Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung. Learn about risk factors, staging, treatment, and prognosis for this disease.
Comparison of normal lung (left) and lung with cancer (right)
Image by TheVisualMD
Key Points
Non-small cell lung cancer in a 54-year-old woman
Image by Oregon State University
Non-small cell lung cancer in a 54-year-old woman
This photo provided by Naturopathic Doctor News and Review shows non-small cell lung cancer in a 54-year-old woman.
Image by Oregon State University
General Information About Non-Small Cell Lung Cancer
KEY POINTS
Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.
There are several types of non-small cell lung cancer.
Smoking is the major risk factor for non-small cell lung cancer.
Signs of non-small cell lung cancer include a cough that doesn't go away and shortness of breath.
Tests that examine the lungs are used to detect (find), diagnose, and stage non-small cell lung cancer.
If lung cancer is suspected, a biopsy is done.
Certain factors affect prognosis (chance of recovery) and treatment options.
For most patients with non-small cell lung cancer, current treatments do not cure the cancer.
Source: National Cancer Institute (NIH)
Additional Materials (15)
Non-small Cell Carcinoma of the Lung, FNA
Image by euthman
The Pathophysiology of Non-small Cell Lung Cancer
Video by Mechanisms in Medicine/YouTube
What's the difference between non-small cell lung cancer & small cell lung cancer? | Norton Cancer
Video by Norton Healthcare/YouTube
Battling Lung Cancer with Immunotherapy
Video by Johns Hopkins Medicine/YouTube
Understanding Non-Small Cell Lung Cancer
Video by You and Lung Cancer/YouTube
Osimertinib in Advanced Non–Small-Cell Lung Cancer
Video by NEJMvideo/YouTube
Non-Small Cell Lung Cancer – An Introduction
Video by Cancer.Net/YouTube
Treatment and Management of Non-Small Cell Lung Cancer (NSCLC)
Video by You and Lung Cancer/YouTube
Non-Small Cell Lung Cancer (NSCLC) Immunotherapy: Advancing Hope
Video by Society for Immunotherapy of Cancer/YouTube
Non Small Cell Lung Cancer Part 1
Video by Access Health Care Physicians/YouTube
Targeted Therapy in Non-Small Cell Lung Cancer
Video by You and Lung Cancer/YouTube
What is non-small cell lung cancer (NSCLC)?
Video by You and Lung Cancer/YouTube
Immunotherapy Treatments for Non-Small Cell Lung Cancer (NSCLC)
Video by You and Lung Cancer/YouTube
Understanding Biomarker Testing in Non-Small Cell Lung Cancer
Video by You and Lung Cancer/YouTube
What is Lung Cancer?
Video by Mechanisms in Medicine/YouTube
Non-small Cell Carcinoma of the Lung, FNA
euthman
4:09
The Pathophysiology of Non-small Cell Lung Cancer
Mechanisms in Medicine/YouTube
2:17
What's the difference between non-small cell lung cancer & small cell lung cancer? | Norton Cancer
Norton Healthcare/YouTube
3:29
Battling Lung Cancer with Immunotherapy
Johns Hopkins Medicine/YouTube
4:44
Understanding Non-Small Cell Lung Cancer
You and Lung Cancer/YouTube
2:20
Osimertinib in Advanced Non–Small-Cell Lung Cancer
NEJMvideo/YouTube
8:48
Non-Small Cell Lung Cancer – An Introduction
Cancer.Net/YouTube
6:05
Treatment and Management of Non-Small Cell Lung Cancer (NSCLC)
You and Lung Cancer/YouTube
7:39
Non-Small Cell Lung Cancer (NSCLC) Immunotherapy: Advancing Hope
Society for Immunotherapy of Cancer/YouTube
5:13
Non Small Cell Lung Cancer Part 1
Access Health Care Physicians/YouTube
5:53
Targeted Therapy in Non-Small Cell Lung Cancer
You and Lung Cancer/YouTube
1:01
What is non-small cell lung cancer (NSCLC)?
You and Lung Cancer/YouTube
3:30
Immunotherapy Treatments for Non-Small Cell Lung Cancer (NSCLC)
You and Lung Cancer/YouTube
6:14
Understanding Biomarker Testing in Non-Small Cell Lung Cancer
You and Lung Cancer/YouTube
3:26
What is Lung Cancer?
Mechanisms in Medicine/YouTube
What Is
Right Lung Cancer
Image by TheVisualMD
Right Lung Cancer
Visualization of cancer in the right lung. The right breast has been clipped to give a clearer view of the cancerous lung. The lung is also coronally clipped to show the malignant tumors.
Image by TheVisualMD
What Is Non-Small Cell Lung Cancer?
Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.
The lungs are a pair of cone-shaped breathing organs in the chest. The lungs bring oxygen into the body as you breathe in. They release carbon dioxide, a waste product of the body's cells, as you breathe out. Each lung has sections called lobes. The left lung has two lobes. The right lung is slightly larger and has three lobes. Two tubes called bronchi lead from the trachea (windpipe) to the right and left lungs. The bronchi are sometimes also involved in lung cancer. Tiny air sacs called alveoli and small tubes called bronchioles make up the inside of the lungs.
Anatomy of the respiratory system showing the trachea, the right and left lungs and their lobes, and the bronchi. The lymph nodes and the diaphragm are also shown. Oxygen is inhaled into the lungs and passes through the alveoli (the tiny air sacs at the end of the bronchioles) and into the bloodstream (see inset), where it travels to the tissues throughout the body.
A thin membrane called the pleura covers the outside of each lung and lines the inside wall of the chest cavity. This creates a sac called the pleural cavity. The pleural cavity normally contains a small amount of fluid that helps the lungs move smoothly in the chest when you breathe.
There are two main types of lung cancer: non-small cell lung cancer and small cell lung cancer.
There are several types of non-small cell lung cancer.
Each type of non-small cell lung cancer has different kinds of cancer cells. The cancer cells of each type grow and spread in different ways. The types of non-small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look under a microscope:
Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This is also called epidermoid carcinoma.
Large cell carcinoma: Cancer that may begin in several types of large cells.
Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.
Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.
Source: National Cancer Institute (NIH)
Additional Materials (1)
Understanding Non-Small Cell Lung Cancer
Video by You and Lung Cancer/YouTube
4:44
Understanding Non-Small Cell Lung Cancer
You and Lung Cancer/YouTube
Risk Factors
The Lungs Under Attack
Image by TheVisualMD
The Lungs Under Attack
How smoking damages the delicate tissues in your lungs and airways, causing a wide range of respiratory ills
Image by TheVisualMD
Smoking Is the Major Risk Factor for Non-Small Cell Lung Cancer
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for lung cancer.
Risk factors for lung cancer include the following:
Smoking cigarettes, pipes, or cigars, now or in the past. This is the most important risk factor for lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer.
Being exposed to secondhand smoke.
Being exposed to radiation from any of the following:
Radiation therapy to the breast or chest.
Radon in the home or workplace.
Imaging tests such as CT scans.
Atomic bomb radiation.
Being exposed to asbestos, chromium, nickel, beryllium, arsenic, soot, or tar in the workplace.
Living where there is air pollution.
Having a family history of lung cancer.
Being infected with the human immunodeficiency virus (HIV).
Taking beta carotene supplements and being a heavy smoker.
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
When smoking is combined with other risk factors, the risk of lung cancer is increased.
Source: National Cancer Institute (NIH)
Additional Materials (9)
Stop Smoking
Damage to your respiratory, neurological and cardiovascular health from Smoking
Image by TheVisualMD
Stop Smoking and drinking
Stop Smoking and drinking
Image by TheVisualMD
Depiction of a person smoking and stages of Lung Cancer
Depiction of a person smoking and stages of Lung Cancer
Image by https://www.myupchar.com
Smoking and Lung Cancer
64,300 cases of cancer are caused by smoking each year in the UK/ 2014
Image by Cancer Research UK / Wikimedia Commons
Smoking
Smoking can damage every part of the body
Image by CDC
What are the risk factors for non-small cell lung cancer (NSCLC)?
Video by You and Lung Cancer/YouTube
Differences in Small Cell vs Non-Small Cell Lung Cancer
Video by curetoday/YouTube
How Smoking Impacts Your Lung Health
Video by American Lung Association/YouTube
Understanding Small Cell Lung Cancer
Video by You and Lung Cancer/YouTube
Stop Smoking
TheVisualMD
Stop Smoking and drinking
TheVisualMD
Depiction of a person smoking and stages of Lung Cancer
https://www.myupchar.com
Smoking and Lung Cancer
Cancer Research UK / Wikimedia Commons
Smoking
CDC
0:50
What are the risk factors for non-small cell lung cancer (NSCLC)?
You and Lung Cancer/YouTube
5:44
Differences in Small Cell vs Non-Small Cell Lung Cancer
curetoday/YouTube
6:47
How Smoking Impacts Your Lung Health
American Lung Association/YouTube
5:10
Understanding Small Cell Lung Cancer
You and Lung Cancer/YouTube
Signs & Prognosis
Coughing, Wheezing, and Shortness of Breath
Image by TheVisualMD
Coughing, Wheezing, and Shortness of Breath
Coughing, wheezing, and shortness of breath
Image by TheVisualMD
What Are Signs of Non-Small Cell Lung Cancer?
Signs
Sometimes lung cancer does not cause any signs or symptoms. It may be found during a chest x-ray done for another condition. Signs and symptoms may be caused by lung cancer or by other conditions. Check with your doctor if you have any of the following:
Chest discomfort or pain.
A cough that doesn't go away or gets worse over time.
Trouble breathing.
Wheezing.
Blood in sputum (mucus coughed up from the lungs).
Hoarseness.
Loss of appetite.
Weight loss for no known reason.
Feeling very tired.
Trouble swallowing.
Swelling in the face and/or veins in the neck.
Prognosis
The prognosis (chance of recovery) and treatment options depend on the following:
The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
The type of lung cancer.
Whether the cancer has mutations (changes) in certain genes, such as the epidermal growth factor receptor (EGFR) gene or the anaplastic lymphoma kinase (ALK) gene.
Whether there are signs and symptoms such as coughing or trouble breathing.
The patient's general health.
Source: National Cancer Institute (NIH)
Additional Materials (4)
What are the symptoms of non-small cell lung cancer (NSCLC)?
Video by You and Lung Cancer/YouTube
Rates of Lung Cancer
Although the rate of new cases of lung cancer continues to decrease, along with the smoking rate, lung cancer is still the second most common cancer. (Instagram crop; see attachments for other social media crops.) This image is part of the Annual Report to the Nation on the Status of Cancer collection.
See also https://www.cancer.gov/research/progress/annual-report-nation.
Image by National Cancer Institute (NCI)
Lung Cancer and Traditional Chinese Medicine
Image by StoryMD/Pixabay
The Pathophysiology of Non-small Cell Lung Cancer
Video by Mechanisms in Medicine/YouTube
0:50
What are the symptoms of non-small cell lung cancer (NSCLC)?
You and Lung Cancer/YouTube
Rates of Lung Cancer
National Cancer Institute (NCI)
Lung Cancer and Traditional Chinese Medicine
StoryMD/Pixabay
4:09
The Pathophysiology of Non-small Cell Lung Cancer
Mechanisms in Medicine/YouTube
Diagnosis
Lung biopsy guided by computertomography: Lung cancer
Image by Hellerhoff
Lung biopsy guided by computertomography: Lung cancer
Lung biopsy guided by computertomography: Lung cancer
Image by Hellerhoff
How Is Non-Small Cell Lung Cancer Diagnosed?
Tests that examine the lungs are used to diagnose and stage non-small cell lung cancer.
Tests and procedures to detect, diagnose, and stage non-small cell lung cancer are often done at the same time. Some of the following tests and procedures may be used:
Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, including smoking, and past jobs, illnesses, and treatments will also be taken.
Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Sputum cytology: A procedure in which a pathologist views a sample of sputum (mucus coughed up from the lungs) under a microscope, to check for cancer cells.
Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
If lung cancer is suspected, a biopsy is done.
One of the following types of biopsies is usually used:
Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.
Fine-needle aspiration biopsy of the lung. The patient lies on a table that slides through the computed tomography (CT) machine, which takes x-ray pictures of the inside of the body. The x-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer.
An endoscopic ultrasound (EUS) is a type of ultrasound that may be used to guide an FNA biopsy of the lung, lymph nodes, or other areas. EUS is a procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
Endoscopic ultrasound-guided fine-needle aspiration biopsy. An endoscope that has an ultrasound probe and a biopsy needle is inserted through the mouth and into the esophagus. The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the lymph nodes near the esophagus. The sonogram helps the doctor see where to place the biopsy needle to remove tissue from the lymph nodes. This tissue is checked under a microscope for signs of cancer.
Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
Bronchoscopy. A bronchoscope is inserted through the mouth, trachea, and major bronchi into the lung, to look for abnormal areas. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a cutting tool. Tissue samples may be taken to be checked under a microscope for signs of disease.
Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.
Mediastinoscopy: A surgical procedure to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.
Mediastinoscopy. A mediastinoscope is inserted into the chest through an incision above the breastbone to look for abnormal areas between the lungs. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a cutting tool. Tissue samples may be taken from lymph nodes on the right side of the chest and checked under a microscope for signs of cancer. In an anterior mediastinotomy (Chamberlain procedure), the incision is made beside the breastbone to remove tissue samples from the lymph nodes on the left side of the chest.
Anterior mediastinotomy: A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and heart for abnormal areas. An incision (cut) is made next to the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. This is also called the Chamberlain procedure.
Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the lymph node tissue under a microscope to check for cancer cells.
One or more of the following laboratory tests may be done to study the tissue samples:
Molecular test: A laboratory test to check for certain genes, proteins, or other molecules in a sample of tissue, blood, or other body fluid. Molecular tests check for certain gene or chromosome changes that occur in non-small cell lung cancer.
Immunohistochemistry: A laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient’s tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.
Source: National Cancer Institute (NIH)
Additional Materials (18)
Biopsy, Fine Needle Aspiration (FNA), Lung
Fine-needle aspiration biopsy of the lung. The patient lies on a table that slides through the computed tomography (CT) machine, which takes x-ray pictures of the inside of the body. The x-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer.
Micrograph showing a PD-L1-positive NSCLC, PD-L1 immunostain
Interactive by Nephron
X-ray of Lung Cancer
X-ray of Lung Cancer
Image by Aspérule/Wikimedia
CT Scan of Lung Cancer
CT Scan of Lung Cancer
Image by Aspérule/Wikimedia
Lung Cancer
Three-dimensional (3D) CT with volume rendering of a male's thorax shows a tumor in the peripheral airway of the left lung.
Image by Lange123 at German Wikipedia
Adenocarcinoma
Researchers from The Cancer Genome Atlas (TCGA) Research Network have identified novel mutations in a well-known cancer-causing pathway in lung adenocarcinoma, the most common subtype of lung cancer. Knowledge of these genomic changes may expand the number of possible therapeutic targets for this disease and potentially identify a greater number of patients with treatable mutations because many potent cancer drugs that target these mutations already exist. Credit: Jonathan Bailey, NHGRI.
Image by Jonathan Bailey, NHGRI
Lung Cancer Metastasis
This image shows how lung cancer cells invade surrounding tissues and start to spread (metastasis). These lung cancer cells have a mutation of a gene called LKB1 (in green) that promotes invasion. Actin, a cytoskeletal protein, is in red, and the cell nucleus is blue. These H157 lung cancer cells are expressing a GFP-tagged piece of LKB1 to disrupt its normal function. Spheroids of these cells were embedded in a 3-D collagen matrix with cells invading for 24 hours.
This image was originally submitted as part of the 2016 NCI Cancer Close Up project. This image is part of the NCI Cancer Close Up 2016 collection.
