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Healthy Heart Month - Cardiology

Thoracic surgery

Thoracic surgery

Truman Medical Center Hospital Hill

2301 Holmes Street
Kansas City, MO 64108
816.404.1000
Providers
Use this tool to help you ponder the pros and cons of lung cancer screening.

Should you be screened for lung cancer?

Reviewed 11/1/2020

Lung cancer screening

Is it right for you?

If you've ever been a smoker—or spent a lot of time around secondhand smoke—you might wonder if you should be screened for lung cancer. Low-dose CT scans can detect lung cancer early, before symptoms appear. But screening isn't for everybody. This tool is designed to help you decide whether lung cancer screening is appropriate for you.

Are you age 55 to 74 with a history of heavy smoking?

If you answered "yes." Two of the criteria for lung cancer screening are being age 55 to 74* and having a history of heavy smoking. Heavy smoking is defined as a smoking history of 30 "pack years" or more. A "pack year" is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 30-pack-year history by smoking one pack a day for 30 years or two packs a day for 15 years.

*If you're on Medicare, the covered age range is 55 to 77 years old.

If you answered "no." Two of the criteria for lung cancer screening are being age 55 to 74* and having a history of heavy smoking. Heavy smoking is defined as a smoking history of 30 "pack years" or more. A "pack year" is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 30-pack-year history by smoking one pack a day for 30 years or two packs a day for 15 years.

If you don't have a history of heavy smoking, lung cancer screening may not be recommended.

*If you're on Medicare, the covered age range is 55 to 77 years old.

Are you a current smoker? If not, did you quit within the last 15 years?

If you answered "yes." Quitting smoking is even better than screening for reducing your risk of lung cancer. But if you still smoke or quit within the past 15 years, screening may be recommended.

If you answered "no." Quitting smoking is even better than screening for reducing your risk of lung cancer. If you never smoked or you successfully quit more than 15 years ago, lung cancer screening may not be recommended.

Have you discussed the benefits of screening with your doctor?

If you answered "yes." Great. But just to recap, if you are screened for lung cancer, you may have a decreased chance of dying from lung cancer.

People with the highest risk are the most likely to benefit from screening. For example, people who smoke more than one pack a day have a higher risk for lung cancer than people who quit 10 years ago.

If you answered "no." If you are screened for lung cancer, you may have a decreased chance of dying from lung cancer.

People with the highest risk are the most likely to benefit from screening. For example, people who smoke more than one pack a day have a higher risk for lung cancer than people who quit 10 years ago.

Are you aware of the potential harms of screening?

If you answered "yes." OK. But just to make sure, harms include false alarms and additional testing that may turn out to have been unnecessary. A false alarm occurs when a person has a positive screening test but doesn't actually have lung cancer. That can lead to other tests, such as a biopsy, which involves removing a small bit of lung tissue to test it for signs of cancer. An invasive procedure like a biopsy can have complications, such as a collapsed lung or an infection.

The risks of invasive procedures like biopsies may be greater if you have medical problems caused by heavy or long-term smoking.

If you answered "no." Potential harms include false alarms and additional testing that may turn out to have been unnecessary. A false alarm occurs when a person has a positive screening test but doesn't actually have lung cancer. That can lead to other tests, such as a biopsy, which involves removing a small bit of lung tissue to test it for signs of cancer. An invasive procedure like a biopsy can have complications, such as a collapsed lung or an infection.

The risks of invasive procedures like biopsies may be greater if you have medical problems caused by heavy or long-term smoking.

Are you willing and healthy enough to have surgery if lung cancer is detected?

If you answered "yes." OK. Lung cancer screening is not recommended for people who are not willing or able to undergo surgery to treat their lung cancer.

If you answered "no." Lung cancer screening is not recommended for people who are not willing or able to undergo surgery to treat their lung cancer. That's because the benefits would not be worth the risks of the screening.

Do you have any symptoms of lung cancer?

If you answered "yes." Signs and symptoms of lung cancer include:

  • A cough that doesn't go away or gets worse.
  • Chest pain that is often worse when you breathe deeply, cough or laugh.
  • A hoarse voice.
  • Unexplained weight loss and loss of appetite.
  • Coughing up blood or rust-colored spit or phlegm.
  • Shortness of breath.
  • Infections like bronchitis and pneumonia that won't go away or keep returning.
  • Wheezing.

If you have any of the above symptoms, talk to your doctor as soon as possible. Screening tests are meant to detect signs and symptoms of cancer before they become apparent.

If you answered "no." That's good. Screening tests are meant to detect signs and symptoms of cancer before they become apparent. But just to review, possible signs and symptoms of lung cancer include:

  • A cough that doesn't go away or gets worse.
  • Chest pain that is often worse when you breathe deeply, cough or laugh.
  • A hoarse voice.
  • Unexplained weight loss and loss of appetite.
  • Coughing up blood or rust-colored spit or phlegm.
  • Shortness of breath.
  • Infections like bronchitis and pneumonia that won't go away or keep returning.
  • Wheezing.

If you have any of the above symptoms, you should call your doctor's office as soon as possible.

