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An irregularity on an X-ray may make you think that a diagnosis of cancer is imminent but there is more to it. There are specific characteristics and markers that can point to one form of cancer to another or may even suggest cancer is not likely at all.

When you come into a medical office and hear the further testing is necessary, that can already start to build the tension in the room. The tension only worsens when you do not hear from your doctor that the preliminary chest X-ray looks good. Although it is not the best diagnostic tool that we have in our arsenal in order to make a diagnosis of lung cancer, any suspicious densities on the lungs that we see on an X-ray needs to be worked up for cancer. In this article, we will explore some of the warning signs of lung cancer and how the lesions for lung cancer will look like on an X-ray. 

The Use of an X-ray 

As I have already alluded to, an X-ray is not the most accurate investigation to use when you are trying to make a diagnosis of lung cancer, but it is the safest, quickest and can help guide subsequent investigations [1]. If you are like most patients, there is probably a time in your life when you were quite worried about your health and wanted to have a full-body screening test in order to make sure you are healthy. Even if the logic behind why you would want to do this is sound, the unfortunate thing is that if you have test after test, there is a strong likelihood that something irregular will appear. Another fact that you may not realize is that not only will you increase your stress worrying about an irregularity, but you are also putting yourself at risk for some serious health risks. 

CT scans are a great tool to use to get a full picture of what is happening but there is a substantial amount of radiation that patients experience when they are waiting for the test to finish. That is why it is in your best interest not to have the test unless you see that there is an irregularity on quickest and least dangerous test for the patient. [2]

What Will a Suspicious Lesion for Lung Cancer Look Like? 

When a radiologist is looking at your Chest X-ray, the first thing that he will want to look for is signs of malignancy. The key to this is determining if there are any calcifications on the X-ray. A calcification usually is a sign that the lesion you are seeing on the screen in not cancerous and probably caused by some type of infection [3]. This is much easier said than done, however. In one study determining how well a radiologist was able to identify calcifications on an X-ray, 35 experts were asked to review X-rays where the final diagnosis was unknown to them and make an interpretation of what they see. It was determined that the radiologists had difficulty determining if calcifications were present and even 7 percent of cases were falsely identified as benign when in reality, they were cancerous. This point is not to ridicule a radiologist — they are some of the smartest people in the hospital. My aim is to show that it is very difficult to make this diagnosis alone on a chest X-ray and you will need to have a CT scan in order to make a proper diagnosis. [4]

What can make suspicious densities on the lungs more suggestive of lung cancer would also be pleural effusion. This is a collection of fluid that will be most seen at the bottom of the lung that has the mass. It is not a guarantee that a mass and pleural effusion will also suggest lung cancer but you will need to have not only a CT scan but also a biopsy in order to determine if that is the case. [5]

Lesions of Various Types of Lung Cancer 

Even if you know lung cancer may be dangerous, what you may not realize is there are many types of lung cancer; some more dangerous than others.

  • Small cell carcinomas are the most dangerous type of lung cancer and are most likely associated with smoking.
  • Large cell carcinomas, on the other hand, have better prognoses compared to small cell carcinomas and they are not as likely seen with smokers. Large cell carcinomas also have lesions for lung cancer that are more obvious for lung cancer on X-ray. [6]

These large cell carcinomas are also more likely to have caveated lesions. This is an occurrence that happens when a tumor mass collapses on itself and leads to this strange formation. If the tumor is too large, there is also a very good chance that the entire lobe of the lung can collapse. This will lead to a very characteristic sign called the "Golden S" sign. This is the pattern seen when the upper lobe of the lung collapses on itself. It is also highly likely that the patient will have lung cancer if they have the "Golden S" sign. [7]

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