See also https://visualsonline.cancer.gov/closeup2016.
Image by National Cancer Institute \ Winship Cancer Institute of Emory University / Scott Wilkinson, Adam Marcus
Lung Cancer Is the Biggest Cancer Killer in Both Men and Women
Image by CDC
Diagram showing how you have internal radiotherapy for lung cancer CRUK 160
Diagram showing how you have internal radiotherapy for lung cancer.
Image by Cancer Research UK/Wikimedia
African-American Men and Lung Cancer
Image by CDC
Benefits and Harms of LDCT Screening for Lung Cancer
The benefits of lung cancer screening may be greater if your lung cancer risk is higher. For example, current smokers who smoke more than one pack a day have a higher risk for lung cancer than smokers who quit 10 years ago.
The harms of lung cancer screening may be greater if you have other health problems, such as heart disease or severe lung disease like asthma or chronic obstructive pulmonary disease (COPD). The risk of problems from biopsies may be higher in these people.
Image by Agency for Healthcare Research and Quality (AHRQ)
Rates of Lung Cancer
Although the rate of new cases of lung cancer continues to decrease, along with the smoking rate, lung cancer is still the second most common cancer. (Instagram crop; see attachments for other social media crops.) This image is part of the Annual Report to the Nation on the Status of Cancer collection.
See also https://www.cancer.gov/research/progress/annual-report-nation.
Image by National Cancer Institute (NCI)
PD-L1 Testing in Non-Small Cell Lung Carcinoma
Video by Mayo Clinic Laboratories/YouTube
How is non-small cell lung cancer (NSCLC) diagnosed?
Video by You and Lung Cancer/YouTube
Lung Cancer: Early Diagnosis, Treatment
Video by Nucleus Medical Media/YouTube
Understanding Biomarker Testing in Non-Small Cell Lung Cancer
Video by You and Lung Cancer/YouTube
A patient’s perspective on biomarker testing in non-small cell lung cancer
National Cancer Institute \ Winship Cancer Institute of Emory University / Scott Wilkinson, Adam Marcus
Lung Cancer Is the Biggest Cancer Killer in Both Men and Women
CDC
Diagram showing how you have internal radiotherapy for lung cancer CRUK 160
Cancer Research UK/Wikimedia
African-American Men and Lung Cancer
CDC
Benefits and Harms of LDCT Screening for Lung Cancer
Agency for Healthcare Research and Quality (AHRQ)
Rates of Lung Cancer
National Cancer Institute (NCI)
14:38
PD-L1 Testing in Non-Small Cell Lung Carcinoma
Mayo Clinic Laboratories/YouTube
1:45
How is non-small cell lung cancer (NSCLC) diagnosed?
You and Lung Cancer/YouTube
4:13
Lung Cancer: Early Diagnosis, Treatment
Nucleus Medical Media/YouTube
6:14
Understanding Biomarker Testing in Non-Small Cell Lung Cancer
You and Lung Cancer/YouTube
5:10
A patient’s perspective on biomarker testing in non-small cell lung cancer
Novartis/YouTube
4:09
The Pathophysiology of Non-small Cell Lung Cancer
Mechanisms in Medicine/YouTube
Lung Cancer Tumor Markers
Lung Cancer Genetic Tests
Also called: Lung Cancer Targeted Gene Panel, Lung Cancer Tumor Markers
Lung cancer genetic tests look for changes in the genes of the cancer cells in your body. The test results may guide treatment choices for targeted therapies.
Lung Cancer Genetic Tests
Also called: Lung Cancer Targeted Gene Panel, Lung Cancer Tumor Markers
Lung cancer genetic tests look for changes in the genes of the cancer cells in your body. The test results may guide treatment choices for targeted therapies.
If you have lung cancer, your health care provider may order genetic tests. These tests look for changes in the genes of the cancer cells in your body. Gene changes are also called gene variants or mutations. There are many types of gene changes that are found in lung cancer. Knowing what type of gene change you have may help your provider to:
Predict how your lung cancer will develop over time
Match your cancer to a targeted therapy that's most likely to help you
Targeted therapy uses drugs or other substances that mainly attack specific cancer cells and cause less harm to normal cells. It usually has fewer side effects than chemotherapy or radiation therapy.
There are different types of targeted therapies. Each type is designed to work for cancers with specific gene changes. So, lung cancer genetic tests are important to check if your cancer has a gene change that can be treated with targeted therapy.
There are two main types of lung cancer, small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Most people with lung cancer have NSCLC. The most common lung cancer genetic tests are done for NSCLC. That's because this type of lung cancer is more likely to have gene changes that respond to targeted therapies.
Genes are parts of DNA in your cells that you inherit from your parents. Genes carry information that controls what you look like and how your body works. The gene changes found in lung cancer affect genes that control how fast your cells grow and divide to make new cells. Cells with these changes grow out of control and form cancerous tumors that can spread through your body.
The gene changes in lung cancer usually aren't inherited. That means you can't pass them down to your children. You develop gene changes in certain cells in your lungs after you're born. These changes can happen if you're exposed to substances that cause cancer, such as tobacco smoke, radon gas, or air pollution. Gene changes can also happen if your cells make a mistake when they divide to make new cells.
Lung cancer genetic testing is most often used to look for gene changes that are often involved in non-small cell lung cancer. The results may help guide treatment choices for targeted therapies.
There are many types of gene changes that can be involved in NSCLC. And researchers are still learning about more.
Lung cancer genetic tests may check a single gene or several genes may be checked in one test.
You may need a lung cancer genetic testing if you have been diagnosed with lung cancer. The test results may help your provider know which treatments are likely to help you the most and which ones may not help at all.
The best sample for lung cancer genetic tests is tissue from a tumor in your lung. The procedure to collect a tissue sample is called a biopsy. If you had a biopsy to diagnose your cancer, the same tissue may be used to test for gene changes.
There are several ways to do a lung biopsy. The type of biopsy you have depends on many things, including where the cancer is growing in your lungs. In certain cases, tissue may be removed with a special hollow needle inserted through your skin and into your lung.
A tissue sample may also be removed during a bronchoscopy or with a procedure that involves making an incision (cut) in your chest area to insert special tube-like instruments into your lung. Talk with your provider to find out which biopsy method will work for you.
If tumor tissue can't be collected, a blood test may be used for genetic testing in certain cases. Tumor cells shed DNA into your bloodstream. Testing the tumor DNA in your blood is called a "liquid biopsy." This test is not as accurate as tests that use tumor tissue. Researchers are still studying the use of liquid biopsies to test for certain gene changes.
Ask your provider if you need to do anything to prepare for your test.
If you have a biopsy, the risks depend on the type of procedure you have. In general, you may have a little bruising or bleeding at the biopsy site. You may also have some discomfort. Ask your provider about any risks involved with the test you're having.
If your lung cancer cells have a gene change that may respond well to a targeted therapy, your provider may start you on that treatment.
If your results show you don't have a gene change that matches a targeted therapy, your provider may discuss other treatment options. If you were tested for one gene change, other tests may be done to look for other gene changes that have targeted therapies.
Your test results may also show that your lung cancer has a gene change that:
May prevent a certain therapy from working. This information could spare you from getting treatment that won't help.
Doesn't help make treatment decisions. Researchers don't understand the importance of all the gene changes that are found in cancer.
Genetic testing may take longer than many other types of lab tests. So, you may not get your results for a few days to a week or more. If you have questions about your results, talk with your provider.
Lung Cancer Genetic Tests: MedlinePlus Medical Test [accessed on Dec 26, 2023]
An EGFR genetic test is most often used to guide treatment for certain cancers. It helps determine whether treatment with EGFR-targeted drugs would be beneficial for you.
An EGFR genetic test is most often used to guide treatment for certain cancers. It helps determine whether treatment with EGFR-targeted drugs would be beneficial for you.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
If your biopsy results showed that your type of cancer does not have an EGFR gene mutation, then you are not likely to benefit from treatment with a tyrosine kinase inhibitor drug.
Related conditions
Non-small cell lung cancer
Colon cancer
Brain cancer
Pancreas cancer
EGFR is a protein found on certain types of cells that binds to a substance called epidermal growth factor. The EGFR protein is involved in cell signaling pathways that control cell division and survival. Sometimes, mutations (changes) in the EGFR gene cause EGFR proteins to be made in higher than normal amounts on some types of cancer cells. This causes cancer cells to divide more rapidly.
Drugs that block EGFR proteins are being used in the treatment of some types of cancer, including colon cancer, brain cancer, pancreas cancer, and especially in non-small cell lung cancer. EGFRs are a type of receptor tyrosine kinase.
An EGFR genetic test identifies specific rearrangements in the EGFR gene present in a tumor tissue sample (biopsy).
Your doctor might want to order an EGFR test if you were already diagnosed with non-small cell lung cancer.
This test can help your doctor decide on an appropriate therapeutic management plan that may include tyrosine kinase inhibitors, like for instance drugs such as gefitinib and erlotinib.
Tyrosine kinase inhibitors (TKIs) block the action of EGFR, which cause cell growth inhibition, making it effective for cancer treatment.
After using anesthesia, a biopsy procedure (taking a small piece of the affected tissue) is performed to collect a tumor sample, which then will be evaluated by a pathologist.
You may be asked to refrain from eating, but, usually, no preparations are needed. Follow the instructions provided by your health-care practitioner.
Biopsies are considered to be low-risk procedures, and they are usually entirely pain-free. However, depending on the site from where the tissue sample is taken, you might feel bloated, uncomfortable, or have a sore throat.
As with most procedures, a biopsy also carries the risk of infection and bleeding.
If your biopsy result came back positive, it means that your cancer tissue contains a specific EGFR gene mutation. Therefore, you are likely to benefit from treatment with tyrosine kinase inhibitors, like gefitinib or erlotinib.
If your biopsy results showed that your type of cancer does not have an EGFR gene mutation, then you are not likely to benefit from treatment with a tyrosine kinase inhibitor drug.
This test is normally ordered along with or as a follow-up test to KRAS and anaplastic lymphoma receptor tyrosine kinase (ALK) mutation testing.
In some cases, a negative EGFR test may be repeated if the tumor tissue sample was considered to be insufficient.
EGFR Mutation Testing [accessed on Oct 03, 2018]
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/egfr [accessed on Oct 03, 2018]
EGFRD - Clinical: Cell-Free DNA EGFR Exon 18, 19, 20, 21, Mutation Analysis, Blood [accessed on Oct 03, 2018]
EGFRT - Clinical: EGFR Gene, Mutation Analysis, 29 Mutation Panel, Tumor [accessed on Oct 03, 2018]
489360: Epidermal Growth Factor Receptor (EGFR) Gene... | LabCorp [accessed on Oct 03, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (5)
VEGF and EGFR pathways in detail: Target for new therapies against cancer
Video by Bowel Cancer Australia/YouTube
Introduction to Cancer Biology (Part 1): Abnormal Signal Transduction
Video by Mechanisms in Medicine/YouTube
Introduction to Cancer Biology (Part 3): Tissue Invasion and Metastasis
Video by Mechanisms in Medicine/YouTube
Introduction to Cancer Biology (Part 2): Loss of Apoptosis
Video by Mechanisms in Medicine/YouTube
Introduction to Cancer Biology (Part 4): Angiogenesis
Video by Mechanisms in Medicine/YouTube
4:22
VEGF and EGFR pathways in detail: Target for new therapies against cancer
Bowel Cancer Australia/YouTube
7:47
Introduction to Cancer Biology (Part 1): Abnormal Signal Transduction
Mechanisms in Medicine/YouTube
3:10
Introduction to Cancer Biology (Part 3): Tissue Invasion and Metastasis
Mechanisms in Medicine/YouTube
4:16
Introduction to Cancer Biology (Part 2): Loss of Apoptosis
Mechanisms in Medicine/YouTube
3:59
Introduction to Cancer Biology (Part 4): Angiogenesis
A KRAS genetic test is most often used to guide treatment for certain cancers, particularly colon and non-small cell lung cancer. Some medicines are especially effective in cancer patients with KRAS mutations.
A KRAS genetic test is most often used to guide treatment for certain cancers, particularly colon and non-small cell lung cancer. Some medicines are especially effective in cancer patients with KRAS mutations.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
This person may respond to anti-EGFR therapy.
Related conditions
Non-small Cell Lung Cancer
Colon cancer
KRAS gene provides instructions for making a protein called K-Ras. These proteins play important roles in cell division, cell differentiation, and the self-destruction of cells (apoptosis). KRAS gene belongs to a class of genes known as oncogenes. When there is a gene mutation, oncogenes can turn normal cells into cancerous cells.
KRAS genetic test is used to detect the most common KRAS mutations in the DNA cells and help to guide cancer treatment.
It is ordered to evaluate the response to a therapy with anti-epidermal growth factor receptor (anti-EGFR) drug therapy in patients with colon cancer and non-small cell lung cancer.
A doctor may perform this test after an individual has been diagnosed with colon cancer or non-small cell lung cancer, to test for drug sensitivity with epidermal growth factor receptor-targeted therapies.
After using anesthesia, a biopsy procedure (taking a small piece of the affected tissue) is performed to collect a tumor sample, which then will be evaluated by a pathologist.
You may be asked to refrain from eating, but usually, no preparations are needed. Follow the instructions provided by your health-care practitioner.
Risks of a biopsy depend on size, place of biopsy and type of procedure, among several other variables. There is a risk of infection, bleeding and accidental injury to a nearby tissue/organ where the biopsy was taken. There is also a risk of spreading the cancer cells.
If the biopsy result of the cancer tissue evaluated is:
Positive for KRAS mutation: this person is not eligible for treatment with anti-EGFR drug therapy.
Negative for KRAS mutation: this person may respond to anti-EGFR therapy.
However, there can be false negatives.
According to the American Society of Clinical Oncology, their guidelines suggest doing KRAS genetic test to evaluate drug therapy response, before treatment with epidermal growth factor receptor-targeted therapies.
KRAS Mutation [accessed on Oct 03, 2018]
Medscape: Medscape Access [accessed on Oct 03, 2018]
KRASC - Clinical: KRAS Mutation Analysis, 7 Mutation Panel, Colorectal [accessed on Oct 03, 2018]
KRASO - Clinical: KRAS Mutation Analysis, 7 Mutation Panel, Other (Non-Colorectal) [accessed on Oct 03, 2018]
481075: KRAS Gene Mutation Analysis, Extended | LabCorp [accessed on Oct 03, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
ALK
ALK Genetic Test
Also called: Anaplastic lymphoma receptor tyrosine kinase gene, ALK gene rearrangement, ALK gene fusion, ALK gene rearrangements and overexpression
An ALK genetic test is most often used to guide treatment for certain cancers, especially non-small cell lung cancer. Some medicines are especially effective in cancer patients with ALK gene mutations.
ALK Genetic Test
Also called: Anaplastic lymphoma receptor tyrosine kinase gene, ALK gene rearrangement, ALK gene fusion, ALK gene rearrangements and overexpression
An ALK genetic test is most often used to guide treatment for certain cancers, especially non-small cell lung cancer. Some medicines are especially effective in cancer patients with ALK gene mutations.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
If your biopsy results showed that your type of cancer does not have an ALK gene rearrangement, then you are not likely to benefit from treatment with an ALK kinase inhibitor drug.
Related conditions
The anaplastic lymphoma receptor tyrosine kinase (ALK) gene codes for a protein known as anaplastic lymphoma kinase, which is believed to participate in cell growth.
Mutations (changes) in the ALK gene and protein promotes the uncontrolled growth of cancer cells and have been found in various types of cancer, including lymphoma, neuroblastoma, and especially non-small cell lung cancer.
