Testing for Lung Cancer

Someone asked me about testing for lung cancer, so I thought I would address that quickly. First and foremost, when talking about medical stuff, I have to say that I am not a licensed respiratory therapist in Kentucky at this time (but will be within a couple of months), and am currently licensed in the state of Ohio, as that is the last place I worked. Regardless of where I am, or am not, licensed, I have to say that I have to act under my profession's standards, one of which is that I am not allowed to practice medicine without a physician over me. So with that in mind, I have to say, your physician is the best person to talk to if you have medical concerns. I can tell you what I know of certain things, but for a proper diagnosis and treatment, you need to speak with a physician.

With that in mind, I know a little about lung cancer because it is how my father died. Believe me, between my experience as a respiratory therapist, my education, and taking care of my father, I could easily write a book about it. Very basically, though, cancers are cells that have, for one reason or another, grown out of control. There are many different types, but they are generally classified as small cell or non-small cell cancers. This covers cancers that affect the alveolar sac, the bronchials and the tissue. 

One of the insidious things about lung cancer is that there are no nerve endings in the lung tissue itself, so that you can have a tumor there the size of a grapefruit, and it won't hurt. Common symptoms prior to diagnosis of cancer are shoulder pain, a sensation of something pulling,  deviation in your trachea (your trachea moving to the right or left instead of running down the center), increased shortness of breath (due to decreased lung capacity), and coughing, either productive (including blood) or non-productive. The symptom that my father initially presented with was shoulder pain, which was misdiagnosed as "Uncle Arthur" (arthritis). 

Lung cancer, at least, causes you to lose a lot of weight, really fast.

Here we get into the practice of medicine vs. the reimbursement machine. Health insurance, medicare, medicaid, etc., wants a diagnosis before they will reimburse for a procedure. It's better to go to your doctor looking for a specific procedure and the reason for it instead of with just a bunch of vague symptoms. So if you were concerned about lung cancer, the very first thing I would tell my doctor is, I have this particular symptom, and I'm concerned about lung cancer because (history of smoking, family history or whatever), and I would like a chest x-ray, (which may or may not pick it up, but still, it's the first step). Hopefully you have a good doctor that you can be truthful with and say this.  And he, or she, will do a few procedural things in the office and then let you get an x-ray. If you don't have a good doctor, you can always go to an urgent treatment center, and complain of coughing or something to do with your lungs. They will almost always do a chest x-ray for you. 

Here is the kicker, though. The doctors will look at the x-ray, but there are professional radiologists who also do a reading, and this reading is a lot more involved than the cursory reading you would get at a doctor's office, or the UTC. It is your right, as a patient, to get a copy of that x-ray, and to get a copy of the radiologist's reading, and I would definitely do that. 

I will probably write more about being a smart patient at a later time, but that is the point I would like to make now. So, to answer the question, I would first get a chest x-ray, then get the radiologist's reading, and based on that talk with your doctor. If you don't have a good one, get one. If there is anything to be seen on the x-ray, then you would do the next step, which would be to get a cat scan or MRI. Then if there is something, a biopsy. 

Try to find a doctor who expects you to be a savvy patient. This is so important. Doctors are not gods, even though they are treated like they are. Just because they are a doctor, and maybe even an excellent doctor, if you can't be up front, honest and direct with them, then maybe they are not the doctor for you. It's your job to be critical of them, because it's your life you're putting in their hands. When I was going through respiratory school, someone once asked me, what do you call a med student who has graduated with low C grades? The answer, of course, was "Doctor." So be a critical consumer when dealing with medical issues. Access to your medical information is your right, and it would be better for you if you dealt with people who understood and respected that.