh-pee) is one of the most common methods. It lets your doctor look inside your lung airways using a small camera called a bronchoscope (BRON-koh-SKOPE).
You’ll first get anesthesia (medicine to make you sleep). Your doctor will place the bronchoscope in your mouth or nose. They’ll gently move it through your throat, trachea (windpipe), and airways. They’ll use small tools to remove a tissue sample.
Bronchoscopy is mostly used to reach the growth from the airway, or just outside the airway.
There are other biopsy methods if the growth is in another area, or it’s not the right size for a bronchoscopy.
If a bronchoscopy cannot reach the growth, we may recommend a needle biopsy through the chest wall. This procedure is called a transthoracic (tranz- thor-A-sik) needle biopsy.
You’ll first get anesthesia (medicine to make you sleepy). Your doctor will insert (put) a needle through your skin. It will go right into the spot or growth and remove a small tissue sample.
Your biopsy will be done by an interventional radiologist (also called an IR doctor). This is a doctor who has special training in doing image-guided procedures. Images include X-rays and CT scans.
An endobronchial ultrasound (EBUS) uses sound waves to show images of your lung or surrounding lymph nodes. This procedure gives your doctor information about how deep a tumor is in your tissue, or if it has spread.
During your EBUS biopsy, your doctor uses a small camera with an ultrasound attached to it called a bronchoscope. It’s placed through your mouth into your airways. You doctor uses a needle to take a tissue sample.
In some cases, you may need surgery to do the biopsy. This happens when the growth’s location or size makes it hard to use other biopsy methods.
Our experts are always exploring new ways to diagnose lung cancer and find it early when it’s easier to treat. Explore the latest lung cancer news from MSK.
Thoracic medical oncologist Dr. Mark Awad says new treatments for lung cancer include a growing number of targeted therapies and new forms of immunotherapy.
Learning you have lung cancer can be overwhelming. You’ll hear many medical terms you've never heard before. We’re here to help you understand what they mean and why they matter.
The information in your diagnosis describes important details about the type of lung cancer you have. Your doctors use that information to create the best plan of care for you.
EGFR is a gene that makes a protein called epidermal (eh-pih-DER-mul) growth factor receptor. This protein is on some types of cells that bind to something called an epidermal growth factor.
About 2 out of every 10 people who have non-small cell lung cancer have a mutation in the EGFR gene. People who have this genetic change often never smoked or smoked only a little.
We also test for a mutation in a gene called KRAS. About 2 out of every 10 people who have non-small cell lung cancer have a KRAS mutation. It’s more common in people who smoke now, or who used to smoke. About half of all KRAS mutations are a kind called a KRAS-G12C mutation.
We also test the ALK gene for an abnormality (problem) called rearrangement. This happens when ALK fuses (attaches) to other genes, most often the EML4 gene. They form a mutant gene called EML4-ALK. This changes the way both genes work.
Nearly 5 out of every 100 people with non-small cell lung tumors have ALK gene rearrangements. It also affects about 10 to 15 out of every 100 people with non-small cell lung cancer who never smoked.
More than half of people with squamous cell cancer may have changes in proteins and molecular pathways. A molecular pathway is a set of actions inside a cell that help it work.
Cancer cells can have changes in the FGFR1 or DDR2 genes. We have new treatments for cancer cells that have these changes. We’re also researching new targeted therapies, and may have a clinical trial you can join.
We know less about gene mutations that can cause small cell lung cancer. MSK has clinical trials that involve these mutations. We’re testing treatments for some small cell lung cancer tumors that have certain proteins.
We use a genetic testing tool only offered at MSK called MSK-IMPACT®. This test looks at about 500 genes for genetic changes and other tumor traits. Developed by MSK, it finds genetic changes in the tumor that other tests can miss. We use this test to learn which treatments are best for you.
Genomic testing is also known as biomarker testing or genetic testing. It looks to see if cancer cells have changes in their genes. We can use targeted therapies on some mutations to slow or stop lung cancer from growing. There are treatments for lung cancer caused by these genes:
MSK recommends you ask about testing for another biomarker, called PD-L1. Test results can guide us about how you may respond to a form of immunotherapy called an immune checkpoint inhibitor. For some people, this can be a powerful treatment for lung cancer.
If you learn you have lung cancer, we recommend you get a second opinion right away. This will confirm you’re getting an accurate diagnosis and detailed information about the cancer.
It’s best to get a second opinion before surgery or any other treatment. It can help you avoid treatment you may not need. It can make sure you have the right treatment. Getting a second opinion may take a few days to a week. Sometimes it takes longer.
Second opinions are common. There’s no need to worry you’re hurting your doctor’s feelings. They know second opinions are important when they are not experts in the type of cancer you have.
