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How We Diagnose Small Cell Lung Cancer

  • Most patients are referred to Dana-Farber Brigham Cancer Center by their general practitioner or another doctor because of symptoms or an abnormal chest X-ray. Some patients have already undergone diagnostic testing prior to coming to Dana-Farber Brigham Cancer Center, while others come for a second opinion, or to seek more treatment options than may be available elsewhere.

    Second Opinions

    Our diagnostic team provides second opinions, including for challenging or difficult cases. We are happy to consult with you, your primary care physician, or other specialists. Consider a second opinion for:

    • Confirmation of a diagnosis
    • An evaluation of an uncommon presentation
    • Details on the type and stage of cancer
    • Treatment options
    • Clinical trials

    Phone: 877-442-DFCI or 877-442-3324
    Online: Complete the Appointment Request Form
    If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service

    Diagnostic Testing

    A surgeon or medical oncologist will coordinate with a multidisciplinary team to determine which tests are necessary to diagnose and analyze your condition. The process of diagnosis may include a number of different procedures, including imaging and biopsy.

    All diagnostic scans are performed using a low-dose technique to minimize radiation exposure.


    X-ray of lungs

    Typically, patients have already had a chest X-ray before coming to Dana-Farber Brigham Cancer Center. That test may be repeated, or existing films may be viewed. In addition to an X-ray, your physician may recommend additional imaging. We use state-of-the-art imaging techniques, including:

    • Multidetector CT (Computerized Tomography) scan: A CT scan is often used as a follow-up to an X-ray, to provide more detailed images of your lungs and surrounding organs.
    • MRI (Magnetic Resonance Imaging): The MRI allows physicians to look for any invasion of a tumor into your chest wall, diaphragm, or other areas.
    • Nuclear imaging: Bone scans or positron emission tomography (PET) scans may be used to determine the presence of disease in the bones or elsewhere.


    Biopsy involves sampling a piece of tissue from a node or tumor for examination. In the case of small cell lung cancer, pathologists specializing in thoracic conditions conduct multiple tests on your tissue sample to determine the type and stage of the cancer. Sometimes, a biopsy is conducted without surgery; at other times, surgery is the best way to obtain a useful tissue specimen. A biopsy may be conducted using one of the following procedures:

    • Fine and core needle biopsies of the lung: A sample of tissue or fluid from the lung is obtained using a fine needle. CT or ultrasound imaging is used for exact guidance. A sample is taken with the needle and evaluated by a pathologist while the patient is in the CT suite to ensure there is adequate diagnostic tissue. The entire sample is then sent to cytology for definitive evaluation to identify the presence and type of cancer cells.
    • 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 also has a tool to remove tissue samples, which are checked under a microscope for signs of cancer. Learn more about bronchoscopy.
    • EBUS: Endobronchial ultrasound is a specialized technique that combines bronchoscopy with an ultrasound. This enables clinicians to visualize lymph nodes with high sensitivity, and allows a biopsy without an incision.
    • Navigational bronchoscopy: This new procedure creates a GPS-type guidance system combined with a bronchoscope to biopsy deeper and smaller spots in the lung.
    • Surgery: Depending on the location of your node or tumor, it may be necessary to surgically remove a tissue sample. One type of operation is mediastinoscopy. This is an out-patient procedure in which mediastinal lymph nodes in the center of the chest are removed and analyzed for tumor and genetic markers to guide therapy.

    Staging Small Cell Lung Cancer

    Magda Stumpfova, PhD, studies lung cancer cells.

    Diagnosis begins with determining whether or not a node or lump is cancer. The pathologist will then analyze the tissue to establish the type of cancer, and to what degree the cancer has spread.

    When a clinician "stages" cancer, he or she is determining its size, its extent, and to what degree it has spread (metastasized) outside its initial location. Typically, cancer stages range from stage 1 (very early and treatable) to stage 4 (advanced, metastasized, and more complex to treat).

    However, in small cell lung cancer, your doctor will often describe the stages as limited or extensive.

    Limited-Stage Small Cell Lung Cancer

    In limited-stage, cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only.

    Extensive-Stage Small Cell Lung Cancer

    In extensive-stage, cancer has spread outside of the lung in which it began or to other parts of the body.

    Depending on the stage of the cancer, patients meet with the appropriate combination of a surgical oncologist, medical oncologist, and radiation oncologist. Decisions regarding diagnosis and treatment are thoroughly reviewed by our entire team of clinicians. As a result, patients are guaranteed the broadest range of options, including clinical trials which may be ongoing in medical or radiation oncology.