This test is used to identify specific mutations in the ALK gene in a sample of tumor tissue.
Your doctor might want to order an ALK genetic test if you were already diagnosed with non-small cell lung cancer (especially adenocarcinoma) because this test can help guide your doctor decide an appropriate therapeutic management plan that may include an ALK kinase inhibitor.
The ALK kinase inhibitor drugs, like for instance a medication called crizotinib, form part of what is called the “anti-cancer drugs.”
After using anesthesia, a biopsy procedure (taking a small piece of the affected tissue) is performed to collect a tumor sample, which then will be typically evaluated by a pathologist.
You may be asked to refrain from eating, but usually, no preparations are needed.
Biopsies are considered to be low-risk procedures, and they are usually completely pain-free. However, depending on the site from where the tissue sample is taken, you might feel bloated, uncomfortable, or have a sore throat.
As with most procedures, a biopsy also carries the risk of infection and bleeding.
If your biopsy result came back positive, it means that your cancer tissue contains a specific ALK gene rearrangement mutation or altered ALK protein. Therefore, you are likely to benefit from treatment with an ALK kinase inhibitor drug such as crizotinib, ceritinib, or alectinib.
If your biopsy results showed that your type of cancer does not have an ALK gene rearrangement, then you are not likely to benefit from treatment with an ALK kinase inhibitor drug.
This test is normally ordered along with or as a follow-up test to KRAS and epidermal growth factor receptor (EGFR) protein mutation testing.
In some cases, a negative ALK genetic test may be repeated if the tumor tissue sample was considered to be insufficient.
Definition of ALK gene - NCI Dictionary of Cancer Terms - National Cancer Institute [accessed on Sep 17, 2018]
ALK Mutation (Gene Rearrangement) [accessed on Sep 17, 2018]
ALK gene - Genetics Home Reference - NIH [accessed on Sep 17, 2018]
Guideline Recommendations for Testing of ALK Gene Rearrangement in Lung Cancer: A Proposal of the Korean Cardiopulmonary Pathology Study Group [accessed on Sep 17, 2018]
Lung Cancer Mutation Panel (EGFR, KRAS, ALK) [accessed on Sep 17, 2018]
Genetics of Non-Small Cell Lung Cancer: Practice Essentials, Targeting the Genetic Mutations, Genetic Testing [accessed on Sep 17, 2018]
https://www.oncotest.co.il/en/lung-cancer-en/lung-cancer-tests/alk-gene-rearrangement/ [accessed on Sep 17, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Chest X-Ray Test
Chest X-Ray Test
Also called: CXR, Chest X Ray, Chest Radiograph, Chest Radiography, Chest Film
A chest X-ray is an imaging test that uses electromagnetic waves to create pictures of the structures in and around the chest. The test can help diagnose and monitor conditions of the heart, lungs, bones, and chest cavity.
Chest X-Ray Test
Also called: CXR, Chest X Ray, Chest Radiograph, Chest Radiography, Chest Film
A chest X-ray is an imaging test that uses electromagnetic waves to create pictures of the structures in and around the chest. The test can help diagnose and monitor conditions of the heart, lungs, bones, and chest cavity.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
X rays are electromagnetic waves. They use ionizing radiation to create pictures of the inside of your body. A chest x ray takes pictures of the inside of your chest. The different tissues in your chest absorb different amounts of radiation. Your ribs and spine are bony and absorb radiation well. They normally appear light on a chest x ray. Your lungs, which are filled with air, normally appear dark.
Related conditions
A chest x ray is a painless, noninvasive test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. "Noninvasive" means that no surgery is done and no instruments are inserted into your body. This test is done to find the cause of symptoms such as shortness of breath, chest pain, chronic cough (a cough that lasts a long time), and fever.
Chest x rays help doctors diagnose conditions such as pneumonia (nu-MO-ne-ah), heart failure, lung cancer, lung tissue scarring, and sarcoidosis (sar-koy-DO-sis). Doctors also may use chest x rays to see how well treatments for certain conditions are working. Also, doctors often use chest x rays before surgery to look at the structures in the chest.
Chest x rays are the most common x-ray test used to diagnose health problems.
Doctors may recommend chest x rays for people who have symptoms such as shortness of breath, chest pain, chronic cough (a cough that lasts a long time), or fever. The test can help find the cause of these symptoms.
Chest x rays look for conditions such as pneumonia, heart failure, lung cancer, lung tissue scarring, or sarcoidosis. The test also is used to check how well treatments for certain conditions are working.
Chest x rays also are used to evaluate people who test positive for tuberculosis (tu-ber-kyu-LO-sis) exposure on skin tests.
Sometimes, doctors recommend more chest x rays within hours, days, or months of an earlier chest x ray. This allows them to follow up on a condition.
People who are having certain types of surgery also may need chest x rays. Doctors often use the test before surgery to look at the structures inside the chest.
Depending on your doctor's request, you'll stand, sit, or lie for the chest x ray. The technician will help position you correctly. He or she may cover you with a heavy lead apron to protect certain parts of your body from the radiation.
The x-ray equipment usually consists of two parts. One part, a box-like machine, holds the x-ray film or a special plate that records the picture digitally. You'll sit or stand next to this machine. The second part is the x-ray tube, which is located about 6 feet away.
Before the pictures are taken, the technician will walk behind a wall or into the next room to turn on the x-ray machine. This helps reduce his or her exposure to the radiation.
Usually, two views of the chest are taken. The first is a view from the back. The second is a view from the side.
For a view from the back, you'll sit or stand so that your chest rests against the image plate. The x-ray tube will be behind you. For the side view, you'll turn to your side and raise your arms above your head.
If you need to lie down for the test, you'll lie on a table that contains the x-ray film or plate. The x-ray tube will be over the table.
You'll need to hold very still while the pictures are taken. The technician may ask you to hold your breath for a few seconds. These steps help prevent a blurry picture.
Although the test is painless, you may feel some discomfort from the coolness of the exam room and the x-ray plate. If you have arthritis or injuries to the chest wall, shoulders, or arms, you may feel discomfort holding a position during the test. The technician may be able to help you find a more comfortable position.
When the test is done, you'll need to wait while the technician checks the quality of the x-ray pictures. He or she needs to make sure that the pictures are good enough for the doctor to use.
You don't have to do anything special to prepare for a chest x ray. However, you may want to wear a shirt that's easy to take off. Before the test, you'll be asked to undress from the waist up and wear a gown.
You also may want to avoid wearing jewelry and other metal objects. You'll be asked to take off any jewelry, eyeglasses, and metal objects that might interfere with the x-ray picture. Let the x-ray technician (a person specially trained to do x-ray tests) know if you have any body piercings on your chest.
Let your doctor know if you're pregnant or may be pregnant. In general, women should avoid all x-ray tests during pregnancy. Sometimes, though, having an x ray is important to the health of the mother and fetus. If an x ray is needed, the technician will take extra steps to protect the fetus from radiation.
Chest x rays have few risks. The amount of radiation used in a chest x ray is very small. A lead apron may be used to protect certain parts of your body from the radiation.
The test gives out a radiation dose similar to the amount of radiation you're naturally exposed to over 10 days.
Chest x rays show the structures in and around the chest. The test is used to look for and track conditions of the heart, lungs, bones, and chest cavity. For example, chest x-ray pictures may show signs of pneumonia, heart failure, lung cancer, lung tissue scarring, or sarcoidosis.
Chest x rays do have limits. They only show conditions that change the size of tissues in the chest or how the tissues absorb radiation. Also, chest x rays create two-dimensional pictures. This means that denser structures, like bone or the heart, may hide some signs of disease. Very small areas of cancer and blood clots in the lungs usually don't show up on chest x rays.
For these reasons, your doctor may recommend other tests to confirm a diagnosis.
https://www.nhlbi.nih.gov/health-topics/chest-x-ray [accessed on Aug 25, 2021]
https://medlineplus.gov/ency/article/003804.htm [accessed on Aug 25, 2021]
https://www.radiologyinfo.org/en/info/chestrad [accessed on Aug 25, 2021]
https://www.emedicinehealth.com/chest_x-ray/article_em.htm [accessed on Aug 25, 2021]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (50)
Chest X-Ray Basics in 5 min
Video by Nick Smith/YouTube
How X-rays see through your skin - Ge Wang
Video by TED-Ed/YouTube
What causes Acute respiratory distress syndrome (ARDS) and who is at Risk?
Chest X-ray of transfusion-related acute lung injury (TRALI syndrome) compared to chest X-ray of the same subject afterwards.
Image by Altaf Gauhar Haji, Shekhar Sharma, DK Vijaykumar and Jerry Paul
Tuberculosis X-ray
An anteroposterior X-ray of a patient diagnosed with advanced bilateral pulmonary tuberculosis. This AP X-ray of the chest reveals the presence of bilateral pulmonary infiltrate (white triangles), and caving forma.
Image by CDC / Der Lange
Respiratory Syncytial Virus
This highly-magnified, 1981 transmission electron microscopic (TEM) image, reveals some of the morphologic traits exhibited by a human respiratory syncytial virus (RSV). The virion is variable in shape, and size, with an average diameter between 120-300nm. RSV is the most common cause of bronchiolitis and pneumonia among infants and children, under 1-year of age.
Image by CDC/ E. L. Palmer
Q Fever Pneumonia X-ray
Combination of two x-rays (A) normal chest x-ray (B) x-ray documenting Q fever pneumonia.
Image by US Gov
Chest X Ray
A Lateral Chest X-Ray with the heart shadow outlined.
Image by US Army
Projectional radiography
Image relating focal spot size to geometric unsharpness in projectional radiography.
Image by Source images by Blausen Medical and LadyofHats (Mariana Ruiz Villarreal) Derivative by Mikael Haggstrom
Chest Radiograph
Chest X-Ray : Specialized test, like a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan, may be needed to confirm the presence of an aneurysm.
Image by TheVisualMD
X-ray of Healthy Lung
This image shows an x-ray of healthy lungs.
Image by TheVisualMD
Cancer screening
Cancer Imaging: X-Rays : Chest X-rays can be used to show the presence of tumors, as for lung cancer, but they may also indicate problems associated with cancer. An X-ray may produce images suggestive of fluid accumulation, masses, or enlarged lymph nodes.
Image by TheVisualMD
Lung Cancer
Chest X-ray (Cancer): This is an x-ray image of a chest. Both sides of the lungs are visible with a growth on the left side of the lung, which could possibly be lung cancer.
Image by National Cancer Institute
Chest X Ray
Mediastinal structures on a chest radiograph.
Image by Mikael Haggstrom, from source images by ZooFari, Stillwaterising and Gray's Anatomy creators
CT Chest Scan of Pleura effusion
CT scan of chest showing loculated pleural effusion in left side. Some thickening of pleura is also noted. From my personal collection. Permission obtained from patient.
Image by Drriad
Chest X-ray (Cancer)
This is an x-ray image of a chest. Both sides of the lungs are visible with a growth on the left side of the lung, which could possibly be lung cancer.
Image by National Cancer Institute / Unknown Photographer
This browser does not support the video element.
CT Scans (VIDEO)
This video shows how modern science of scanning can expose the health condition of the patient. The video starts with a patient undergoing CT scanning, an x-ray procedure that combines many x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. Visible are the heart, lungs, and arteries of a patient.
Video by TheVisualMD
Chest X-Ray
Air-filled trachea and lungs Diaphragmatic domes Mediastinal structures Vascular markings
Arrows indicate costophrenic angles
Image by US Army
Gallstones
Gallstones as seen on plain x-ray.
Image by James Heilman, MD
Hemoptysis x-ray
Hemoptysis can be discovered with the help of radiology.
Image by Aidan Jones from Oxford, U.K.
X-ray of Lung with Pulmonary Edema
Within the lungs, the main airways (bronchi) branch off into smaller passageways, the smallest of which are called bronchioles. At the end of the bronchioles are tiny air sacs (alveoli). Pulmonary edema is a condition caused when excess fluid collects in these air sacs, making it difficult to breathe. Fluid in the lungs can be caused by pneumonia, acute respiratory distress and other conditions, but in most cases, the cause of pulmonary edema is heart problems (when a damaged heart can't pump enough blood and fluid leaks into the lungs).
Image by TheVisualMD
What To Expect During and After Implantable Cardioverter Defibrillator Surgery
A normal chest X-ray after placement of an ICD, showing the ICD generator in the upper left chest and the ICD lead in the right ventricle of the heart. Note the 2 opaque coils along the ICD lead.
Image by Gregory Marcus, MD, MAS, FACC
This browser does not support the video element.
Chest X-ray: NCI B-roll [video]
NCI B-roll of a patient receiving a Chest X-ray. This video is silent.
Video by National Cancer Institute (NCI)
X-Ray of Aneurysm within Chest frontal view
Most aneurysms are detected in the course of an exam, such as a physical exam or a chest X-ray, being performed for a different reason.
Image by TheVisualMD
Pleural Effusion: Tests
Pleural effusion Chest x-ray of a pleural effusion. The arrow A shows fluid layering in the right pleural cavity. The B arrow shows the normal width of the lung in the cavity. A pleural effusion: as seen on chest X-ray. The A arrow indicates fluid layering in the right chest. The B arrow indicates the width of the right lung. The volume of the lung is reduced because of the collection of fluid around the lung.Pleural effusion Chest x-ray of a pleural effusion. The arrow A shows fluid layering in the right pleural cavity. The B arrow shows the normal width of the lung in the cavity. A pleural effusion: as seen on chest X-ray. The A arrow indicates fluid layering in the right chest. The B arrow indicates the width of the right lung. The volume of the lung is reduced because of the collection of fluid around the lung.
Image by CDC InvictaHOG
Coccidioidomycosis
This anteroposterior (AP) chest x-ray revealed pulmonary changes indicative of pulmonary fibrosis in a case of coccidioidomycosis, caused by fungal organisms of the genus, Coccidioides. Because these changes also resemble those seen in other lung infections including tuberculosis, the findings uncovered with a chest x-ray needs to be coupled with serologic testing, as well as possible tissue biopsy. The degree of fibrotic changes, indicative of scarring found on x-ray, can be directly correlated to the severity of the fungal infection.
Image by CDC/ Dr. Lucille K. Georg
How Is Acute respiratory distress syndrome (ARDS) Diagnosed?
Chest X-Ray: Acute respiratory distress syndrome on plain Xray
Image by James Heilman, MD
How Are Asbestos-Related Lung Diseases Diagnosed?
Early Asbestosis in a Retired Pipe Fitter : Chest X-ray in asbestosis shows plaques above diaphragm
Image by Clinical Cases
Aspergillosis
This was a photomicrograph of a lung tissue specimen, harvested from a caged, sulfur-crested cockatoo, that depicted some of the histopathologic changes that had been caused by the fungal organism, Aspergillus fumigatus, in a case of avian pulmonary aspergillosis. Here, you are able see how the periodic acid-Schiff (PAS) stain, revealed A. fumigatus ultrastructural morphology including conidial heads and mycelium.
Image by CDC/ Dr. William Kaplan
Pleural Effusion - Defined
A large left sided pleural effusion as seen on an upright chest X-ray
Image by Drriad
Pleural Effusion: Tests
A large left sided pleural effusion as seen on an upright chest X-ray
Image by James Heilman MD
Breast implants
Chest X-ray showing breast implants
Image by James Heilman
Living With Idiopathic Pulmonary Fibrosis
No cure is available for idiopathic pulmonary fibrosis (IPF) yet. Your symptoms may get worse over time. As your symptoms worsen, you may not be able to do many of the things that you did before you had IPF.
However, lifestyle changes and ongoing care can help you manage the disease.
