Lung Cancer Specialists in Northwest Indiana

Because lung cancer doesn’t often cause early symptoms, lung cancer screening has proven to be effective in identifying lung cancers earlier than ever before. If you have a history of smoking, talk to your doctor about whether lung cancer screening is right for you.

For others who are diagnosed after symptoms appear, such as a cough that won’t go away, shortness of breath, and/or chest pain, a chest x-ray is likely to be performed to see if there is anything unusual in the lungs. If something is spotted, further testing is needed.

Often the doctors will start by running lab tests of the blood and/or urine. These tests can show indicators that cancer may be present by looking for tumor markers in the blood. They may also perform a sputum cytology where sputum (mucus coughed up from the lungs) is used to check for cancer cells. If these tests show signs of cancer cells, a biopsy is most often the next step so that tissue samples can be tested.

Commonly a fine-needle aspiration (FNA) biopsy of the lung is performed. To do this a CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision is made in the skin where the thin biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is performed afterward to ensure no air leaks from the lung into the chest.

The tests used will vary for each patient based on the type of lung cancer and whether it’s suspected that it has spread (metastasized) outside of the lungs. Factors that may influence which tests to be used include:

• Size, location, and type of lung cancer suspected
• Your signs and symptoms
• Your age and general health
• The results of earlier medical tests

In addition to a physical examination and discussion about your family health history, the following tests may be used to diagnose and stage both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC): 

• CT Scan or MRI of the brain, chest, and abdomen: This is a series of detailed pictures of areas inside the body taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show more clearly. 
• PET Scan (positron emission tomography scan): A small amount of radioactive glucose (sugar) is injected into a vein, which aims to find malignant tumor cells in the body. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Cancerous cells appear as bright spots on the images taken during the scan. Even if a tumor is not visible, the PET scan results give the oncologist a sense of where the cancer is trying to go. 
• Bronchoscopy: This test uses a bronchoscope, which is a thin, tube-like instrument with a light and a lens for viewing, that is inserted through the nose or mouth into the trachea and lungs to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Thoracoscopy: A surgical procedure to check for abnormal areas by looking at the organs inside the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. Typically, an incision (cut) is made between two ribs to insert a thoracoscope into the chest for viewing or for using a tool to remove tissue or lymph node samples that are then checked under a microscope for signs of cancer.
• Thoracentesis: This test uses a needle to remove fluid from the space between the lining of the chest and the lung. A pathologist then views the fluid under a microscope to look for cancer cells.
• Radionuclide bone scan: This procedure is used to check if there are rapidly dividing cells in the bone, such as cancer cells. A very small amount of radioactive material is injected into a vein and travels through the bloodstream, where it collects in the bones and is detected by a scanner.

The main tumor can’t be assessed for some reason, or cancer cells are seen in a sample of sputum or other lung fluids, but the cancer isn’t found with other tests, so its location can’t be determined. The cancer is not thought to have spread to nearby lymph nodes or to distant parts of the body.

Abnormal cells are found in the innermost lining of the airways. These abnormal cells may become cancerous and spread into nearby normal tissue. Stage 0 is also called adenocarcinoma in situ (AIS) or squamous cell carcinoma in situ (SCIS).

Cancer has formed. Stage I is divided into stages IA and IB:

• Stage IA: The tumor is located within the lung only and is 3 centimeters or smaller. 
  
  
• Stage IB: The cancer has not spread to nearby lymph nodes or to distant parts of the body. One or more of the following applies:
• The tumor is larger than 3 centimeters.
• Cancer has spread to the main bronchus of the lung and is at least 2 centimeters from the carina (where the trachea joins the bronchi).
• Cancer has spread to the innermost layer of the membrane that covers the lungs.
• The tumor partly blocks the bronchi or bronchioles, and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).

Stage II is divided into stages IIA and IIB:

• Stage IIA: The tumor is larger than 4 centimeters but not larger than 5 centimeters and has not spread to nearby lymph nodes or to distant parts of the body. The tumor has one or more of the following features:
• It has grown into the main bronchus but is not to the carina.
• The tumor has grown into the membranes surrounding the lungs.
• The tumor is partially clogging the airways.
  
