Early Detection and Diagnosis

It is extremely difficult to detect lung cancer early. If lung cancer is suspected, a chest X-ray or a spiral CT (computed tomography) scan will be taken to look for a spot or mass on the lungs, or for lung tumors or metastatic disease. Improvements in computer imaging and particularly spiral CT allow physicians to see a more detailed cross-sectional view of the lungs, and have improved detection of early stage lung cancer. If something suspicious is found, then a bronchoscopy, which involves a lighted scope being placed into the lungs, may be performed to confirm the diagnosis. Innovative technologies involving fiber optics are being developed that uses laser light with bronchoscopy to identify early lung cancer and as well as precancerous changes in cells; the technology can be used as a research tool for diagnosis and prevention.

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A lung tissue biopsy may be performed to look for cancer cells in the phlegm and lung tissue as well.
In 2004, the U.S. Preventive Services Task Force, on the basis of results of several studies, upgraded its recommendations regarding the use of spiral CT in routine screening. The group said that there was not enough evidence to date to recommend for or against routine screening in individuals who do not have symptoms.
A large, randomized clinical trial called the National Lung Screening Trial is trying to determine whether taking spiral CT scans of people at high risk will save lives. The trial, which started in 2002, involves some 50,000 people. The International Early Lung Cancer Action Project involves 27,000 individuals enrolled in a clinical trial at 30 sites on three continents. Preliminary results from the first 20,000 enrollees found a stage I lung cancer detection rate of 82 percent. Some 96 percent of the patients were cancer-free up to 100 months after surgery.

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