Page last updated: May 2024
The information on this webpage was adapted from Understanding Lung Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in May 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:
- A/Prof Brett Hughes, Senior Staff Specialist Medical Oncologist, Royal Brisbane and Women’s Hospital, The Prince Charles Hospital and The University of Queensland, QLD
- Dr Brendan Dougherty, Respiratory and Sleep Medicine Specialist, Flinders Medical Centre, SA
- Kim Greco, Nurse Consultant – Lung Cancer, Flinders Medical Centre, SA
- Dr Susan Harden, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC
- A/Prof Rohit Joshi, Medical Oncologist, GenesisCare and Lyell McEwin Hospital, Director, Cancer Research SA
- Kathlene Robson, 13 11 20 Consultant, Cancer Council ACT
- Peter Spolc, Consumer
- Nicole Taylor, Lung Cancer and Mesothelioma Cancer Specialist Nurse, Canberra Hospital, ACT
- Rosemary Taylor, Consumer
- A/Prof Gavin M Wright, Director of Surgical Oncology, St Vincent’s Hospital and Research and Education Lead – Lung Cancer, Victorian Comprehensive Cancer Centre, VIC.
Initial tests for lung cancer
To investigate abnormal symptoms, the first test is usually an x-ray, often followed by a CT scan. You may also have a test to check how your lungs are working and blood tests to check your overall health.
- Chest x-ray – a painless scan which can show tumours one centimetre wide or larger.
- CT scan – uses x-ray beams to take many pictures of the inside of your body.
- Lung function test (spirometry) – measures how much air the lungs can hold and how quickly the lungs can be filled with air and then emptied.
- 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
Biopsy
The most common way to confirm a lung cancer diagnosis is by biopsy. A small sample of tissue is taken from the lung, the nearby 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.
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 a routine way to diagnose lung cancer.
There are various ways to take a biopsy. If there is concern that the cancer may have spread to other organs, such as the brain, different types of biopsies may be done.
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 does occur.
Bronchoscopy
The doctor will look inside the large airways (bronchi) using a bronchoscope, a flexible tube with a light and camera. A bronchosopy is usually performed under light sedation, so you will be awake but feel relaxed and drowsy.
You will 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.
If the tumour is near the bronchi, samples of cells can be collected using either a “washing” or “brushing” method. During “washing”, fluid is injected into the lung and then removed to be looked at under a microscope.
“Brushing” uses a brush-like instrument to remove some cells from the bronchi. If possible, the doctor will use small forceps to take a tissue sample for biopsy
Endobronchial ultrasound (EBUS)
This is a type of bronchoscopy that allows the doctor to see a cancer deeper in the lung. 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 of your chest 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 bronchi. 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
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 passed into your mouth and down your oesophagus and a cell sample is taken from the lymph nodes
Mediastinoscopy
This type of biopsy is not used often but 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 take a tissue sample from the lungs.
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, because only light sedation is needed.
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 using ultrasound for guidance.
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 – examines a sample of mucus (sputum) from your lungs. You will be asked to cough deeply and forcefully into a container, which will be sent to a laboratory to check under a microscope.
- Pleural tap – also known as pleurocentesis or thoracentesis, a pleural tap is a procedure to drain fluid from around the lungs. While it is often done to ease breathlessness, the fluid can be tested for cancer cells. It is mostly performed under local anaesthetic using an ultrasound for guidance.
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 be most effective in treating the cancer.
Genetic 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 is not the same thing as genes inherited from your parents. Most gene changes linked to lung cancer are not inherited.
In NSCLC, the most common genetic mutations are changes in the EGFR (epidermal growth factor receptor), ALK (anaplastic lymphoma Diagnosis 21 kinase), ROS1 (ROS proto-oncogene 1), and KRAS (Kirsten rat sarcoma virus) genes.
Lung cancers with these gene mutations can be treated with a type of medicine called targeted therapy targeted therapy.
Proteins
Certain proteins found in some types of non-small cell lung cancer suggest that the cancer may respond to immunotherapy. The most common protein tested for is called PD-L1.
“I had a PET scan and they could tell that the cancer was only in the right lung and one lymph node nearby.” Judy
Further tests
If the tests described above show that you have lung cancer, you will have further tests to see whether the cancer has spread to other parts of your body. 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) or a bone scan.
For more information, talk to your doctor.
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 your specialist work out how far the cancer has spread. This is known as staging, and it helps your health care team recommend the best treatment for you.
Non-small cell lung cancer (NSCLC) is staged using the TNM (Tumour-Nodes-Metastasis) system. Although the TNM system can be used for SCLC, doctors usually use a two-stage system:
- Limited stage – cancer is only on one side of the chest and in one part of the lung, nearby lymph nodes may also be affected.
- Extensive stage – cancer has spread widely through the lung, to the other lung, to lymph nodes on the other side of the chest or to other areas of the body.
“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 and wash.” James
Prognosis for lung cancer
Prognosis means the expected outcome of a disease. It is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about the general outlook for people with the same type and stage of 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
- how well you and the cancer respond to treatment
- other factors such as your age, fitness and overall health,
- whether you're currently a smoker.
Discussing your prognosis and thinking about the future can be challenging and stressful. It is important to know that although the statistics for lung cancer can be frightening, they are an average and may not apply to your situation.
Find support services
As in most types of cancer, the results of lung cancer treatment tend to be better when the cancer is found and treated early.
Newer treatments such as targeted therapy and immunotherapy are effective in some people with advanced lung cancer and are bringing hope to those who have lung cancer that has spread.