If you're still smoking, the most important thing you can do is quit. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. Ask family members and friends not to smoke in front of you or in your home, car, or workplace.
Image by Drriad
Symptoms and Spread of SARS (Severe acute respiratory syndrome)
A chest x-ray showing increased opacity in both lungs, indicative of pneumonia, in a patient with SARS.
Image by CDC
Chilaiditi syndrome
Chest X-ray showing obvious Chilaiditi's sign, or presence of gas in the right colic angle between the liver and right hemidiaphragm (left side of the image).
Piper's Sign: In days gone by the lateral chest x-ray (demonstrating greater opacity in the aortic arch and descending aorta than the thoracic spine) gave an indication to the degree of calcified plaque burden a patient had. This has been known as Piper's sign and can often be seen in elderly persons particularly those with concomitant osteoporosis.
Image by U4077905
Aspect of a bulky thymoma (red circle) on the chest x-ray.
Aspect of a bulky thymoma (red circle) on the chest x-ray.
Image by Stockholm
Lambert–Eaton myasthenic syndrome-Chest X-ray showing a tumor in the left lung (right side of the image)
Lambert–Eaton myasthenic syndrome-Chest X-ray showing a tumor in the left lung (right side of the image)
Image by Lange123 at German Wikipedia
Chest X-ray in influenza and Haemophilus influenza
Chest X-ray of a 76 year old woman, who developed cough and labored breathing. First testing showed influenza B virus, and later a nasopharyngeal swab detected Haemophilus influenzae. The H influenzae presumably developed as an opportunistic infection secondary to the flu. This X-ray was taken 2 weeks after cultures and start of antibiotics, showing delayed pneumonic infiltrates that were only vaguely visible on initial (not shown) X-rays.
Image by Mikael Häggström
Chest X-ray in influenza and Haemophilus influenzae, lateral
Chest X-ray of a 76 year old woman, who developed cough and labored breathing. First testing showed influenza B virus, and later a nasopharyngeal swab detected Haemophilus influenzae. The H influenzae presumably developed as an opportunistic infection secondary to the flu. This X-ray was taken 2 weeks after cultures and start of antibiotics, showing delayed pneumonic infiltrates that were only vaguely visible on initial (not shown) X-rays.
Image by Mikael Häggström
Fungal Parasites and Pathogens
(a) Ringworm presents as a red ring on skin; (b) Trichophyton violaceum, shown in this bright field light micrograph, causes superficial mycoses on the scalp; (c) Histoplasma capsulatum is an ascomycete that infects airways and causes symptoms similar to influenza. (credit a: modification of work by Dr. Lucille K. Georg, CDC; credit b: modification of work by Dr. Lucille K. Georg, CDC; credit c: modification of work by M. Renz, CDC; scale-bar data from Matt Russell)
Image by CNX Openstax
This anteroposterior (AP) chest x-ray revealed radiologic evidence of pulmonary pneumocystosis in the form of bilateral pulmonary interstitial infiltrates. This infection was due to the presence of an opportunistic fungal infection by the fungal organism Pneumocystis jirovecii, formerly known as Pneumocystis carinii. (This image was provided by Jonathan W.M. Gold. M.D., Assoc. Dir. Special Microbiology Lab, Assist. Attending Physician, Memorial Sloan-Kettering Cancer Center and Assist. Prof. of Medicine, Cornell Univ. Med. College, New York.)
Pneumocystis jirovecii is the causative agent of Pneumocystis pneumonia (PCP), one of the most frequent and severe opportunistic infections in immunocompromised patients. Pneumocystis organisms represent a large group of species of atypical fungi with universal distribution and pulmonary tropism, and each species has a strong specificity for a given mammalian host species.
Image by CDC/ Jonathan W.M. Gold, MD
Chest X-ray PA inverted and enhanced
Chest X-ray PA inverted and enhanced
Image by Stillwaterising
Chest X-Ray of Canadian dollar coin in esophagus of child
PA view Chest X-Ray of Canadian dollar coin in esophagus of child. Released per permission of mother.
Image by Samir (talk)
Chest X Ray
Structures shown: Air-filled trachea and lungs Diaphragmatic domes Mediastinal structures Vascular markings. Arrows indicate costophrenic angles
Image by US Army
Thoracic diaphragm
X-ray of chest, showing top of diaphragm.
Image by OpenStax College
Chest X Ray
Roentgenogram or Medical X-ray image. May not be to scale.
Aspect of a bulky thymoma (red circle) on the chest x-ray.
Stockholm
Lambert–Eaton myasthenic syndrome-Chest X-ray showing a tumor in the left lung (right side of the image)
Lange123 at German Wikipedia
Chest X-ray in influenza and Haemophilus influenza
Mikael Häggström
Chest X-ray in influenza and Haemophilus influenzae, lateral
Mikael Häggström
Fungal Parasites and Pathogens
CNX Openstax
This anteroposterior (AP) chest x-ray revealed radiologic evidence of pulmonary pneumocystosis in the form of bilateral pulmonary interstitial infiltrates. This infection was due to the presence of an opportunistic fungal infection by the fungal organism Pneumocystis jirovecii, formerly known as Pneumocystis carinii. (This image was provided by Jonathan W.M. Gold. M.D., Assoc. Dir. Special Microbiology Lab, Assist. Attending Physician, Memorial Sloan-Kettering Cancer Center and Assist. Prof. of Medicine, Cornell Univ. Med. College, New York.)
CDC/ Jonathan W.M. Gold, MD
Chest X-ray PA inverted and enhanced
Stillwaterising
Chest X-Ray of Canadian dollar coin in esophagus of child
A chest computed tomography (CT) scan is an imaging test that takes detailed pictures of the lungs and the inside of the chest. Computers combine the pictures to create a 3-D model showing the size, shape, and position of the lungs and structures in the chest.
A chest computed tomography (CT) scan is an imaging test that takes detailed pictures of the lungs and the inside of the chest. Computers combine the pictures to create a 3-D model showing the size, shape, and position of the lungs and structures in the chest.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
A chest CT scan provides detailed pictures of the size, shape, and position of your lungs and other structures in your chest. A normal chest CT means your chest appears normal.
Related conditions
A chest CT scan is a more detailed type of chest X-ray. This painless imaging test takes many detailed pictures, called slices, of your lungs and the inside of your chest. Computers can combine these pictures to create three-dimensional (3D) models to help show the size, shape, and position of your lungs and structures in your chest.
This imaging test is often done to follow up on abnormal findings from earlier chest x rays. A chest CT scan also can help determine the cause of lung symptoms such as shortness of breath or chest pain, or check to see if you have certain lung problems such as a tumor, excess fluid around the lungs that is known as pleural effusion, pulmonary embolism, emphysema, tuberculosis, and pneumonia.
A chest CT scan provides detailed pictures of the size, shape, and position of your lungs and other structures in your chest. Doctors use this test to:
Follow up on abnormal results from standard chest x rays.
Find the cause of lung symptoms, such as shortness of breath or chest pain.
Find out whether you have a lung problem, such as a tumor, excess fluid around the lungs, or a pulmonary embolism (a blood clot in the lungs). The test also is used to check for other conditions, such as tuberculosis, emphysema, and pneumonia.
Your doctor may recommend a chest CT scan if you have symptoms of lung problems, such as chest pain or trouble breathing. The scan can help find the cause of the symptoms.
A chest CT scan looks for problems such as tumors, excess fluid around the lungs, and pulmonary embolism (a blood clot in the lungs). The scan also checks for other conditions, such as tuberculosis, emphysema, and pneumonia.
Your doctor may recommend a chest CT scan if a standard chest x ray doesn't help diagnose the problem. The chest CT scan can:
Provide more detailed pictures of your lungs and other chest structures than a standard chest x ray
Find the exact location of a tumor or other problem
Show something that isn't visible on a chest x ray
Your chest CT scan may be done in a medical imaging facility or hospital. The CT scanner is a large, tunnel-like machine that has a table. You will lie still on the table and the table will slide into the scanner. Talk to your doctor if you are uncomfortable in tight or closed spaces to see if you need medicine to relax you during the test. You will hear soft buzzing or clicking sounds when you are inside the scanner and the scanner is taking pictures. You will be able to hear from and talk to the technician performing the test while you are inside the scanner. For some diagnoses, a contrast dye, often iodine-based, may be injected into a vein in your arm before the imaging test. This contrast dye highlights areas inside your chest and creates clearer pictures. You may feel some discomfort from the needle or, after the contrast dye is injected, you may feel warm briefly or have a temporary metallic taste in your mouth.
Wear loose-fitting, comfortable clothing for the test. Sometimes the CT scan technician (a person specially trained to do CT scans) may ask you to wear a hospital gown. You also may want to avoid wearing jewelry and other metal objects. You'll be asked to take off any jewelry, eyeglasses, and metal objects that might interfere with the test. You may be asked to remove hearing aids and dentures as well. Let the technician know if you have any body piercing on your chest.
Tell your doctor whether you're pregnant or may be pregnant. If possible, you should avoid unnecessary radiation exposure during pregnancy. This is because of the concern that radiation may harm the fetus.
Chest CT scans have some risks. In rare instances, some people have an allergic reaction to the contrast dye. There is a slight risk of cancer, particularly in growing children, because the test uses radiation. Although the amount of radiation from one test is usually less than the amount of radiation you are naturally exposed to over three years, patients should not receive more CT scans than the number that clinical guidelines recommend. Another risk is that chest CT scans may detect an incidental finding, which is something that doesn’t cause symptoms but now may require more tests after being found.
Talk to your doctor and the technicians performing the test about whether you are or could be pregnant. If the test is not urgent, they may have you wait to do the test until after your pregnancy. If it is urgent, the technicians will take extra steps to protect your baby during this test. Let your doctor know if you are breastfeeding because contrast dye can pass into your breast milk. If you must have contrast dye injected, you may want to pump and save enough breast milk for one to two days after your test or you may bottle-feed your baby for that time.
https://www.nhlbi.nih.gov/health-topics/chest-ct-scan [accessed on Aug 25, 2021]
https://medlineplus.gov/ency/article/003788.htm [accessed on Aug 25, 2021]
Additional Materials (50)
Pleural empyema
CT chest showing large right sided hydro-pneumothorax from pleural empyema. Arrows A: air, B: fluid
Image by Amit Banga, GC Khilnani, SK Sharma1, AB Dey, Naveet Wig and Namrata Banga
How Are Pleurisy and Other Pleural Disorders Diagnosed?
CT with the identification of underlying lung lesion: an apical bulla.
Image by Robertolyra
How Are Pleurisy and Other Pleural Disorders Treated?
Right-sided pneumothorax (right side of image) on CT scan of the chest with chest tube in place.
Image by en:User:Clinical Cases
Chest Radiograph
Chest X-Ray : Specialized test, like a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan, may be needed to confirm the presence of an aneurysm.
Image by TheVisualMD
What To Expect During a Coronary Calcium Scan
3D reconstruction of the thin multislice CT, covering human heart and lungs
Image by Semnic
Incision for Open-Chest Bypass Surgery
Open-chest bypass surgery requires the surgeon to make an incision down the center of the chest, along the breastbone. The rib cage is spread open to expose the heart.
Image by TheVisualMD
A child's guide to hospital: CT Chest
Video by The Royal Children's Hospital Melbourne/YouTube
What is it like to have a CT scan? | Cancer Research UK
Video by Cancer Research UK/YouTube
Coronary CT angiography of coronary arteries
Researchers have found that anti-inflammatory biologic therapies used to treat moderate to severe psoriasis can significantly reduce coronary inflammation in patients with the chronic skin condition. Scientists said the findings are particularly notable because of the use of a novel imaging biomarker, the perivascular fat attenuation index (FAI), that was able to measure the effect of the therapy in reducing the inflammation.
The study published online in JAMA Cardiology, has implications not just for people with psoriasis, but for those with other chronic inflammatory diseases, such as lupus and rheumatoid arthritis. These conditions are known to increase the risk for heart attacks and strokes. The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
In this image: Coronary CT angiography image of the coronary arteries depicting the perivascular fat attenuation index before and after biologic therapy at one-year follow-up for patients with excellent response to biologic therapy.
Image by Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI
Coronary CT
Coronary CT
Image by Bác sĩ Nguyễn Minh Đức
CT of the blood vessels and heart
CT of the blood vessels and heart
Image by Bác sĩ Nguyễn Minh Đức
Chest CT showing pulmonary sequestration
chest CT: diagnosis is pulmonary sequestration
Image by RadsWiki
Scimitar syndrome chest CT
Scimitar syndrome chest CT
Image by Matthew Cham, MD
/Wikimedia
Having a Cardiac CT Scan in Hospital
Video by Oxford AHSN/YouTube
What to Expect from a CT Exam with Contrast
Video by RAYUS Radiology™/YouTube
Protocoling chest CTs
Video by Thoracic Radiology/YouTube
Low Dose CT Scans to Look for Lung Cancer
Video by Lee Health/YouTube
Lung Cancer Screening (LCS)
Video by Cleveland Clinic/YouTube
CT Scan of the Chest Explained Clearly - High Resolution CT Scan (HRCT)
Video by MedCram - Medical Lectures Explained CLEARLY/YouTube
What to Expect: CT Scan | Cedars-Sinai
Video by Cedars-Sinai/YouTube
How I Read a Chest CT
Video by Thoracic Radiology/YouTube
Introduction to Computed Tomographic imaging of the Chest
Video by Yale Radiology and Biomedical Imaging/YouTube
Lung Cancer Screening: The Life-saving CT Scan
Video by RAYUS Radiology™/YouTube
How to prepare for a CT scan
Video by Sunnybrook Hospital/YouTube
Using CT Scans to Screen for Lung Cancer
Video by UConn Health/YouTube
Cardiac CT scan
Video by UHP_NHS/YouTube
Real look at Chest, Abdomen and Pelvis CT Scan from Start to Finish.
Video by Dumb Old Dad/YouTube
What is it like to get a CT Scan with Contrast?
Video by STRIDE Project/YouTube
Thorax with Healthy Heart
3D visualization based on scanned human data of a healthy heart in the thorax.
Image by TheVisualMD
Heart and Lungs
The heart and lungs are the primary contents of the thorax. They are interconnected with very large blood vessels. The heart sends oxygen-poor blood through the pulmonary arteries to the lungs, which oxygenate it and return it to the heart through the pulmonary veins. The pulmonary arteries arise from one large pulmonary trunk, and then begin branching exponentially once they enter the lungs in order to reach the functional respiratory units and pick up oxygen. The smallest pulmonary veins then take the oxygenated blood backwards through the lungs and empty into the back of the heart through four larger pulmonary veins. The oxygen-rich blood is then pumped by the heart out into the body through the aorta. Deoxygenated blood from body tissues returns to the heart through the superior and inferior vena cava and the cardiac cycle repeats continuously. The pulmonary veins and arteries are the only case where arteries carry deoxygenated blood and veins carry blood that has been oxygenated.
Image by TheVisualMD
Thorax with Muscle Involved in Respiration
3D visualization of an anterior view of the muscles involved in respiration. The primary job of the thorax is to promote movements necessary for breathing. Three muscles of the thorax assist in this function; the external intercostals, internal intercostals and diaphragm. The intercostals do the job of lifting the ribs up and pulling them outward, which in turn enlarges the lungs. As the lungs expand, the pressure inside them is reduced, and they suck in air. During extreme inhalation, the neck muscles also contract. During inhalation, the diaphragm contracts and pushes downward; during exhalation, it relaxes and is pushed up into a dome shape by the lower digestive organs, compressing the lungs. As pressure rises in the chest cavity, exhale occurs, pressure is equalized and the cycle restarts.
