Page last updated: October 2024
The information on this webpage was adapted from Understanding Lung Cancer - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in October 2024.
Expert content reviewers:
This information was developed based on Australian and international clinical practice guidelines, and with the help of a range of health professionals and people affected by lung cancer:
- Dr Malinda Itchins, Thoracic Medical Oncologist, Royal North Shore Hospital and Chris O’Brien Lifehouse, NSW
- Dr Cynleen Kai, Radiation Oncologist, GenesisCare, VIC
- Dr Naveed Alam, Thoracic Surgeon, St Vincent’s Hospital, Epworth Richmond, and Monash Medical Centre, VIC
- Helen Benny, Consumer
- Dr Rachael Dodd, Senior Research Fellow, The Daffodil Centre, NSW
- Kim Greco, Specialist Lung Cancer Nurse Consultant, Flinders Medical Centre, SA
- Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA
- Marco Salvador, Consumer
- Janene Shelton, Lung Foundation Australia – Specialist Lung Cancer Nurse, Darling Downs Health, QLD
- Prof Emily Stone, Respiratory Physician, Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital Sydney, NSW
- A/Prof Marianne Weber, Stream Lead, Lung Cancer Policy and Evaluation, The Daffodil Centre, NSW.
Your doctors will arrange several tests to make a diagnosis and work out whether the cancer is in the lung only or has spread beyond the lung. The test results will help them recommend a treatment plan for you.
Initial tests for lung cancer
The first test is usually an x-ray, which is often followed by a CT scan. You may also have a breathing test to check how your lungs are working and blood tests to check your overall health.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast (dye) during previous scans. You should also let them know if you have diabetes or kidney disease, or are pregnant or breastfeeding.
Chest x-ray
A chest x-ray is painless and can show tumours one centimetre wide or larger. Small tumours may not show up or may be hidden by other organs.
CT scan
A CT (computerised tomography) scan uses x-ray beams to create detailed, cross-sectional pictures of the inside of your body. This scan can detect smaller tumours than those found by chest x-rays.
It provides information about the tumour, the lymph nodes and other organs. CT scans are usually done at a hospital or radiology clinic. You may be asked to fast (not eat or drink) for several hours before having the scan.
Immediately before the scan, a liquid dye is injected into a vein. This dye is known as contrast, and it makes the pictures clearer.
The contrast may make you feel hot all over and leave a bitter taste in your mouth, and you may have nausea (feel sick) or feel a sudden urge to pass urine (pee or wee). These sensations should go away quickly, but tell your doctor if you continue to feel unwell.
The CT scanner is a large, doughnut-shaped machine. You lie still on a table while the scanner moves around you. Getting ready for the scan can take 10–30 minutes, but the scan itself takes only a few minutes and is painless.
A low-dose CT scan, which uses less radiation, has been shown to find lung cancer in people with no signs or symptoms. In July 2025, the Australian Government is introducing a national lung cancer screening program (NLCSP) using low-dose CT scans.
It is for people aged 50–70 years old who have smoked at least 20 cigarettes a day for 30 years (or the equivalent, e.g. 40 cigarettes a day for 15 years), and smokers who have quit in the last 10 years.
Talk to your GP or call Cancer Council 13 11 20 for updates on this screening program.
Lung function test (spirometry)
This test checks how well the lungs are working. It measures how much air the lungs can hold and how quickly the lungs can be filled with air and then emptied.
For a lung function test, you will be asked to take a full breath in and then blow out into a machine called a spirometer. You may also have a lung function test before you have surgery or radiation therapy.
Blood tests
A sample of your blood will be tested to check the number of red blood cells, white blood cells and platelets (full blood count), and to see how well your kidneys and liver are working.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for lung cancer can help you make sense of what should happen.
It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Tests to confirm diagnosis
If a tumour is suspected after a chest x-ray or CT scan, you will need further tests to work out if it is lung cancer.
FDG PET–CT scan
This scan combines a PET (positron emission tomography) scan, with a CT scan in one machine. As well as helping with the diagnosis, a PET scan can provide detailed information about any cancer that is found.
First, a small amount of safe radioactive glucose solution called fluorodeoxyglucose (FDG) is injected into a vein, usually in your arm. You will be asked to sit or lie quietly for 30–90 minutes while the glucose solution travels around your body.
