Lung cancer


Diagnosis

Page last updated: October 2024

Expert content reviewers:

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

CT scan

Lung function test (spirometry)

Blood tests

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

“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

Bronchoscopy

Endobronchial ultrasound (EBUS)

Endoscopic ultrasound (EUS)

Mediastinoscopy

Thoracoscopy

Biopsy of neck lymph nodes

“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

Proteins

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

Pleural tap

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.

Find support services

 

Understanding Lung Cancer

Download our Understanding Lung Cancer booklet to learn more.

Download now  Order for free

 

Talking bubbles icon

Questions about cancer?

Call or email our experienced cancer nurses for information and support.

Contact a cancer nurse