Physical Exam Findings Before a Lung Cancer Diagnosis

Lung cancer is the number one cause of cancer death in the United States, taking more than 130,000 lives in 2021. Someone is diagnosed with lung cancer every two and a half minutes, roughly 646 people per day.

The symptoms of lung cancer—cough, shortness of breath, hemoptysis, pallor, and fatigue —are often insidious and non-specific, so they are easily confused with other medical conditions.

This article discusses the variety of tests used to make a diagnosis. It explains who should be screened for lung cancer and what to expect after testing is complete.

Initial Assessment of Lung Cancer (With Your Healthcare Provider)

Lung cancer is often insidious—producing no symptoms until the disease is in its advanced stages. This underscores the importance of routine check-ins with a healthcare provider, especially if you are at high risk.

You are considered at high risk of lung cancer if you are:

• A current smoker
• Have a non-smoking family member who developed lung disease
• Work a job that requires you to work with toxic chemicals

Physical Exam

The first steps in investigating abnormal symptoms are:

• Take a detailed medical history
• Perform a focused physical exam, listening to the heart and lungs for decreased or absent breath sounds and wheezing and crackling

On observation, your healthcare provider may note:

• Fullness in the head
• More prominent neck veins
• Veiny patterns on the face and neck
  

Vitals 

Low blood pressure and oxygen saturation (O2 Sat) levels are common in those with lung cancer.

An increased breathing rate (tachypnea) and an increased heart rate (tachycardia) may also be observed, but these signs are non-specific and, therefore, less meaningful in diagnosing lung cancer.

Chest X-Ray (CXR)

A chest X-ray is usually the first imaging modality that is ordered if there is any suspicion of lung cancer because it is quick and inexpensive to do. It is a painless scan that uses radiation to show tumors. CXRs usually pick up masses that are one centimeter wide or larger.

Chest Computerized Tomography (CT)

CT scans are an imaging technique that uses low-radiation X-ray beams to take pictures of the inside of your body. It is particularly helpful in diagnosing lung cancer because it can detect smaller lung cancers and provide more details than a CXR.

Pulmonary Function Tests (PFT)

Also known as lung function tests and spirometry, PFTs are a series of tests that assess lung function by measuring how much air the lungs can hold and how quickly the lungs can be filled with air and then emptied.

Blood Tests

A blood sample may be tested to check the number of red blood cells, white blood cells, and platelets (complete blood count) and to see how well your kidneys and liver are working.

Lung cancer can throw off these numbers, so comparing your baseline numbers to your current numbers can help provide details on potential changes resulting from your lung cancer.

Bronchoscopy

A bronchoscopy is a specialized procedure where a healthcare provider places a scope with a built-in camera through a sedated person’s mouth, down the airway, and into the lungs to examine the lung tissue.

Lung masses with increased vascularization, irregular shape, or a hard, immovable nodule are concerning and will usually prompt your healthcare provider to remove a piece of tissue for biopsy.

Biopsy

A biopsy involves extracting a piece of tissue from the lung and then examining it under a microscope.

If your oncologist identifies tissue that looks concerning, they will send a piece of the tissue to a pathologist for examination. A biopsy is not only important for diagnosis but also staging and functional evaluation, all of which affect treatment planning and determination of prognosis.

Confirming Your Diagnosis 

In order to confirm your diagnosis, the below tests and procedures may occur.

Scans and X-Rays

Repeat CT scans and X-rays may be performed semi-routinely throughout the course of your treatment.

Positron emission tomography (PET) is a commonly used imaging modality that is used with CT to confirm the diagnosis of lung cancer and assess how your lung cancer is responding to treatment.

PET involves injecting a small amount of radioactive tracer, usually fluorodeoxyglucose (FDG), into a person's bloodstream. The body takes up the radiotracer and is taken up by the body like glucose. Active cancer cells will take up the glucose-like radiotracer giving off a red-orange color on the PET scanner, like simple sugar glucose.

A PET Scan is especially useful for restaging lung cancer following treatment and providing additional information on the histology of your lung cancer.

Biopsy

A biopsy is used to examine lung tissue for the presence of cancer cells. This can be done by taking a piece of tissue via bronchoscopy, fine need aspiration, or surgical incision.

Sometimes a repeat biopsy may be used to confirm a suspicion of lung cancer if the diagnosis is unclear. 

Who Treats Lung Cancer?

A pulmonologist is a healthcare provider specializing in treating lung diseases.

A pulmonary oncologist specifically specializes in the treatment of lung cancer.

Your care team may also include:

• A thoracic surgeon (if removal of your lung cancer is indicated)
• A medical oncologist who will prescribe chemotherapy
• A radiation oncologist who uses radiation to eliminate cancer cells

Nurses, nurse practitioners, and physician’s assistants support these healthcare providers. 

What to Expect From Your Lung Cancer Care Team 

There is no one-size-fits-all approach to cancer treatment.

Comprehensive treatment of your lung cancer will require seeing multiple specialists and other healthcare providers, including:

• Primary healthcare provider
• Pulmonary, medical, and radiation oncologists
• Nurses and physician’s assistants who specialize in lung cancer
• Pulmonologist
• Thoracic surgeon
• Psychologist

Input from a team of healthcare providers is often needed to develop an effective, detailed, and personalized treatment plan.

Shared decision-making is key to achieving patient-centered health care. This process, involving collaborative decision-making between clinicians and individuals, is the best way to meet your health goals.

It’s also important to remember that while you have the final say on your treatment options, shared decision-making means that you don’t have to make crucial decisions alone and increases the likelihood that you will stick to your treatment plan even if you have setbacks. 

Summary

A detailed physical exam is the first step in determining lung cancer diagnosis. Lung cancer may present with little to no symptoms, or non-specific symptoms such as cough, shortness of breath, hemoptysis, pallor, and fatigue. 

A Word From Verywell

The physical exam is one of the initial methods used to diagnose lung cancer. Even an experienced healthcare provider will need to use additional modalities like imaging, blood tests, and taking a detailed medical history to make a diagnosis. After diagnosis, your primary healthcare provider will help coordinate care from a multidisciplinary team of specialists who will help you develop a personalized treatment plan that is best for you.