Diagnosis of Lung Cancer

Radiological Examination

An isolated solitary lesion may be small or large, solid or cavitated and sharply demarcated or serrated or umbilicated at its margin.
A solitary pulmonary nodule in a chronic smoker above age of 40 years requires aggressive management.
Spiculated irregular lesions with a lobular contour favor a diagnosis of bronchogenic carcinoma.
Cavitation may represent a necrotic tumor or abscess formation distal to the tumor.
Segmental, lobar or massive collapse of the lung may be present.
Associated hilar and mediastinal shadows indicate spread of tumor to lymph nodes in these areas.
Pleural and pericardial effusion suggest invasion of pleura and the pericardium respectively.
A raised and stationary diaphragm on fluoroscopy suggests phrenic nerve involvement.
Secondary deposits in the ribs and other bones may be evident.

Tomography may provide additional help by defining the patency of the main airways and showing the presence or absence of calcification and involvement of the regional and mediastinal lymph nodes.

CT-scan of chest has become indispensable in management of lung cancer.
It may help in differentiating malignant nodules from benign ones.
CT-san can also be used to search for metastatic diseases in the brain, liver, adrenal, kidney and lymph nodes of the abdomen.

It may be helpful in persons considered for surgery with superior sulcus tumors.

In a peripherally situated mass USG can be used to localize the lesion and a guided aspiration cytology or biopsy can be done.
USG also localizes small pockets of pleural or pericardial effusions.

The use of fibro-optic bronchoscopy, trans-bronchoscopic biopsy and brushing procedures has increased the diagnostic yield.
It may reveal paralyzed vocal colds or abnormalities of the carina and main bronchi which will help in assessment of operability.
Bronchial aspirate and bronchial washing are examined for malignant cells.

Examination of broncho-pulmonary secretions, sputum, pleural fluid and other body fluids for malignant cells is of great value in the diagnosis of bronchogenic carcinoma and its classification by cells type.

Metastasis to the mediastinal lymph nodes is a common problem in person with bronchogenic carcinoma.
Anterior cervical mediastinoscopy is used to obtain a biopsy of the mediastinal nodes.

This allows access into the chest cavity using small Trocars and visualization by thoracoscope equipped with video camera.
Thoracoscopy is also useful to biopsy nodes.

Lung cancer survival rate depends on the type of cancer and other physical conditions of the affected person.

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