The number one warning sign of lung cancer is coughing up blood (hemoptysis).
There are other significant warning signs of lung cancer. The physician will exam the patient's armpits (axillas) and neck for swelling and inflammation, which can be caused by enlarged lymph nodes. Enlarged lymph nodes are often caused by lung cancer. The physician will also listen to the patient's breathing sounds for abnormalities, such as rales or wheezing, which may be caused by lung cancer. Enlarged lymph nodes in the armpits and neck and abnormal breathing sounds, when combined with hemoptysis, are strongly associated with lung cancer.
When the physician suspects lung cancer, the patient's "social history" is crucial and with lung cancer, the focus is upon the patient's past history of smoking. The physician must find out whether the patient smokes or has a past history of smoking and the quantity of cigarettes or cigars smoked on a daily, weekly, or monthly basis. Studies show that 93% of all cases of lung cancer are caused by smoking. The physician's index of suspicion for lung cancer does up dramatically with a social history of smoking.
How does the physician rule out lung cancer? A chest x-ray is one way, but the best imaging study for lung cancer is a CAT scan of the chest. A chest x-ray is a single photograph or image of the lung, while a CAT (computerized axial tomography) is a series of roughly 100 images of the lungs that shows all five lobes of the lungs(three lobes on the right side of the body and two lobes on the left side) in extraordinary detail. Each CT image shows a 5 millimeter section of the lung (this is almost microscopic). A chest CT scan is the best way to rule out lung cancer as an initial step when a patient has new signs and symptoms that can be associated with lung cancer.
If the CT scan of the chest shows evidence of lung cancer, then the next step is bronchoscopy where the inside of the lung is viewed by the physician and biopsy samples of the inner tissues of the lungs can be taken. A bronchoscopy with biopsy is a definitive way to confirm lung cancer.
Early diagnosis of lung cancer is critically important to the patient's five year survival rate. You should insist that your physician order a CT scan of the chest if you have any of the signs or symptoms of lung cancer and if there are any areas of concern on the CT scan, then you should insist upon a bronchoscopy.
If you have the signs and symptoms of lung cancer, and the physician fails to take the steps listed above to rule out lung cancer, the doctor has not complied with the standard of care and you may have a case.