Image by TheVisualMD
Thorax with Muscle Involved in Respiration
3D visualization of an inferior view of the muscles involved in respiration. The primary job of the thorax is to promote movements necessary for breathing. Three muscles of the thorax assist in this function; the external intercostals, internal intercostals and diaphragm. The intercostals do the job of lifting the ribs up and pulling them outward, which in turn enlarges the lungs. As the lungs expand, the pressure inside them is reduced, and they suck in air. During extreme inhalation, the neck muscles also contract. During inhalation, the diaphragm contracts and pushes downward; during exhalation, it relaxes and is pushed up into a dome shape by the lower digestive organs, compressing the lungs. As pressure rises in the chest cavity, exhalation occurs, pressure is equalized and the cycle restarts.
Image by TheVisualMD
Thorax with visible Lung and Heart
3D visualization of a posterior view of the lungs and heart reconstructed from scanned human data. De-oxygenated red blood cells are sent by the right side of the heart through the pulmonary artery into the vessels of the lungs to be refilled with oxygen for their next circuit through the body. The blood is carried through the lung tissues, where it exchanges its carbon dioxide for oxygen in the alveoli. It is then returned through the pulmonary veins to the left side of the heart and sent out to the rest of the body. The pulmonary artery carries away the deoxygenated blood, which returns fully oxygenated through the pulmonary vein.
Image by TheVisualMD
Female Thorax Showing Breast
Visualization based on scanned human data of an anterior view of female breast.
Image by TheVisualMD
Male Thorax with Visible Heart
Visualization of male heart. The nerve supply of the heart is emphasized specifically the cardiac plexus. The plexus which rest around the base of the heart, mainly in the epicardium, is formed by cardiac branches from the vagus nerves and the sympathetic trunks and ganglia.
Image by TheVisualMD
Thorax with Heart and Lung
3D visualization of an anterior view of the lungs and heart reconstructed from scanned human data. The cone-shaped lungs occupy most of the thoracic cavity. Each lung is suspended in its own pleural cavity and connected to the mediastinum (which houses the heart) by its root which is made up of vascular and bronchial attachments. The anterior, lateral and posterior surfaces of the lung are in close contact with the ribs and form a continuously curving surface called the costal surface. De-oxygenated red blood cells are sent by the right side of the heart through the pulmonary artery into the vessels of the lungs to be refilled with oxygen for their next circuit through the body. The blood is carried through the lung tissues, where it exchanges its carbon dioxide for oxygen in the alveoli. It is then returned through the pulmonary veins to the left side of the heart and sent out to the rest of the body. The pulmonary artery carries away the deoxygenated blood, which returns fully oxygenated through the pulmonary vein.
Image by TheVisualMD
Cross Section of Human Thorax. Liver in bottom Left
Cross Section of Human Thorax. Liver in bottom Left
Image by TheVisualMD
Male Thorax Showing Trachea and Lung
3D visualization of an anterior view of the lungs and heart reconstructed from scanned human data. De-oxygenated red blood cells are sent by the right side of the heart through the pulmonary artery into the vessels of the lungs to be refilled with oxygen for their next circuit through the body. The blood is carried through the lung tissues, where it exchanges its carbon dioxide for oxygen in the alveoli. It is then returned through the pulmonary veins to the left side of the heart and sent out to the rest of the body. The pulmonary artery carries away the deoxygenated blood, which returns fully oxygenated through the pulmonary vein.
Image by TheVisualMD
Thoracic Aneurysm in the Aorta
Aneurysms that occur in the part of the aorta that is higher in the chest are called thoracic aortic aneurysms. Aortic aneurysms often grow slowly and usually without any symptoms therefore making them difficult to detect
Image by TheVisualMD
Ventilation/perfusion scan
subFusion processing applied to a SPECT lung ventilation-perfusion scan.
Image by KieranMaher at English Wikibooks
Bronchi and Bronchiole of Lung
3D visualization of an inferior view of a transverse section of the thorax, highlighting the lungs, reconstructed from scanned human data. The trachea, cardiac impression, and transverse sections of the thoracic aorta and esophagus are clearly illustrated. The bronchial tree is also visible. When air is inhaled into the lungs, it flows through large tubes called bronchi, branches into smaller tubes known as bronchioles, and ends up in the thousands of small pouches that are the alveoli. This is where the oxygen is transferred from the air into the bloodstream. Each alveolar sac, or air sac, is surrounded by a bed of capillaries, and the walls between the lung and the capillary are extremely thin. The walls are so delicate, in fact, that the inhaled oxygen can seep from the air sacs to bind to the hemoglobin in the blood, while the carbon dioxide and other waste gasses leave the blood and diffuse into the lungs where they can be exhaled.
Image by TheVisualMD
Chest Pain
Angina
Image by TheVisualMD
Chest Pain
Chest Pain
Image by TheVisualMD
Chest Pain or Tightness
Image by TheVisualMD
CT scanner
A view of the CT scanner in the new Fort Belvoir Community Hospital. The hospital, still under construction, is a 2005 Base Realignment and Closure project, and is scheduled to open later this year.
Image by Official Navy Page from United States of America MC2 Todd Frantom/U.S. Marine Corps
Illustration of 3 X-ray images and a patient entering a CT scanner
Radiation can be dangerous, but it can also save lives. When you’re faced with a medical test that uses radiation, don’t let fear get in your way. Learn about the risks and benefits, and know what questions to ask.
Image by NIH News in Health
Drawing of a computerized tomography scanner with a health care professional looking on a computer screen as a patient lies inside the scanner
CT scan.
Image by NIDDK Image Library
Advanced CT Scanning
An NIH Clinical Center study participant receives a scan in the Photon-Counting CT scanner.
Image by NIH Clinical Center
Sensitive content
This media may include sensitive content
CAT Scan
A computer-assisted tomographic (CAT) scanner, with a Caucasian female technician working at a screen and behind a glass wall. A patient is on a table and being tested by the CAT scanner. The lighting is very subdued. This new technology revolutionized detection of brain tumors.
Image by National Cancer Institute / Linda Bartlett (Photographer)
Virtual Colonoscopy Slice of CT Data
Virtual colonoscopy is a new imaging technology that uses computed tomography (CT) images to look for polyps and cancer in the colon. A computed tomography scanner takes cross-sectional images of the patient's colon, after the colon has been inflated with gas. A three-dimensional model is created from the CT slices and evaluated by a radiologist for abnormalities.
Image by TheVisualMD
Pleural empyema
Amit Banga, GC Khilnani, SK Sharma1, AB Dey, Naveet Wig and Namrata Banga
How Are Pleurisy and Other Pleural Disorders Diagnosed?
Robertolyra
How Are Pleurisy and Other Pleural Disorders Treated?
en:User:Clinical Cases
Chest Radiograph
TheVisualMD
What To Expect During a Coronary Calcium Scan
Semnic
Incision for Open-Chest Bypass Surgery
TheVisualMD
4:22
A child's guide to hospital: CT Chest
The Royal Children's Hospital Melbourne/YouTube
1:50
What is it like to have a CT scan? | Cancer Research UK
Cancer Research UK/YouTube
Coronary CT angiography of coronary arteries
Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI
Coronary CT
Bác sĩ Nguyễn Minh Đức
CT of the blood vessels and heart
Bác sĩ Nguyễn Minh Đức
Chest CT showing pulmonary sequestration
RadsWiki
Scimitar syndrome chest CT
Matthew Cham, MD
/Wikimedia
4:59
Having a Cardiac CT Scan in Hospital
Oxford AHSN/YouTube
2:33
What to Expect from a CT Exam with Contrast
RAYUS Radiology™/YouTube
7:48
Protocoling chest CTs
Thoracic Radiology/YouTube
1:44
Low Dose CT Scans to Look for Lung Cancer
Lee Health/YouTube
8:27
Lung Cancer Screening (LCS)
Cleveland Clinic/YouTube
5:10
CT Scan of the Chest Explained Clearly - High Resolution CT Scan (HRCT)
MedCram - Medical Lectures Explained CLEARLY/YouTube
3:29
What to Expect: CT Scan | Cedars-Sinai
Cedars-Sinai/YouTube
17:21
How I Read a Chest CT
Thoracic Radiology/YouTube
8:46
Introduction to Computed Tomographic imaging of the Chest
Yale Radiology and Biomedical Imaging/YouTube
3:09
Lung Cancer Screening: The Life-saving CT Scan
RAYUS Radiology™/YouTube
2:19
How to prepare for a CT scan
Sunnybrook Hospital/YouTube
2:07
Using CT Scans to Screen for Lung Cancer
UConn Health/YouTube
5:04
Cardiac CT scan
UHP_NHS/YouTube
6:28
Real look at Chest, Abdomen and Pelvis CT Scan from Start to Finish.
Dumb Old Dad/YouTube
2:52
What is it like to get a CT Scan with Contrast?
STRIDE Project/YouTube
Thorax with Healthy Heart
TheVisualMD
Heart and Lungs
TheVisualMD
Thorax with Muscle Involved in Respiration
TheVisualMD
Thorax with Muscle Involved in Respiration
TheVisualMD
Thorax with visible Lung and Heart
TheVisualMD
Female Thorax Showing Breast
TheVisualMD
Male Thorax with Visible Heart
TheVisualMD
Thorax with Heart and Lung
TheVisualMD
Cross Section of Human Thorax. Liver in bottom Left
TheVisualMD
Male Thorax Showing Trachea and Lung
TheVisualMD
Thoracic Aneurysm in the Aorta
TheVisualMD
Ventilation/perfusion scan
KieranMaher at English Wikibooks
Bronchi and Bronchiole of Lung
TheVisualMD
Chest Pain
TheVisualMD
Chest Pain
TheVisualMD
Chest Pain or Tightness
TheVisualMD
CT scanner
Official Navy Page from United States of America MC2 Todd Frantom/U.S. Marine Corps
Illustration of 3 X-ray images and a patient entering a CT scanner
NIH News in Health
Drawing of a computerized tomography scanner with a health care professional looking on a computer screen as a patient lies inside the scanner
NIDDK Image Library
Advanced CT Scanning
NIH Clinical Center
Sensitive content
This media may include sensitive content
CAT Scan
National Cancer Institute / Linda Bartlett (Photographer)
Virtual Colonoscopy Slice of CT Data
TheVisualMD
Sputum Culture
Sputum Culture
Also called: Sputum cytology, Deep cough sputum, Respiratory culture, Bacterial sputum culture, Routine sputum culture
A sputum culture is a test that helps diagnose infections of the lungs or airways. Sputum is a thick mucus made in your lungs. It is not the same as spit or saliva. You may cough up sputum if you have an infection or chronic illness of the respiratory system.
Sputum Culture
Also called: Sputum cytology, Deep cough sputum, Respiratory culture, Bacterial sputum culture, Routine sputum culture
A sputum culture is a test that helps diagnose infections of the lungs or airways. Sputum is a thick mucus made in your lungs. It is not the same as spit or saliva. You may cough up sputum if you have an infection or chronic illness of the respiratory system.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
If your results were normal, it means no harmful bacteria or fungi were found. A normal sputum sample result is negative for malignancy.
Related conditions
A sputum culture is a test that checks for bacteria or another type of organism that may be causing an infection in your lungs or the airways leading to the lungs. Sputum, also known as phlegm, is a thick type of mucus made in your lungs. If you have an infection or chronic illness affecting the lungs or airways, it can make you cough up sputum.
Sputum is not the same as spit or saliva. Sputum contains cells from the immune system that help fight the bacteria, fungi, or other foreign substances in your lungs or airways. The thickness of sputum helps trap the foreign material. This allows cilia (tiny hairs) in the airways to push it through the mouth and be coughed out.
Sputum can be one of several different colors. The colors can help identify the type of infection you may have or if a chronic illness has become worse:
Clear. This usually means no disease is present, but large amounts of clear sputum may be a sign of lung disease.
White or gray. This may also be normal, but increased amounts may mean lung disease.
Dark yellow or green. This often means a bacterial infection, such as pneumonia. Yellowish-green sputum is also common in people with cystic fibrosis. Cystic fibrosis is an inherited disease that causes mucus to build up in the lungs and other organs.
Brown. This often shows up in people who smoke. It is also a common sign of black lung disease. Black lung disease is a serious condition that can happen if you have long-term exposure to coal dust.
Pink. This may be a sign of pulmonary edema, a condition in which excess fluid builds up in the lungs. Pulmonary edema is common in people with congestive heart failure.
Red. This may be an early sign of lung cancer. It may also be a sign of a pulmonary embolism, a life-threatening condition in which a blood clot from a leg or other part of the body breaks loose and travels to the lungs. If you are coughing up red or bloody sputum, call 911 or seek immediate medical attention.
A sputum culture is most often used to:
Find and diagnose bacteria or fungi that may be causing an infection in the lungs or airways.
See if a chronic illness of the lungs has worsened.
See if treatment for an infection is working.
A sputum culture is often done with another test called a Gram stain. A Gram stain is a test that checks for bacteria at the site of a suspected infection or in body fluids such as blood or urine. It can help identify the specific type of infection you may have.
You may need this test if you have symptoms of pneumonia or another serious infection of the lungs or airways. These include:
Cough which produces a lot of sputum
Fever
Chills
Shortness of breath
Chest pain that gets worse when you breathe deeply or cough
Fatigue
Confusion, especially in older people
Your health care provider will need to get a sample of your sputum. During the test:
A health care provider will ask you to breathe deeply and then cough deeply into a special cup.
Your provider may tap you on the chest to help loosen sputum from your lungs.
If you have trouble coughing up enough sputum, your provider may ask you to breathe in a salty mist that can help you cough more deeply.
If you still can't cough up enough sputum, your provider may perform a procedure called a bronchoscopy. In this procedure, you'll first get a medicine to help you relax, and then a numbing medicine so you won't feel any pain.
Then a thin, lighted tube will be put through your mouth or nose and into the airways.
Your provider will collect a sample from your airway using a small brush or suction.
You may need to rinse your mouth out with water before the sample is taken. If you will be getting a bronchoscopy, you may be asked to fast (not eat or drink) for one to two hours before the test.
There is no risk to providing a sputum sample into a container. If you had a bronchoscopy, your throat may feel sore after the procedure.
If your results were normal, it means no harmful bacteria or fungi were found. If your results were not normal, it may mean you have some kind of bacterial or fungal infection. Your provider may need to do more tests to find the specific type of infection you have. The most common types of harmful bacteria found in a sputum culture include those that cause:
Pneumonia
Bronchitis
Tuberculosis
An abnormal sputum culture result may also mean a flare-up of a chronic condition, such as cystic fibrosis or chronic obstructive pulmonary disease (COPD). COPD is a lung disease that makes it hard to breathe.
If you have questions about your results, talk to your health care provider.
Sputum may be referred to as phlegm or mucus. All terms are correct, but sputum and phlegm only refer to the mucus made in the respiratory system (lungs and airways). Sputum (phlegm) is a type of mucus. Mucus can also be made elsewhere in the body, such as the urinary or genital tract.
Sputum Cytology | LungCancer.net [accessed on Jan 01, 2019]
Sputum cytology in suspected cases of carcinoma of lung (Sputum cytology a poor man's bronchoscopy!) [accessed on Jan 01, 2019]
Sputum examination for early detection of lung cancer [accessed on Jan 01, 2019]
Sputum Cytology [accessed on Jan 01, 2019]
Lung Cancer Screening and Tests: LDCT, Biopsy, Bronchoscopy, and More [accessed on Jan 01, 2019]
Lung disease | womenshealth.gov [accessed on Jan 11, 2019]
009076: Sputum Cytology Series | LabCorp [accessed on Jan 11, 2019]
Sputum Culture and Cytology Study - MidMichigan Health [accessed on Jan 17, 2019]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (5)
Phlegm
Sputum
Image by Zhangmoon618
Mycobacterium tuberculosis
This illustration depicts a photomicrograph of a sputum specimen, processed using the Ziehl-Neelsen staining method, and revealed the presence of numerous, Mycobacterium tuberculosis bacteria. This bacterium can attack any part of the body, though usually the lungs, causing tuberculosis, and is spread through inhalation of infected sputum from a coughing, or sneezing individual.