When you learn you have lung cancer, you’ll probably have many questions. Talking about treatment options with your doctor can help you feel better prepared to make decisions about your care.
There are many types of lung cancer. We’re experienced in treating them all, from the most common to the most rare.
This information describes each type of lung cancer and explains how we classify (sort) them.
Non-small cell lung cancer (NSCLC) gets its name from how the cells look under a microscope. Small cell lung cancer also gets its name from how the cells look under a microscope.
Non-small cell lung cancer is by far the most common type of lung cancer. About 85 out of every 100 cases of lung cancer are NSCLC.
It starts when the cells that make up the lining of the lungs become abnormal (not normal). They grow very quickly and form a mass called a tumor.
Surgery is often the treatment for early-stage non-small cell lung cancer. Treatments for locally advanced or stage 4 non-small cell lung cancer include chemotherapy, targeted therapy, immunotherapy, and radiation therapy.
Adenocarcinoma (A-deh-noh-KAR-sih-NOH-muh) starts in the cells that line the alveoli (tiny air sacs).
About half of all NSCLCs are adenocarcinomas. It’s the most common lung cancer among smokers, nonsmokers, and people under age 45. More women than men have adenocarcinomas not linked to smoking.
We treat very early lung adenocarcinomas with resection (surgery) or radiation alone. For stage 2 or 3, you may have chemotherapy, immunotherapy, or both. You may have surgery, radiation, or both.
We treat stage 4 with chemotherapy, immunotherapy, or both. You may have targeted therapy.
Squamous (SKWAY-mus) cell carcinoma (KAR-sih-NOH-muh) starts in the cells that line the bronchial tubes.
It’s one of the 2 most common lung cancers. About 3 out of every 10 cases of lung cancers are squamous cell carcinoma (also known as epidermoid carcinoma).
Squamous cell carcinoma most often is linked to smoking.
Studies show that men are more likely than women to have squamous cell carcinoma.
Treatment for lung squamous cell carcinomas and adenocarcinomas are similar. However, squamous cell carcinomas often respond well to chemotherapy or immunotherapy. Many people may have surgery.
Large cell neuroendocrine (NOOR-oh-EN-doh-krin) carcinoma (KAR-sih-NOH-muh) is a subtype of non-small cell lung cancer (NSCLC).
It’s also called undifferentiated lung cancer. About 5 out of every 100 non-small cell lung cancers are this type.
Sarcomatoid carcinoma (sar-KOH-muh-toyd KAR-sih-NOH-muh) is like both sarcoma and carcinoma. It’s a rare cancer and is a subtype of non-small cell lung cancer (NSCLC).
Sarcoma starts in the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Carcinoma is cancer that starts in the skin or in tissues that line or cover organs. Sarcomatoid carcinoma shares features of these 2 types.
Small cell lung cancer (SCLC) gets its name from how the cells look under a microscope. It starts in neuroendocrine (NOOR-oh-EN-doh-krin) cells that surround the bronchi.
It’s less common than non-small cell lung cancer and is linked to smoking.
Small cell lung cancer can spread fast to lymph nodes and other areas. It’s the most aggressive type of lung cancer. It has often already spread by the time it’s diagnosed.
Small cell lung cancer also is called oat cell cancer. About 13 out of every 100 lung cancers are small cell lung cancer. Men are more likely than women to get this type of lung cancer.
A lung carcinoid (KAR-sih-noyd) tumor starts in neuroendocrine cells, most often in the major bronchi. About 1 in 4 of all carcinoid tumors start in the lungs.
This type of cancer is also called pulmonary carcinoid tumor or pulmonary neuroendocrine tumor.
There are 2 main types of lung carcinoid tumors:
A cancer's stage tells us how advanced the cancer is. It describes traits such as the tumor’s size, location, and whether it has spread.
There are 5 stages of lung cancer, from 0 to 4 (0 to IV). The lower the number, the less the cancer has spread. Your doctor may add a letter (A, B, or C) to these stages to give even more information.
Staging helps your doctor choose the best treatment options for you. The stage also helps them predict the outcome (result) of your treatment. Based on the stage, you also may be able to join a clinical trial.
The stage is based on:
Your doctor may use letters and numbers from the TNM system to describe the stage:
Staging may also involve biopsies. You may have a needle biopsy, a bronchoscopy, or other methods.
Doctors use the same staging system for both non-small cell and small cell lung cancer. Small cell lung cancer often is diagnosed at a later stage than non-small cell lung cancer.
Do you smoke, or did you smoke in the past? Do you think you may be at risk for lung cancer? Should you get screened? MSK doctors designed a lung cancer risk assessment tool that can calculate your risk for getting the disease. You just answer 3 short questions.
