Introduction
Lung cancer is one of the leading causes of cancer-related deaths worldwide. According to estimates, about 235,000 new cases of lung cancer are diagnosed and over 142,000 deaths occur due to lung cancer in the United States every year. The majority of lung cancers are found at an advanced stage when the chances of cure are low. Early detection and diagnosis of lung cancer is critical to improve patient outcomes and survival. This article discusses the importance of lung cancer screening and various diagnostic tests and methods used to detect lung cancer at an early stage.

Symptoms
Some common symptoms of Lung Cancer Diagnostic include a cough that doesn't go away, coughing up blood, shortness of breath, chest pain, hoarseness, loss of appetite and unexplained weight loss. However, these symptoms may not appear until the cancer has advanced to an advanced stage. That is why screening high risk individuals is important even in the absence of symptoms. Not every person with lung cancer experiences symptoms, and symptoms may be vague. It is important to see a doctor if any new symptoms appear, especially if you are at a high risk for lung cancer.

Risk Factors
Smoking tobacco is the leading cause of lung cancer. Other risk factors include exposure to secondhand smoke, radon gas, air pollution, a family history of lung cancer and prior treatment with radiation therapy to the chest. Certain immunodeficiency conditions like HIV/AIDS also increases the risk of lung cancer. People with a history of smoking more than 30 pack years (one pack a day for 30 years) are considered to be at high risk.

Screening Tests
Low-dose CT (LDCT) scans are currently recommended by major health organisations as the primary screening test for lung cancer in high risk individuals. Annual LDCT screening has been shown to reduce lung cancer mortality by 20% in comparison to chest X-rays. LDCT scans are able to detect small lung nodules even before any symptoms appear. Any suspicious nodules detected on screening can then be further evaluated. Major guidelines recommend annual screening LDCT scans for current or former smokers aged 55-80 years with at least 30 pack-year history of smoking.

Diagnostic Tests
If lung cancer is suspected based on symptoms, screening tests or physical examination findings, further diagnostic tests are required for confirmation and staging. This involves tests like chest x-ray, CT scans, PET scans, MRI, endobronchial ultrasound-guided needle aspiration (EBUS) and surgical lung biopsy. Chest x-ray may show an abnormal shadow or mass. A CT scan provides detailed images of the lungs and lymph nodes. PET scan helps identify if the cancer has spread beyond the lungs based on tissue metabolic activity. MRI provides excellent soft tissue contrast. Procedures like EBUS and bronchoscopy help obtain tissue samples from suspicious spots in the lungs and lymph nodes for biopsy and diagnosis. Based on these tests, the type, stage and grade of lung cancer can be determined which helps plan the most suitable treatment.

Staging
Staging is important to understand the extent or spread of lung cancer and plan an appropriate treatment strategy. The most commonly used system for lung cancer staging is the TNM (tumor, node, metastasis) system of the American Joint Committee on Cancer (AJCC). Under this system, the size and extent of the primary lung tumor is evaluated (T stage), whether the cancer has spread to lymph nodes nearby (N stage) and presence of distant metastases (M stage). Based on the T, N and M scores, lung cancers are grouped into stage I to stage IV, with stage I being localized and stage IV being widespread disease. Accurate staging allows oncologists to predict prognosis and compare treatment outcomes.

Types of Lung Cancer
There are two main types of lung cancers - small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC is more common accounting for about 85% of all lung cancers. The three major subtypes of NSCLC are adenocarcinoma, squamous cell carcinoma and large cell carcinoma. NSCLC usually forms a tumor or mass, whereas SCLC tends to spread rapidly and form in both lungs. SCLC grows quickly and has a worse prognosis compared to NSCLC. Diagnostic tests help determine if the lung cancer is SCLC or NSCLC and the specific histologic subtype, which guides treatment decisions.

In conclusion, lung cancer remains a significant healthcare challenge. Early detection through screening at-risk individuals, prompt diagnostic evaluation of symptoms, accurate disease staging and classification help achieve better outcomes in lung cancer. Tobacco control measures must also continue to prevent lung cancer by discouraging smoking initiation and promoting cessation. With increasing screening rates and development of newer targeted and genomic-based therapies, lung cancer mortality is slowly decreasing in the developed world. However, a lot more needs to be done especially in low and middle-income countries where most lung cancer deaths now occur.

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