Image by CDC
Sputum
Video by MSREducators/YouTube
How to Identify Haemophilus influenzae in a Sputum Culture
Video by Suzanne Clark/YouTube
Staph sputum - Staphylococcus aureus: Gram positive cocci under the microscope (40x) from a sputum sample.
Staph sputum - Staphylococcus aureus: Gram positive cocci under the microscope (40x) from a sputum sample.
Image by Bobjgalindo
Phlegm
Zhangmoon618
Mycobacterium tuberculosis
CDC
4:18
Sputum
MSREducators/YouTube
8:03
How to Identify Haemophilus influenzae in a Sputum Culture
Suzanne Clark/YouTube
Staph sputum - Staphylococcus aureus: Gram positive cocci under the microscope (40x) from a sputum sample.
Bobjgalindo
Bronchoscopy
Bronchoscopy and Bronchoalveolar Lavage
Also called: Bronchoscopy, Flexible Bronchoscopy, Bronchoalveolar Lavage, Bronchoalveolar Washing
Bronchoscopy is a procedure that uses a thin tube called a bronchoscope to look at the lungs. Bronchoalveolar lavage is a test that is sometimes done during a bronchoscopy. It is used to collect a fluid sample for testing.
Bronchoscopy and Bronchoalveolar Lavage
Also called: Bronchoscopy, Flexible Bronchoscopy, Bronchoalveolar Lavage, Bronchoalveolar Washing
Bronchoscopy is a procedure that uses a thin tube called a bronchoscope to look at the lungs. Bronchoalveolar lavage is a test that is sometimes done during a bronchoscopy. It is used to collect a fluid sample for testing.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
A normal result means that the large airway leading to the lungs and the breathing tubes in the lungs appear normal. No foreign substances or blockages are seen.
Related conditions
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Use the slider below to see how your results affect your
health.
Your result is Normal.
A normal or negative result means that the biopsied tissue is normal.
Related conditions
Bronchoscopy is a procedure that allows a health care provider to look at your lungs. It uses a thin, lighted tube called a bronchoscope. The tube is put through the mouth or nose and moved down the throat and into the airways. It helps diagnose and treat certain lung diseases.
Bronchoalveolar lavage (BAL) is a procedure that is sometimes done during a bronchoscopy. It is also called bronchoalveolar washing. BAL is used to collect a sample from the lungs for testing. During the procedure, a saline solution is put through the bronchoscope to wash the airways and capture a fluid sample.
Other names: flexible bronchoscopy, bronchoalveolar washing
Bronchoscopy may be used to:
Find and treat growths or other blockages in the airways
Remove lung tumors
Control bleeding in the airway
Help find the cause of persistent cough
If you've already been diagnosed with lung cancer, the test can help show how severe it is.
Bronchoscopy with BAL is used to collect tissue for testing. These tests help diagnose different disorders of the lungs including:
Bacterial infections such as tuberculosis and bacterial pneumonia
Fungal infections
Lung cancer
One or both tests may be used if an imaging test showed a potential problem with the lungs.
You may need one or both tests if you have symptoms of a lung disease, such as:
Persistent cough
Trouble breathing
Coughing up blood
You may also need a BAL if you have an immune system disorder. Some immune system disorders, such as HIV/AIDS, can put you at higher risk for certain lung infections.
Bronchoscopy and BAL are often done by a pulmonologist. A pulmonologist is a doctor who specializes in diagnosing and treating lung diseases.
A bronchoscopy usually includes the following steps:
You may need to remove some or all of your clothing. If so, you will be given a hospital gown.
You will recline in a chair that is like a dentist's chair or sit on a procedure table with your head raised.
You may get medicine (sedative) to help you relax. The medicine will be injected into a vein or given through an IV (intravenous) line that will be placed in your arm or hand.
Your provider will spray a numbing medicine in your mouth and throat, so you won't feel any pain during the procedure.
Your provider will insert the bronchoscope down your throat and into your airways.
As the bronchoscope is moved down, your provider will examine your lungs.
Your provider may perform other treatments at this time, such as removing a tumor or clearing a blockage.
At this point, you may also get a BAL.
During a BAL:
Your provider will put a small amount of saline through the bronchoscope.
After washing the airways, the saline is sucked up into the bronchoscope.
The saline solution will contain cells and other substances, such as bacteria, which will be taken to a lab for testing.
You may need to fast (not eat or drink) for several hours before your procedure. Your provider will let you know how long you need to avoid food and drink.
You should also arrange to have someone drive you home. If you've been given a sedative, you may be drowsy for a few hours after your procedure.
There is very little risk to having a bronchoscopy or a BAL. The procedures may give you a sore throat for a few days. Serious complications are rare, but they may include bleeding in the airways, infection, or a collapsed part of a lung.
If your bronchoscopy results were not normal, it may mean you have a lung disorder such as:
A blockage, growth, or tumor in the airways
Narrowing of part of the airways
Lung damage due to an immune disorder such as rheumatoid arthritis
If you had BAL and your lung sample results were not normal, it may mean you have lung cancer or a type of infection such as:
Tuberculosis
Bacterial pneumonia
Fungal infection
If you have questions about your results, talk to your health care provider.
In addition to BAL, there are other procedures that can be done during a bronchoscopy. These include:
Sputum culture. Sputum is a thick type of mucus made in your lungs. It is different than spit or saliva. A sputum culture checks for certain types of infections.
Laser therapy or radiation to treat tumors or cancer
Treatment to control bleeding in the lungs
https://www.nhlbi.nih.gov/health-topics/bronchoscopy [accessed on Mar 22, 2019]
https://medlineplus.gov/ency/article/003857.htm [accessed on Mar 22, 2019]
https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/bronchoscopy_92,p07743 [accessed on Mar 22, 2019]
https://www.bupa.co.uk/health-information/lungs-breathing/bronchoscopy [accessed on Mar 22, 2019]
https://www.cdc.gov/tb/education/corecurr/pdf/chapter4.pdf#page12 [accessed on Sep 17, 2019]
Additional Materials (20)
Bronchoscopy
Video by Tan Tock Seng Hospital/YouTube
Bronchoscopy - examination of your airways (English version)
Video by Longkanker Nederland/YouTube
Intro to Bronchoscopy: Risks, indications, contraindications and obtaining consent -- BAVLS
Video by American Thoracic Society/YouTube
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Bronchoscopy
Seen is a Caucasian male physician using a bronchoscope which is a flexible tube with a light inside and is inserted into the patient's trachea. Doctors can view inside the body through the tube allowing easier access to removal of tumors.
Image by National Cancer Institute / Unknown Photographer
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What To Expect Before, During and After a Bronchoscopy
Diagram showing a bronchoscopy.
Image by Cancer Research UK / Wikimedia Commons
Rigid bronchoscopy
Rigid bronchoscopy
Image by JBARRETO
Small Cell Lung Cancer
There is extensive growth of small cell lung carcinoma on the pleural surface of one lung simulating the appearance of mesothelioma.
Image by Yale Rosen from USA
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What Does Bronchoscopy Show?
Lung cancer in the left. bronchus as seen with a bronchoscope.
Image by JHeuser
Diagnostic Bronchoscopy
Video by Cleveland Clinic Abu Dhabi/YouTube
EBUS guide for patients: bronchoscopy technique for chest abnormalities
Video by astrazeneca/YouTube
Electromagnetic Navigation Bronchoscopy
Video by Gundersen Health System/YouTube
Robotic bronchoscopy - Mayo Clinic
Video by Mayo Clinic/YouTube
Bronchoscopy Procedure, South West Acute Hospital
Video by WesternTrust/YouTube
Using a Bronchial Scope for a Bronchoscopy at Christian Hospital in St. Louis, Missouri
Video by Christian Hospital/YouTube
Bronchoscopy & Lung Nodule Biopsy | Fox Chase Cancer Center
Video by Fox Chase Cancer Center/YouTube
All About Bronchoscopy
Video by Singapore General Hospital/YouTube
Bronchoscopic Foreign Body Removal -- BAVLS
Video by American Thoracic Society/YouTube
Sedation for Bronchoscopy (English version)
Video by Longkanker Nederland/YouTube
What happens during a bronchoscopy?
Video by Top Doctors UK/YouTube
Bronchoscopy Patient Journey at the Royal Berkshire Hospital
Video by Royal Berkshire NHS Foundation Trust/YouTube
3:12
Bronchoscopy
Tan Tock Seng Hospital/YouTube
1:58
Bronchoscopy - examination of your airways (English version)
Longkanker Nederland/YouTube
7:31
Intro to Bronchoscopy: Risks, indications, contraindications and obtaining consent -- BAVLS
American Thoracic Society/YouTube
Sensitive content
This media may include sensitive content
Bronchoscopy
National Cancer Institute / Unknown Photographer
Sensitive content
This media may include sensitive content
What To Expect Before, During and After a Bronchoscopy
Cancer Research UK / Wikimedia Commons
Rigid bronchoscopy
JBARRETO
Small Cell Lung Cancer
Yale Rosen from USA
Sensitive content
This media may include sensitive content
What Does Bronchoscopy Show?
JHeuser
3:37
Diagnostic Bronchoscopy
Cleveland Clinic Abu Dhabi/YouTube
7:32
EBUS guide for patients: bronchoscopy technique for chest abnormalities
astrazeneca/YouTube
2:09
Electromagnetic Navigation Bronchoscopy
Gundersen Health System/YouTube
4:43
Robotic bronchoscopy - Mayo Clinic
Mayo Clinic/YouTube
9:06
Bronchoscopy Procedure, South West Acute Hospital
WesternTrust/YouTube
5:31
Using a Bronchial Scope for a Bronchoscopy at Christian Hospital in St. Louis, Missouri
Christian Hospital/YouTube
4:25
Bronchoscopy & Lung Nodule Biopsy | Fox Chase Cancer Center
Fox Chase Cancer Center/YouTube
3:36
All About Bronchoscopy
Singapore General Hospital/YouTube
6:02
Bronchoscopic Foreign Body Removal -- BAVLS
American Thoracic Society/YouTube
2:51
Sedation for Bronchoscopy (English version)
Longkanker Nederland/YouTube
2:18
What happens during a bronchoscopy?
Top Doctors UK/YouTube
7:13
Bronchoscopy Patient Journey at the Royal Berkshire Hospital
Royal Berkshire NHS Foundation Trust/YouTube
Low-Dose Computed Tomography
Low-Dose Computed Tomography
Also called: LDCT, Low-Dose CT Scan, Lung Cancer Screening with Low-Dose CT
Lung cancer screening with low-dose computed tomography is recommended only for adults who have no symptoms but are at high risk for developing the disease because of their smoking history and age. In this test, an X-ray machine scans the body and uses low doses of radiation to make detailed pictures of the lungs.
Low-Dose Computed Tomography
Also called: LDCT, Low-Dose CT Scan, Lung Cancer Screening with Low-Dose CT
Lung cancer screening with low-dose computed tomography is recommended only for adults who have no symptoms but are at high risk for developing the disease because of their smoking history and age. In this test, an X-ray machine scans the body and uses low doses of radiation to make detailed pictures of the lungs.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
A negative result means nothing abnormal was seen on the scan. Ask your care team when and if you should repeat the scan based on your health and history. False-negative test results can occur, meaning the scan may appear to be normal even though lung cancer is present.
Related conditions
Who Should Be Screened for Lung Cancer? | CDC [accessed on Jan 07, 2019]
Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439N) [accessed on Jan 07, 2019]
Lung Cancer Screening With Low-Dose CT (LDCT) FAQs [accessed on Jan 07, 2019]
Lung Cancer Screening [accessed on Jan 07, 2019]
PDQ® Screening and Prevention Editorial Board. PDQ Lung Cancer Screening. Bethesda, MD: National Cancer Institute. [accessed on Jan 07, 2019]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
CT Scan
CT Scan
A CT scan is a special x-ray procedure that can make detailed pictures of structures inside your body. A CT scan is commonly used to look for certain chest problems, including infection, lung cancer, and pulmonary embolism.
CT Scan
A CT scan is a special x-ray procedure that can make detailed pictures of structures inside your body. A CT scan is commonly used to look for certain chest problems, including infection, lung cancer, and pulmonary embolism.
Computed tomography, or CT, scans are medical imaging tests that use ionizing radiation to create cross-sectional (slices) pictures inside selected areas of the body from different angles. The images can show internal organs, blood vessels, soft tissues, and bones. CT scans combine a series of x-ray (radiography) images into a three-dimensional picture.
Your healthcare provider may ask for a CT scan to detect, diagnose, or plan treatment for a particular disease or injury.
Common uses of CT scan include checking for:
Tumors
Infections
Blood clots
Internal bleeding
Before the procedure
The radiologist will explain the procedure and ask you if you have any questions. Some CT procedures may use a contrast dye which allows healthcare providers to see specific organ(s). You may be asked to drink the contrast dye or you may receive it in an intravenous (IV) line in the hand or arm.
Make sure to tell your healthcare provider and the radiologist doing the test if you:
Have ever had an allergic reaction to any contrast dye.
Are pregnant or suspect that you may be pregnant.
During the Procedure
You will be asked to remove any clothing and jewelry that may interfere with the procedure.
You will be asked to lie very still on a table while it moves slowly through an x-ray machine (like a tube) taking images of your body.
The computer will organize the x-ray information to show the internal structures in detail.
CT scans usually require more exposure to radiation than common x-rays because they use a series of x-ray images. Increased exposure means a slightly higher risk of possible short-term and long-term health effects. However, CT scans provide your healthcare provider with more detailed images that can include parts of the body that may not be seen on common x-ray images. Talk to your healthcare provider to decide what type of imaging will use the least amount of radiation while providing the information and details needed for your diagnosis.
Computed Tomography (CT) Scans | Radiation | NCEH | CDC. Dec 28, 2021 [accessed on Jan 31, 2023]
Has use of CT scans in emergency departments to test for pulmonary embolism leveled off? | CDC. Centers for Disease Control and Prevention. Oct 22, 2018 [accessed on Jan 31, 2023]
Computed Tomography (CT). National Institute of Biomedical Imaging and Bioengineering [accessed on Jan 31, 2023]
Staging
Stage 1A and 1B lung cancer
Stage 2A lung cancer
Option for stage 2Bb lung cancer
Stage 3A lung cancer - Diagram 1 of 3
Stage 3A lung cancer - Diagram 2 of 3
Stage 3A lung cancer - Diagram 3 of 3
Stage 3B lung cancer - Diagram 1 of 2
Diagram 2 of 2 showing stage 3B lung cancer
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Stages - Lung Cancer
Interactive by Cancer Research UK / Wikimedia Commons
Stage 1A and 1B lung cancer
Stage 2A lung cancer
Option for stage 2Bb lung cancer
Stage 3A lung cancer - Diagram 1 of 3
Stage 3A lung cancer - Diagram 2 of 3
Stage 3A lung cancer - Diagram 3 of 3
Stage 3B lung cancer - Diagram 1 of 2
Diagram 2 of 2 showing stage 3B lung cancer
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2
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Stages - Lung Cancer
Interactive by Cancer Research UK / Wikimedia Commons
Staging of Non-Small Cell Lung Cancer
Stages of Non-Small Cell Lung Cancer
KEY POINTS
After lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lungs or to other parts of the body.