Then you will lie on a table that moves through the scanning machine very slowly. The scan will take about 30 minutes.
Cancer cells take up more of the glucose solution than normal cells do, so they show up more brightly on the scan. Sometimes a PET scan is done to work out if a biopsy is needed or to help guide the biopsy procedure.
You will need to fast (not eat or drink) before having this scan.
“I think the doctors knew I had cancer based on the shadow on my CT scan. But they didn’t tell me right away. I had to wait 2 weeks until I had a bronchoscopy.” James
Biopsy
The most common way to confirm a lung cancer diagnosis is by biopsy. This is when small sample of tissue is taken from the lung, lymph nodes, or both.
The tissue sample is sent to a laboratory, where a specialist doctor called a pathologist looks at the sample under a microscope. There are various ways to take a biopsy.
If there is concern that the cancer may have spread to other organs, such as the liver, different types of biopsies may be done.
A new test known as liquid biopsy involves taking a blood sample and examining it for cancer. Liquid biopsy is still being studied to see how accurate it is, and it is not yet a routine way to diagnose lung cancer.
It could help when a tissue biopsy is not safe to perform.
CT-guided lung biopsy
First, you will be given a local anaesthetic. Then, using a CT scan for guidance, the doctor inserts a needle through the chest wall to remove a small sample of tumour from the outer part of the lungs.
You will be monitored for a few hours afterwards. There is a small risk of damaging the lung, but this can be treated if it happens.
Bronchoscopy
The doctor will look inside the large airways (bronchi) using a bronchoscope, a flexible tube with a light and camera. A bronchoscopy is usually performed under light sedation, so you will be awake but feel relaxed and drowsy.
You’ll also be given a local anaesthetic (a mouth spray or gargle) so you don’t feel any pain during the procedure. The doctor will then pass the bronchoscope into your nose or mouth, down the trachea (windpipe) and into the bronchi.
Samples of cells can be collected from the bronchi using either a “washing” or “brushing” method where fluid is injected into the lung and then removed, or a brush-like instrument is used to remove cells.
Endobronchial ultrasound (EBUS)
This is a type of bronchoscopy that allows the doctor to see deeper in the lung using an ultrasound probe.
During this test, the doctor may also take cell samples from a tumour, from the outer parts of the lung, or from lymph nodes in the area between your lungs (mediastinum).
Samples from the lymph nodes can help to confirm whether or not they are also affected by cancer. You will have light sedation and local anaesthetic, or a general anaesthetic.
The doctor will then put a bronchoscope (a thin tube with a small ultrasound probe on the end) into your mouth. The bronchoscope will be passed down your throat until it reaches the bronchus.
The ultrasound probe uses soundwaves to create pictures that show the size and position of a tumour. After a bronchoscopy, you may have a sore throat or cough up a small amount of blood.
These side effects usually pass quickly but tell your medical team how you are feeling so they can monitor you.
Endoscopic ultrasound (EUS)
Sometimes, an endoscopic ultrasound is used to check whether the lung cancer has spread to the lymph nodes in the mediastinum.
In an endoscopic ultrasound, a probe is put into your mouth and down your oesophagus, and a cell sample is taken from the lymph nodes. You do not need any sedation or anaesthetic for EUS.
Mediastinoscopy
This type of biopsy may be done if larger samples from the lymph nodes found in the area between the lungs (mediastinum) are needed.
You will have a general anaesthetic, then the surgeon will make a small cut (incision) in the front of your neck and pass a thin tube down the outside of the trachea.
You can usually go home on the same day as having a mediastinoscopy, but sometimes you may need to stay overnight in hospital.
Thoracoscopy
If other tests are unable to provide a diagnosis, you may have a thoracoscopy. This uses a thoracoscope – a tube with a light and camera – to look at and take a tissue sample from the lungs or around the outer pleura.
It is usually done under general anaesthetic with a type of keyhole surgery called video-assisted thoracoscopic surgery (VATS). Sometimes a simpler procedure called a medical thoracoscopy can be done as a day procedure with light sedation.
Biopsy of neck lymph nodes
The doctor may take a sample of cells from the lymph nodes in the neck with a thin needle. This is often done by a radiologist using an ultrasound for guidance.