  
• Stage IIB (1): The tumor is larger than 3 centimeters but not larger than 5 centimeters across. Cancer has also spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are within the lung and/or around the area where the bronchus enters the lung. The tumor has one or more of the following features:
• It has grown into the main bronchus but is not in the carina.
• It has grown into the membranes surrounding the lungs.
• It is partially clogging the airways.
  
  OR

• Stage IIB (2): The tumor is larger than 5 centimeters but not larger than 7 centimeters across. The cancer has not spread to nearby lymph nodes or distant parts of the body. The tumor has one or more of the following features:
• It has grown into the chest wall, the inner lining of the chest wall, the phrenic nerve that controls the diaphragm, or membranes of the sac surrounding the heart.
• There are 2 or more separate tumor nodules in the same lobe of a lung.

The lung cancers are categorized as either stage IIIA, IIIB, or IIIC. The stage is dependent on the size of the tumor and which lymph nodes the cancer has spread to. Stage III cancers have not spread to other distant parts of the body.

• Stage IIIA (1): The cancer has spread to the lymph nodes on the same side of the chest as the main lung tumor. The tumor has one or more of the following features:
• The tumor is 5 centimeters or smaller.
• It has grown into the main bronchus but is not in the carina.
• It has grown into the innermost layer of the membrane that covers the lung.
• It is partially clogging the airways.
  
  OR

• Stage IIIA (2): The cancer has also spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung. These lymph nodes are on the same side as the cancer. The tumor has one or more of the following features:
• It is larger than 5 centimeters but not larger than 7 centimeters across.
• It has grown into the chest wall, the inner lining of the chest wall, the phrenic nerve, or the membranes of the sac surrounding the heart.
• There are 2 or more separate tumor nodules in the same lobe of a lung.
  
  OR

• Stage IIIA (3): The cancer may or may not have spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung. Any affected lymph nodes are on the same side of the chest as the primary cancer. The tumor has one or more of the following features:
• It is larger than 7 centimeters across.
• It has grown into the space between the lungs, heart, large blood vessels near the heart, trachea, esophagus, voice box, diaphragm, backbone or breastbone, or the carina.
• There are 2 or more separate tumor nodules in different lobes of the same lung.
  
  
• Stage IIIB (1): The cancer has spread to lymph nodes near the collarbone and/or has spread to lymph nodes on the other side of the body from the primary tumor. The tumor has one or more of the following features:
• It is larger than 3 centimeters but not larger than 5 centimeters across.
• It has grown into the main bronchus but is not within the carina.
• It has grown into the innermost layer of membrane that surrounds the lungs.
• It is partially clogging the airways.
  
  OR

• Stage IIIB (2): The cancer has spread to lymph nodes around the carina or in the space between the lungs. These lymph nodes are on the same side as the main lung tumor. The tumor has one or more of the following features:
• There are 2 or more separate tumor nodules in the same lobe of a lung.
• It has grown into the space between the lungs, heart, large blood vessels near the heart, trachea, esophagus, the voice box, diaphragm, backbone, breastbone, or the carina.
  
  
• Stage IIIC: The cancer has spread to lymph nodes near the collarbone and/or has spread to lymph nodes on the other side of the body from the main tumor. The tumor has one or more of the following features:
• There are two or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
• It has grown into the chest wall, the inner lining of the chest wall, the phrenic nerve, membrane surrounding the heart, large blood vessels near the heart, trachea, esophagus, diaphragm, the breastbone or backbone, or the carina.

Stage IV NSCLC is categorized as either stage IVA or IVB. Cancer can be any size and may or may not have grown into nearby structures or spread to the lymph nodes.

• Stage IVA: The tumor has one or more of the following features:
• There are one or more tumors in the lung that do not have the primary tumor.
• The cancer has spread to the other lung.
• Cancer cells are found in the fluid around the lung or heart.
• Cancer has spread to one place in an organ or tissue not near the heart.
  
  
• Stage IVB: The cancer has spread to multiple places in one or more organs, not near the lungs. It has grown as more than one tumor outside the chest, such as to distant lymph nodes and/or to other organs such as the liver, bones, or brain.