There are three ways that cancer spreads in the body.
Cancer may spread from where it began to other parts of the body.
The following stages are used for non-small cell lung cancer:
Occult (hidden) stage
Stage 0
Stage I
Stage II
Stage III
Stage IV
Non-small cell lung cancer can recur (come back) after it has been treated.
After lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lungs or to other parts of the body.
The process used to find out if cancer has spread within the lungs or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests used to diagnose non-small cell lung cancer are also used to stage the disease.
Other tests and procedures that may be used in the staging process include the following:
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. This procedure is also called nuclear magnetic resonance imaging (NMRI).
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the brain and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
Pulmonary function test (PFT): A test to see how well the lungs are working. It measures how much air the lungs can hold and how quickly air moves into and out of the lungs. It also measures how much oxygen is used and how much carbon dioxide is given off during breathing. This is also called lung function test.
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
Tissue. The cancer spreads from where it began by growing into nearby areas.
Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if non-small cell lung cancer spreads to the brain, the cancer cells in the brain are actually lung cancer cells. The disease is metastatic lung cancer, not brain cancer.
The following stages are used for non-small cell lung cancer:
Occult (hidden) stage
In the occult (hidden) stage, cancer cannot be seen by imaging or bronchoscopy. Cancer cells are found in sputum or bronchial washings (a sample of cells taken from inside the airways that lead to the lungs). Cancer may have spread to other parts of the body.
Stage 0
In stage 0, abnormal cells are found in the lining of the airways. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 may be adenocarcinoma in situ (AIS) or squamous cell carcinoma in situ (SCIS).
Stage I
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
Stage IA:Stage IA lung cancer. The tumor is in the lung only and is 3 centimeters or smaller. Cancer has not spread to the lymph nodes.
The tumor is in the lung only and is 3 centimeters or smaller. Cancer has not spread to the lymph nodes.
Stage IB:Stage IB lung cancer. The tumor is larger than 3 centimeters but not larger than 4 centimeters. Cancer has not spread to the lymph nodes; OR the tumor is 4 centimeters or smaller. Cancer has not spread to the lymph nodes and one or more of the following is found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
The tumor is larger than 3 centimeters but not larger than 4 centimeters. Cancer has not spread to the lymph nodes.
or
The tumor is 4 centimeters or smaller and one or more of the following is found:
Cancer has spread to the main bronchus, but has not spread to the carina.
Cancer has spread to the innermost layer of the membrane that covers the lung.
Part of the lung or the whole lung has collapsed or has developed pneumonitis.
Cancer has not spread to the lymph nodes.
Stage II
Stage II is divided into stages IIA and IIB.
Stage IIA:Stage IIA lung cancer. The tumor is larger than 4 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes and one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
The tumor is larger than 4 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes and one or more of the following may be found:
Cancer has spread to the main bronchus, but has not spread to the carina.
Cancer has spread to the innermost layer of the membrane that covers the lung.
Part of the lung or the whole lung has collapsed or has developed pneumonitis.
Stage IIB:Stage IIB lung cancer (1). The primary tumor is 5 centimeters or smaller and cancer has spread to the lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus.
The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following may be found:
Cancer has spread to the main bronchus, but has not spread to the carina.
Cancer has spread to the innermost layer of the membrane that covers the lung.
Part of the lung or the whole lung has collapsed or has developed pneumonitis.
or
Stage IIB lung cancer (2). Cancer has not spread to lymph nodes and one or more of the following is found: (a) the primary tumor is larger than 5 centimeters but not larger than 7 centimeters; and/or (b) there are one or more separate tumors in the same lobe of the lung as the primary tumor; and/or cancer has spread to any of the following: (c) the chest wall and/or the membrane that lines the inside of the chest wall, (d) the nerve that controls the diaphragm, and/or (e) the outer layer of tissue of the sac around the heart.
Cancer has not spread to the lymph nodes and one or more of the following is found:
The tumor is larger than 5 centimeters but not larger than 7 centimeters.
There are one or more separate tumors in the same lobe of the lung as the primary tumor.
Cancer has spread to any of the following:
The membrane that lines the inside of the chest wall.
Chest wall.
The nerve that controls the diaphragm.
Outer layer of tissue of the sac around the heart.
Stage III
Stage III is divided into stages IIIA, IIIB, and IIIC.
Stage IIIA:Stage IIIA lung cancer (1). The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta (not shown), or where the trachea divides into the bronchi. Also, one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following may be found:
Cancer has spread to the main bronchus, but has not spread to the carina.
Cancer has spread to the innermost layer of the membrane that covers the lung.
Part of the lung or the whole lung has collapsed or has developed pneumonitis.
or
Stage IIIA lung cancer (2). Cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found: (a) the tumor is larger than 5 centimeters but not larger than 7 centimeters; and/or (b) there are one or more separate tumors in the same lobe of the lung as the primary tumor; and/or cancer has spread to any of the following: (c) the chest wall and/or the membrane that lines the inside of the chest wall, (d) the nerve that controls the diaphragm, and/or (e) the outer layer of tissue of the sac around the heart.
Cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:
The tumor is larger than 5 centimeters but not larger than 7 centimeters.
There are one or more separate tumors in the same lobe of the lung as the primary tumor.
Cancer has spread to any of the following:
The membrane that lines the inside of the chest wall.
Chest wall.
The nerve that controls the diaphragm.
Outer layer of tissue of the sac around the heart.
or
Stage IIIA lung cancer (3). Cancer may have spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found: (a) the primary tumor is larger than 7 centimeters; and/or (b) there are one or more separate tumors in a different lobe of the lung with the primary tumor; and/or the tumor is any size and cancer has spread to any of the following: (c) trachea, (d) carina, (e) esophagus, (f) breastbone or backbone, (g) diaphragm, (h) heart, (i) major blood vessels that lead to or from the heart (aorta or vena cava), or the nerve that controls the larynx (not shown).
Cancer may have spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:
The tumor is larger than 7 centimeters.
There are one or more separate tumors in a different lobe of the lung with the primary tumor.
The tumor is any size and cancer has spread to any of the following:
Trachea.
Carina.
Esophagus.
Breastbone or backbone.
Diaphragm.
Heart.
Major blood vessels that lead to or from the heart (aorta or vena cava).
Nerve that controls the larynx (voice box).
Stage IIIB:Stage IIIB lung cancer (1). The primary tumor is 5 centimeters or smaller and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following may be found:
Cancer has spread to the main bronchus, but has not spread to the carina.
Cancer has spread to the innermost layer of the membrane that covers the lung.
Part of the lung or the whole lung has collapsed or has developed pneumonitis.
or
Stage IIIB lung cancer (2). The tumor may be any size and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta (not shown), or where the trachea divides into the bronchi. Also, one or more of the following is found: (a) there are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor; and/or (b) cancer has spread to any of the following: the chest wall or the membrane that lines the inside of the chest wall, the nerve that controls the voice box, the trachea, the carina, the esophagus, the breastbone or backbone (not shown), the diaphragm, the nerve that controls the diaphragm, the heart, the major blood vessels that lead to or from the heart (aorta or vena cava), or the outer layer of tissue of the sac around the heart.
The tumor may be any size and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following is found:
There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
Cancer has spread to any of the following:
The membrane that lines the inside of the chest wall.
Chest wall.
The nerve that controls the diaphragm.
Outer layer of tissue of the sac around the heart.
Trachea.
Carina.
Esophagus.
Breastbone or backbone.
Diaphragm.
Heart.
Major blood vessels that lead to or from the heart (aorta or vena cava).
Nerve that controls the larynx (voice box).
Stage IIIC:Stage IIIC lung cancer. The tumor may be any size and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following is found: (a) there are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor; and/or (b) cancer has spread to any of the following: the chest wall or the membrane that lines the inside of the chest wall, the nerve that controls the voice box, the trachea, the carina, the esophagus, the breastbone or backbone (not shown), the diaphragm, the nerve that controls the diaphragm, the heart, the major blood vessels that lead to or from the heart (aorta or vena cava), or the outer layer of tissue of the sac around the heart.
The tumor may be any size and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following is found:
There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
Cancer has spread to any of the following:
The membrane that lines the inside of the chest wall.
Chest wall.
The nerve that controls the diaphragm.
Outer layer of tissue of the sac around the heart.
Trachea.
Carina.
Esophagus.
Breastbone or backbone.
Diaphragm.
Heart.
Major blood vessels that lead to or from the heart (aorta or vena cava).
Nerve that controls the larynx (voice box).
Stage IV
Stage IV is divided into stages IVA and IVB.
Stage IVA:Stage IVA lung cancer. The tumor may be any size and cancer may have spread to the lymph nodes. One or more of the following is found: (a) there are one or more tumors in the lung that does not have the primary tumor; and/or (b) cancer is found in fluid around the lungs or heart or there are cancer nodules in the lining around the lungs or the sac around the heart; and/or (c) cancer has spread to one place in an organ or tissue not near the lung, such as the brain, adrenal gland, kidney, liver, or bone, or to a lymph node that is not near the lung.
The tumor may be any size and cancer may have spread to the lymph nodes. One or more of the following is found:
There are one or more tumors in the lung that does not have the primary tumor.
Cancer is found in the lining around the lungs or the sac around the heart.
Cancer is found in fluid around the lungs or the heart.
Cancer has spread to one place in an organ not near the lung, such as the brain, liver, adrenal gland, kidney, bone, or to a lymph node that is not near the lung.
Stage IVB:Stage IVB lung cancer. The cancer has spread to multiple places in one or more organs that are not near the lung, such as the brain, adrenal gland, kidney, liver, distant lymph nodes, or bone.
Cancer has spread to multiple places in one or more organs that are not near the lung.
Non-small cell lung cancer can recur (come back) after it has been treated.
The cancer may come back in the brain, lung, or other parts of the body.
There are different types of lung surgery: 1- Removing one lobe (lobectomy); 2- Removing two lobes (bilobectomy); 3- Removing the whole lung (pneumonectomy).
Interactive by Cancer Research UK
Treatment of Non-Small Cell Lung Cancer
KEY POINTS
There are different types of treatment for patients with non-small cell lung cancer.
Nine types of standard treatment are used:
Surgery
Radiation therapy
Chemotherapy
Targeted therapy
Immunotherapy
Laser therapy
Photodynamic therapy (PDT)
Cryosurgery
Electrocautery
New types of treatment are being tested in clinical trials.
Radiosensitizers
New combinations
Treatment for non-small cell lung cancer may cause side effects.
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.
There are different types of treatment for patients with non-small cell lung cancer.
Different types of treatments are available for patients with non-small cell lung cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Nine types of standard treatment are used:
Surgery
Four types of surgery are used to treat lung cancer:
Wedge resection: Surgery to remove a tumor and some of the normal tissue around it. When a slightly larger amount of tissue is taken, it is called a segmental resection.
Wedge resection of the lung. Part of the lung lobe containing the cancer and a small amount of healthy tissue around it is removed.
Lobectomy: Surgery to remove a whole lobe (section) of the lung.Lobectomy. A lobe of the lung is removed.
Pneumonectomy: Surgery to remove one whole lung.Pneumonectomy. The whole lung is removed.
Sleeve resection: Surgery to remove part of the bronchus.
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Stereotactic body radiation therapy is a type of external radiation therapy. Special equipment is used to place the patient in the same position for each radiation treatment. Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor. By having the patient in the same position for each treatment, there is less damage to nearby healthy tissue. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.
Stereotactic radiosurgery is a type of external radiation therapy used to treat lung cancer that has spread to the brain. A rigid head frame is attached to the skull to keep the head still during the radiation treatment. A machine aims a single large dose of radiation directly at the tumor in the brain. This procedure does not involve surgery. It is also called stereotaxic radiosurgery, radiosurgery, and radiation surgery.
For tumors in the airways, radiation is given directly to the tumor through an endoscope.
The way the radiation therapy is given depends on the type and stage of the cancer being treated. It also depends on where the cancer is found. External and internal radiation therapy are used to treat non-small cell lung cancer.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Monoclonal antibodies, tyrosine kinase inhibitors, and mammalian target of rapamycin (mTOR) inhibitors are three types of targeted therapy being used to treat advanced, metastatic, or recurrent non-small cell lung cancer.
Monoclonal antibodies
Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
There are different types of monoclonal antibody therapy:
Vascular endothelial growth factor (VEGF) inhibitor therapy: Cancer cells make a substance called VEGF, which causes new blood vessels to form (angiogenesis) and helps the cancer grow. VEGF inhibitors block VEGF and stop new blood vessels from forming. This may kill cancer cells because they need new blood vessels to grow. Bevacizumab and ramucirumab are VEGF inhibitors and angiogenesis inhibitors.
Epidermal growth factor receptor (EGFR) inhibitor therapy: EGFRs are proteins found on the surface of certain cells, including cancer cells. Epidermal growth factor attaches to the EGFR on the surface of the cell and causes the cells to grow and divide. EGFR inhibitors block the receptor and stop the epidermal growth factor from attaching to the cancer cell. This stops the cancer cell from growing and dividing. Cetuximab and necitumumab are EGFR inhibitors.
Tyrosine kinase inhibitors
Tyrosine kinase inhibitors are small-molecule drugs that go through the cell membrane and work inside cancer cells to block signals that cancer cells need to grow and divide. Some tyrosine kinase inhibitors also have angiogenesis inhibitor effects.
There are different types of tyrosine kinase inhibitors:
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors: EGFRs are proteins found on the surface and inside certain cells, including cancer cells. Epidermal growth factor attaches to the EGFR inside the cell and sends signals to the tyrosine kinase area of the cell, which tells the cell to grow and divide. EGFR tyrosine kinase inhibitors stop these signals and stop the cancer cell from growing and dividing. Erlotinib, gefitinib, afatinib, osimertinib, and dacomitinib are types of EGFR tyrosine kinase inhibitors. Some of these drugs work better when there is also a mutation (change) in the EGFR gene.
Kinase inhibitors that affect cells with certain gene changes:
Dabrafenib is used to stop proteins being made by the BRAF gene.
Trametinib is used to stop proteins being made by the MEK gene.
Crizotinib and entrectinib are used to stop proteins from being made by the ALK and ROS1 genes.
Ceritinib, alectinib, brigatinib, and lorlatinib are used to stop proteins from being made by the ALK gene.
Larotrectinib and entrectinib are used to stop proteins being made by NTRK1, NTRK2, and NTRK3 gene fusions.
Selpercatinib is used to stop proteins being made by the RET fusion gene or the mutated RET gene.
Tepotinib and capmatinib are used to stop proteins being made by the mutated MET gene.
Mammalian target of rapamycin (mTOR) inhibitors
mTOR inhibitors block a protein called mTOR, which may keep cancer cells from growing and prevent the growth of new blood vessels that tumors need to grow. Everolimus is a type of mTOR inhibitor.
Immunotherapy
Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biologic therapy.
Immune checkpoint inhibitor therapy is a type of immunotherapy used to treat some patients with advanced non-small-cell lung cancer.
Types of immune checkpoint inhibitor therapy include:
PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. Pembrolizumab and nivolumab are types of PD-1 inhibitors. Atezolizumab and durvalumab are types of PD-L1 inhibitors.
Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).
Laser therapy
Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining of internal organs. When the tumor is in the airways, PDT is given directly to the tumor through an endoscope.
Cryosurgery
Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. For tumors in the airways, cryosurgery is done through an endoscope.
Electrocautery
Electrocautery is a treatment that uses a probe or needle heated by an electric current to destroy abnormal tissue. For tumors in the airways, electrocautery is done through an endoscope.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied.
Radiosensitizers
Radiosensitizers are substances that make tumor cells easier to kill with radiation therapy. The combination of chemotherapy and radiation therapy given with a radiosensitizer is being studied in the treatment of non-small cell lung cancer.