Results

Talk with your doctor about your results, and be sure to ask any questions that came up in this assessment. Together, you can decide what the right next step is for you.

Sources: American Cancer Society; Medicare.gov; National Cancer Institute

Thoracic surgery involves the organs of the chest, but extends to the esophagus (tube between mouth and stomach), the trachea (airway) and the chest wall (rib cage and breastbone). Thoracic surgery works closely with oncology and pulmonology, as well as other specialties within the organization, to ensure that patients receive a high-quality, comprehensive approach to health-care, and the most optimal surgical treatment for patients with cancerous and non-cancerous thoracic (chest) conditions.

Thoracic surgery, also known as chest surgery, may be used to diagnose or repair lungs affected by cancer, trauma or pulmonary disease. For lung cancer, your surgeon may remove nodules, tumors and lymph nodes to diagnose, stage and treat the disease. Examples of other thoracic surgery include esophagostomies and removal of parts of the lung affected by cancer.

Schedule an appointment

Most patients require a referral to be seen at our surgery clinic.

For more information, please call 816.404.0099.

Learn how doctors look for signs of the disease.

Testing for lung cancer

When it comes to lung cancer, prevention is far and away the best medicine. But if this cancer does develop, an early, accurate and detailed diagnosis can help your doctor decide on the best approach for treatment.

If your doctor thinks you may have lung cancer, he or she will do several tests to find out for sure. If it is lung cancer, further testing can provide important information about what type of lung cancer it is and how far the disease has progressed.

According to the American Cancer Society (ACS) and the National Cancer Institute, tests used to diagnose lung cancer include:

Chest x-rays. This simple imaging test is often the first test a doctor recommends when lung cancer is suspected. If the x-ray image shows no unusual spots on the lungs, cancer is unlikely. If the image reveals an abnormality, the doctor may recommend more tests.

Computed tomography (CT) scans. These imaging tests use a special x-ray machine that rotates around the body. The images are sent to a computer, which creates a detailed image of internal organs. The test can reveal the size, shape and location of a tumor. It can also reveal enlarged lymph nodes or growths in other organs, signs that cancer cells may be spreading beyond the original tumor.

Magnetic resonance imaging (MRI) scans. MRIs produce more detailed images than CT scans, using powerful magnets, radio waves and computer processing. This test requires lying still inside a machine shaped like a tunnel, typically for 45 minutes to an hour. MRI scans are especially helpful for finding lung cancer that has spread to the brain or spinal cord.

Positron-emission tomography (PET) scans. PET scans are done with a special camera that picks up signals from radioactive substances. Before the test, a person swallows a form of sugar with radioactive atoms. The camera then creates images that show where the radioactive substance is collecting. Cancer cells absorb much more of the sugar than normal cells, so areas with a heavy concentration of radioactive substance are likely to be cancer.

Bone scans can reveal unusual cell growth inside bones. This test may be recommended if other tests or symptoms suggest that lung cancer may have spread into the bones. For this test, a small amount of radioactive material is injected into a vein and a scanner outside the body measures radioactive buildup in the bones, a sign of possible cancer.

A closer look

If imaging tests show something that could be cancer, other tests may be recommended to confirm it. These more definitive tests include:

Sputum cytology. A sample of mucus coughed up from the lungs is examined under a microscope to look for cancer cells.

Needle biopsy. In this test, doctors take a tissue sample from the lungs using a tiny needle and examine it under a microscope for signs of cancer.

Mediastinoscopy. This test checks a tissue sample from the lymph nodes for cancer cells. The sample is taken through a small cut in the neck, where a hollow, lighted tube is inserted behind the chest bone.

Bronchoscopy. This test uses a flexible, lighted tube passed through the mouth into the airways of the lungs to look for tumors or blockages. The same instrument can be used to take tissue or fluid samples that can be checked for cancer cells.

Blood tests to check for signs that cancer may have spread to the bone marrow or liver.

Bone marrow biopsy to check a sample of bone marrow for cancer cells. The sample is usually taken from the pelvic bone with a long, thin needle.

Endobronchial ultrasound or endoscopic esophageal ultrasound (EUS). These tests capture ultrasound images of the lungs and lymph nodes from inside the body, using a flexible, lighted tube fitted with ultrasound equipment. The tube is passed into the airways or the esophagus to get the imaging equipment as close as possible to the area being examined. These instruments can also be used to guide a needle to a lymph node to take a tissue sample that can be examined for signs that the cancer has spread beyond the lungs.

Thoracentesis or thoracoscopy to get information about the fluid that surrounds the lungs. A sample is drawn out with a needle and examined under a microscope.

Finding better ways

Many cases of lung cancer aren't found until they've been growing for some time, according to the ACS. This makes it more difficult to treat the cancer effectively.

When doctors find cancers early, they are often easier to treat. That's why the U.S. Preventive Services Task Force recommends that certain people at high risk of lung cancer be screened once a year for lung cancer. That includes people between ages 55 and 80 with a 30-year pack history who still smoke or who quit in the last 15 years. The test uses low-dose computed tomography.

Reviewed 6/5/2020