“It is hard to think about talking when you are diagnosed. You feel so overwhelmed with your own feelings that to share the diagnosis in a calm and controlled manner is hard.” Judy
Molecular testing
The biopsy sample may be tested for genetic changes or specific proteins in the cancer cells (biomarkers). The tests are known as molecular tests and help work out which drugs may help treat the cancer.
Gene changes
Genes are found in every cell of the body and are inherited from both parents. If something triggers the genes to change (mutate), cancer may start growing.
A mutation that occurs after you are born (acquired mutation) is not the same thing as abnormal genes that can be inherited from your parents. Most gene changes linked to lung cancer are not inherited.
Lung cancers with these gene mutations can be treated with a type of medicine called targeted therapy.
Proteins
If certain proteins are found in the biopsy sample from an NSCLC, the cancer may respond to immunotherapy. The most common protein tested for is called programmed death ligand-1 (PD–L1) on the surface of the cancer cells.
Other tests
In some circumstances, such as if you aren't well enough for a biopsy, mucus or fluid from your lungs may be checked for abnormal cells.
Sputum cytology
In this test, a sample of mucus from your lungs (called sputum or phlegm) is examined to see if it contains cancer cells. Sputum contains cells that line the airways, and is not the same as saliva.
To collect a sample for this test, you will be asked to cough deeply and forcefully into a small container. You can do this at home in the morning before eating or drinking.
The sample can be kept in your fridge until you take it to your doctor, who will send it to a laboratory to check under a microscope.
Pleural tap
Also known as pleurocentesis or thoracentesis, this procedure drains fluid from around the lungs. A pleural tap can help to ease breathlessness, and the fluid can be tested for cancer cells.
It is mostly done with a local anaesthetic, with the doctor – often a radiologist – using ultrasound to guide the procedure.
Further tests
If the tests described in this chapter show that you have lung cancer, you will have further tests to see whether the cancer has spread beyond the lung to other parts of the body or the bones.
You may also have a CT or MRI (magnetic resonance imaging) scan of the brain. If a PET–CT scan is not available or the results are unclear, you may have a CT scan of the abdomen (belly) and pelvis or a bone scan.
For more information, talk to your doctor or call Cancer Council 13 11 20.
Contact cancer support
When you call the Cancer Council support line on 13 11 20, you’ll talk to a cancer nurse and get the support you need.
It’s free, confidential, and available for anyone affected by cancer who has a question – those diagnosed as well as their family, friends, and carers.
Get support
Staging lung cancer
The tests described above help show what type of lung cancer you have and how far it has spread. Called staging, this helps your doctors recommend the best treatment for you.
Both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) are staged using the TNM (tumour-nodesmetastasis) system, which considers the size of the tumour, whether it has affected lymph nodes and whether it has spread.
This information may be combined to give the lung cancer an overall stage of 0, 1, 2, 3 or 4 (often written in Roman numerals as I, II, III or IV).
Sometimes, SCLC is staged using a two-stage system in which the cancer is classified as either limited stage or extensive stage:
- Limited disease (stages 1–3) – cancer is only on one side of the chest and in one part of the lung; nearby lymph nodes may also be affected.
- Extensive disease (stage 4) – cancer has spread to the other lung, to lymph nodes on the other side of the chest or to other areas in the body.
“I had a PET scan and they could tell that the cancer was only in the right lung and one lymph node nearby.” Judy
Prognosis for lung cancer
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict exactly how the disease will respond to treatment.
Instead, your doctor can give you a general idea of the outlook for people with the same type and stage of lung cancer. To work out your prognosis, your doctor will consider:
- your test results
- the type and stage of lung cancer
- the rate and extent of tumour growth
- other factors such as your age, fitness and overall health, and whether you smoke or vape.
Discussing your prognosis and thinking about the future can be challenging and stressful. It is important to know that although some statistics for lung cancer can be frightening, they are an average and may not apply to your situation.
Talk to your doctor about how to interpret any statistics that you come across, as well as the best and worst possible outcomes. This information can help you make treatment decisions.
As in most types of cancer, the outcomes of lung cancer treatment tend to be better when the cancer is found and treated early.
Newer drug treatments such as immunotherapy and targeted therapy have given promising results in many people with advanced lung cancer and are bringing hope for a longer, healthier life to those who have lung cancer that has spread.
For certain circumstances, these therapies are now being used for earlier stage lung cancer.
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