New combinations
New combinations of treatments are being studied in clinical trials.
Treatment for non-small cell lung cancer may cause side effects.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Source: National Cancer Institute (NIH)
Additional Materials (20)
Wedge Resection
Lobectomy
1
2
Lung Cancer Surgery - Wedge Resection and Lobectomy
Algorithm for treatment of patients with non-small cell lung cancer (NSCLC)
Algorithm for treatment of patients with non-small cell lung cancer (NSCLC). First line Immunotherapy for Non-Small Cell Lung Cancer. Nasser NJ, Gorenberg M, Agbarya A. Pharmaceuticals (Basel). 2020 Nov 8;13(11):373. https://doi.org/10.3390/ph13110373
Image by Nicola J. Nasser, Miguel Gorenberg, and Abed Agbarya/Wikimedia
Small cell lung cancer may respond to combination of immunotherapy and targeted therapy
Video by MD Anderson Cancer Center/YouTube
Immunotherapy: New Hope for Lung Cancer Treatment
Video by American Lung Association/YouTube
Lung cancer treatment | Respiratory system diseases | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
Interstitial Lung Disease and Lung Transplant: What Patients Need to Know
Video by Mayo Clinic/YouTube
Lung Carcinoma (Lung cancer)
Video by Armando Hasudungan/YouTube
Immunotherapy Treatments for Non-Small Cell Lung Cancer (NSCLC)
Video by You and Lung Cancer/YouTube
Treatment and Management of Non-Small Cell Lung Cancer (NSCLC)
Micrograph showing a PD-L1 positive lung adenocarcinoma. PD-L1 immunostain.
Image by https://commons.wikimedia.org/wiki/File:PD-L1_positive_lung_adenocarcinoma_--_high_mag.jpg
PD-L1 positive lung adenocarcinoma -- low mag
Image by /Wikimedia
PD-L1 positive lung adenocarcinoma -- very low mag
PD-L1 positive lung adenocarcinoma. PD-L1 immunostain.
Related images
PD-L1 lung ca. - very low mag.
PD-L1 lung ca. - low mag.
PD-L1 lung ca. - intermed. mag.
PD-L1 lung ca. - high mag.
PD-L1 positive lung adenocarcinoma -- very high mag.jpg
PD-L1 lung ca. - very high mag.
Image by Nephron/Wikimedia
Lung Cancer Surgery - Wedge Resection and Lobectomy
PD-L1 positive lung adenocarcinoma -- very low mag
Nephron/Wikimedia
Treatment by Stage
Genomic information
Image by NHS HEE Genomics Education Programme
Genomic information
This image was created by the NHS HEE Genomics Education Programme. For further information and resources please visit our website www.genomicseducation.hee.nhs.uk
Image by NHS HEE Genomics Education Programme
Non-Small Cell Lung Cancer – Treatment of Stage
Treatment of Occult Non-Small Cell Lung Cancer
Treatment of occult non-small cell lung cancer depends on the stage of the disease. Occult tumors are often found at an early stage (the tumor is in the lung only) and sometimes can be cured by surgery.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done.
Treatment of Stage 0 (Carcinoma in Situ)
Treatment of stage 0 may include the following:
Surgery (wedge resection or segmental resection).
Photodynamic therapy, electrocautery, cryosurgery, or laser surgery for tumors in or near the bronchus.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done.
Treatment of Stage I Non-Small Cell Lung Cancer
Treatment of stage IA non-small cell lung cancer and stage IB non-small cell lung cancer may include the following:
Surgery (wedge resection, segmental resection, sleeve resection, or lobectomy).
Surgery followed by targeted therapy with an EGFR tyrosine kinase inhibitor, such as osimertinib.
External radiation therapy, including stereotactic body radiation therapy for patients who cannot have surgery or choose not to have surgery.
A clinical trial of chemotherapy or radiation therapy following surgery.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done.
Treatment of Stage II Non-Small Cell Lung Cancer
Treatment of stage IIA non-small cell lung cancer and stage IIB non-small cell lung cancer may include the following:
Surgery (wedge resection, segmental resection, sleeve resection, lobectomy, or pneumonectomy).
Chemotherapy followed by surgery.
Surgery followed by chemotherapy.
Surgery followed by targeted therapy with an EGFR tyrosine kinase inhibitor, such as osimertinib.
External radiation therapy for patients who cannot have surgery.
A clinical trial of radiation therapy following surgery.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done.
Treatment of Stage IIIA Non-Small Cell Lung Cancer
Treatment of stage IIIA non-small cell lung cancer that can be removed with surgery may include the following:
Chemotherapy followed by surgery.
Chemotherapy and radiation therapy followed by surgery.
Surgery followed by chemotherapy.
Surgery followed by targeted therapy with an EGFR tyrosine kinase inhibitor, such as osimertinib.
Surgery followed by chemotherapy combined with radiation therapy.
Surgery followed by radiation therapy.
A clinical trial of new combinations of treatments.
Treatment of stage IIIA non-small cell lung cancer that cannot be removed with surgery may include the following:
Chemotherapy and radiation therapy.
Chemotherapy and radiation therapy followed by immunotherapy with an immune checkpoint inhibitor, such as durvalumab.
External radiation therapy alone.
Internal radiation therapy or laser surgery, as palliative treatment to relieve symptoms and improve the quality of life.
Non-small cell lung cancer of the superior sulcus, often called Pancoast tumor, begins in the upper part of the lung and spreads to nearby tissues such as the chest wall, large blood vessels, and spine. Treatment of Pancoast tumors may include the following:
Surgery.
Chemotherapy and radiation therapy followed by surgery.
Radiation therapy alone.
A clinical trial of new combinations of treatments.
Some stage IIIA non-small cell lung tumors that have grown into the chest wall may be completely removed. Treatment of chest wall tumors may include the following:
Surgery.
Surgery and radiation therapy.
Radiation therapy alone.
Chemotherapy combined with radiation therapy and/or surgery.
A clinical trial of new combinations of treatments.
Treatment of Stage IIIB and Stage IIIC Non-Small Cell Lung Cancer
Treatment of stage IIIB non-small cell lung cancer and stage IIIC non-small cell lung cancer may include the following:
Chemotherapy followed by external radiation therapy.
Chemotherapy and radiation therapy given as separate treatments over the same period of time.
Chemotherapy and radiation therapy given as separate treatments over the same period of time, with the dose of radiation therapy increasing with time.
Chemotherapy and radiation therapy given as separate treatments over the same period of time. Chemotherapy alone is given before or after these treatments.
Chemotherapy and radiation therapy followed by immunotherapy with an immune checkpoint inhibitor, such as durvalumab.
External radiation therapy alone for patients who cannot be treated with chemotherapy.
External radiation therapy as palliative therapy, to relieve symptoms and improve the quality of life.
Laser therapy and/or internal radiation therapy to relieve symptoms and improve the quality of life.
Clinical trials of new external radiation therapy schedules and new types of treatment.
A clinical trial of chemotherapy and radiation therapy combined with a radiosensitizer.
Clinical trials of targeted therapy combined with chemotherapy and radiation therapy.
Treatment of Newly Diagnosed Stage IV, Relapsed, and Recurrent Non-Small Cell Lung Cancer
Treatment of newly diagnosed stage IV, relapsed, and recurrent non-small cell lung cancer may include the following:
Combination chemotherapy.
Combination chemotherapy and targeted therapy with a monoclonal antibody, such as bevacizumab, cetuximab, or necitumumab.
Combination chemotherapy followed by more chemotherapy as maintenance therapy to help keep cancer from progressing.
Targeted therapy with an EGFR tyrosine kinase inhibitor, such as osimertinib, dacomitinib, gefitinib, erlotinib, or afatinib.
Targeted therapy with an ALK inhibitor, such as alectinib, lorlatinib, crizotinib, ceritinib, or brigatinib.
Targeted therapy with a BRAF inhibitor or MEK inhibitor, such as dabrafenib or trametinib.
Targeted therapy with crizotinib and entrectinib to stop proteins from being made by the ALK and ROS1 genes.
Targeted therapy with a NTRK inhibitor, such as larotrectinib or entrectinib.
Targeted therapy with a RET inhibitor, such as selpercatinib.
Targeted therapy with a MET inhibitor, such as tepotinib or capmatinib.
Immunotherapy with an immune checkpoint inhibitor, such as pembrolizumab or atezolizumab, with or without chemotherapy.
Targeted therapy with an mTOR inhibitor, such as everolimus.
Laser therapy and/or internal radiation therapy for tumors that are blocking the airways.
External radiation therapy as palliative therapy, to relieve symptoms and improve the quality of life.
Surgery to remove a second primary tumor.
Surgery to remove cancer that has spread to the brain, followed by radiation therapy to the whole brain.
Stereotactic radiosurgery for tumors that have spread to the brain and cannot be treated with surgery.
A clinical trial of new drugs and combinations of treatments.
Treatment of Progressive Stage IV, Relapsed, and Recurrent Non-Small Cell Lung Cancer
Treatment of progressive stage IV, relapsed, and recurrent non-small cell lung cancer may include the following:
Chemotherapy.
Targeted therapy with an EGFR tyrosine kinase inhibitor, such as erlotinib, gefitinib, afatinib, or osimertinib.
Targeted therapy with an ALK inhibitor, such as crizotinib, ceritinib, alectinib, brigatinib, or lorlatinib.
Targeted therapy with a BRAF inhibitor or MEK inhibitor, such as dabrafenib or trametinib.
Targeted therapy with crizotinib and entrectinib to stop proteins from being made by the ALK and ROS1 genes.
Targeted therapy with a NTRK inhibitor, such as larotrectinib or entrectinib.
Targeted therapy with a RET inhibitor, such as selpercatinib.
Targeted therapy with a MET inhibitor, such as tepotinib or capmatinib.
Immunotherapy with an immune checkpoint inhibitor, such as nivolumab, pembrolizumab, or atezolizumab.
Targeted therapy with an mTOR inhibitor, such as everolimus.
A clinical trial of new drugs and combinations of treatments.
Source: National Cancer Institute (NCI)
Additional Materials (8)
Lung cancer cells treated with discodermolide
lung cancer cells treated with discodermolide.jpg
Image by ocean explorer/Wikimedia
PD-L1 positive lung adenocarcinoma -- very low mag
Micrograph showing a PD-L1-positive NSCLC, PD-L1 immunostain
Interactive by Nephron
Photo of lung adenocarcinoma tissue stained with fluorescent antibodies by Immunohistochemistry.
Image by Мария Шитова/Wikimedia
Monoclonal antibodies used in the treatment of non small cell lung cancer and their mechanism of action
Non-small cell lung cancer (NSCLC) cells expressing programmed death-ligand 1 (PD-L1) could interact with programmed death receptor 1 (PD-1) expressed on the surface of T cells, and result in decreased tumor cell kill by the immune system. Atezolizumab is an anti PD-L1 monoclonal antibody. Nivolumab and Pembrolizumab are anti PD-1 monoclonal antibodies. Ipilimumab is a monoclonal antibody that targets Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) on the surface of T cells. Bevacizumab is a monoclonal antibody that targets Vascular Endothelial Growth Factor (VEGF) in the circulation and functions as an angiogenesis inhibitor.
First line Immunotherapy for Non-Small Cell Lung Cancer. Nasser NJ, Gorenberg M, Agbarya A. Pharmaceuticals (Basel). 2020 Nov 8;13(11):373. https://doi.org/10.3390/ph13110373
Image by First line Immunotherapy for Non-Small Cell Lung Cancer.
Nasser NJ, Gorenberg M, Agbarya A.
Pharmaceuticals (Basel). 2020 Nov 8;13(11):373. doi: 10.3390/ph13110373./Wikimedia
Pharmaceuticals- Immunotherapy phase III studies in the first line treatment of Non-Small Cell Lung Cancer (NSCLC)
Immunotherapy phase III studies in the first line treatment of Non-Small Cell Lung Cancer (NSCLC), includes Pembrolizumab in KEYNOTE-024, KEYNOTE-042, KEYNOTE-189 and KEYNOTE-407; Nivolumab and Ipilimumab in CHECKMATE-227 and CHECKMATE 9LA; and Atezolizumab in IMpower110, IMpower130 and IMpower150. https://doi.org/10.3390/ph13110373
Image by First line Immunotherapy for Non-Small Cell Lung Cancer.Nasser NJ, Gorenberg M, Agbarya A.Pharmaceuticals (Basel). 2020 Nov 8;13(11):373. doi: 10.3390/ph13110373./Wikimedia
Overall survival in non-small lung cancer patients treated with modern immunotherapy in the first line for advanced or metastatic disease
Comparison of over survival and hazard ratios (HR) in clinical trials incorporating immunotherapy in the first line for patients with non-small cell lung cancer. The treatment arms without and with immunotherapy are compared in KEYNOTE-024, KEYNOTE-042, KEYNOTE-189, KEYNOTE-407, CHECKMATE-227, CHECKMATE 9LA, IMpower110, IMpower130, and IMpower150.Nasser NJ, Gorenberg M, Agbarya A.Pharmaceuticals 2020, 13(11), 373; https://doi.org/10.3390/ph13110373
Image by Nicola J. Nasser, Miguel Gorenberg, Abed Agbarya.
Pharmaceuticals (Basel). 2020 Nov 8;13(11):373 https://doi.org/10.3390/ph13110373/Wikimedia
Atezolizumab for treatment of non small cell lung cancer in the first line, IMpower 110, 130 and 150 studies
Patients median survival with Atezolizumab (Atezo) for treatment of non small cell lung cancer in the first line, IMpower 110 comparing Atezo to chemotherapy , IMpower 130 comparing Atezo+chemotherapy to chemotherapy and IMpower150 comparing ATEZOLIZUMAB+ chemotherapy + bevacizumab versus chemotherapy + bevacizumab
Image by Nicola J. Nasser, Miguel Gorenberg, Abed Agbarya/Wikimedia
Targeted Therapy in Non-Small Cell Lung Cancer
Video by You and Lung Cancer/YouTube
Lung cancer cells treated with discodermolide
ocean explorer/Wikimedia
PD-L1 positive lung adenocarcinoma
Nephron
Photo of lung adenocarcinoma tissue stained with fluorescent antibodies by Immunohistochemistry.
Мария Шитова/Wikimedia
Monoclonal antibodies used in the treatment of non small cell lung cancer and their mechanism of action
First line Immunotherapy for Non-Small Cell Lung Cancer.
Nasser NJ, Gorenberg M, Agbarya A.
Pharmaceuticals (Basel). 2020 Nov 8;13(11):373. doi: 10.3390/ph13110373./Wikimedia
Pharmaceuticals- Immunotherapy phase III studies in the first line treatment of Non-Small Cell Lung Cancer (NSCLC)
First line Immunotherapy for Non-Small Cell Lung Cancer.Nasser NJ, Gorenberg M, Agbarya A.Pharmaceuticals (Basel). 2020 Nov 8;13(11):373. doi: 10.3390/ph13110373./Wikimedia
Overall survival in non-small lung cancer patients treated with modern immunotherapy in the first line for advanced or metastatic disease
Nicola J. Nasser, Miguel Gorenberg, Abed Agbarya.
Pharmaceuticals (Basel). 2020 Nov 8;13(11):373 https://doi.org/10.3390/ph13110373/Wikimedia
Atezolizumab for treatment of non small cell lung cancer in the first line, IMpower 110, 130 and 150 studies
Nicola J. Nasser, Miguel Gorenberg, Abed Agbarya/Wikimedia
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Non-Small Cell Lung Cancer
Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung. Learn about risk factors, staging, treatment, and prognosis for this disease.