NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

19 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 2 Assessing lung nodules Confirming cancer Confirming cancer Tissue or fluid must be removed from your body and be tested to confirm (diagnose) cancer. There is no single plan for diagnosis that is best for all people. Your plan will depend on the tumor’s size, where cancer might be in your body, your health, and the experience of your doctors. Choice of method For lung cancers, biopsy and surgery are two methods that doctors use to remove tissue or fluid. Some people have a choice between the two methods. When deciding between methods, doctors should think about 1) how strongly they think there’s cancer; 2) where the cancer is in your body; and 3) what method you prefer. There is more than one type of biopsy and surgery to diagnose lung cancer. They are briefly described next by broad groups. Read Part 4 for more details. Which type you will have depends partly on where the cancer is. † † External needle biopsies involve inserting a needle through your chest wall. The needle is guided to the site with an imaging test like CT. These biopsies include TTNA ( t rans t horacic n eedle a spiration), core needle biopsies, and thoracentesis. † † Down-the-throat biopsies involve guiding tools down your throat into your windpipe or esophagus. Samples may be removed by needle, brush, tongs, or liquid. These biopsies include bronchoscopy and EUS ( e ndoscopic u ltra s ound)-guided biopsies. † † Phlegm biopsy requires that you cough up some mucus (phlegm). The phlegm will be tested for cancer cells. This may be the easiest way to test for cancer, but you’ll likely have another biopsy or surgery. More tissue is needed for the cancer tests discussed in Part 4. † † Portal surgeries involve cutting small holes (ports) into your chest. Small tools are inserted through the ports to remove tissue. Compared to open surgery, this technique is “minimally invasive.” These surgeries include thoracoscopy and mediastinoscopy. † † Open surgery involves making a large cut between your ribs to spread them farther apart. The whole nodule is removed by your doctor with a surgical knife. You may have open surgery when other methods won’t work or a larger piece of tissue is needed. Choice of timing Another choice you may have is when to confirm whether there’s cancer. Diagnosis may occur before or at the time of surgical treatment. There may be no need to have a biopsy before treatment if your doctors strongly think a nodule is cancer. A biopsy done beforehand would increase health risks, time spent, and costs. If confirmed at the time of surgery, tissue can be removed by biopsy or excision. More lung tissue may be removed if cancer is present. A biopsy before treatment may be done if diagnosis during surgery would be hard or risky. Likewise, FNA ( f ine- n eedle a spiration) or core needle biopsy before treatment may be done if the cancer may not be lung cancer. An FNA removes a small group of cells with a thin needle and a core needle biopsy removes a solid tissue sample with a needle. A biopsy before treatment is also needed if you will receive treatment other than surgery.