OSUCCC – James offers comprehensive screening for people at high risk for lung cancer. High-risk individuals include:

  • People between 55 and 80 years old who have a history of smoking the equivalent of two packs a day for 15 years or a pack a day for 30 years and who still smoke
  • Ex-smokers who quit within the past 15 years

Lung-cancer screening at the OSUCCC – James, which starts with low-dose computed tomography (CT), is more comprehensive than at nearly any other hospital or commercial laboratory in the United States.

Because we know that no lung cancer is ever routine, screenings at The James are highly detailed, looking for the greatest number of gene mutations and cell changes. Our team of lung cancer specialists, sub-specialists and super sub-specialists perform some of the world’s most advanced tumor sequencing (right on site at The James) by analyzing each patient’s tumor to identify the molecules and genes driving their particular lung cancer.

OSUCCC – James screenings in the state-of-the-art lung screening clinic also include a same-day consultation with a board-certified pulmonologist, same-day results, and if you would like, a certified smoking-cessation specialist as well.  


An accurate, complete diagnosis is essential for effectively treating lung cancer. Because there is no routine lung cancer, the OSUCCC – James’ world-renowned lung cancer subspecialists reach across multiple disciplines and modes of treatment, working together to offer patients the latest technologies and the most advanced procedures to understand lung cancer at the molecular and genetic levels — the levels that drive each patient’s specific kind of lung cancer.

Our team includes experts who specialize in lung cancer — and only lung cancer, 24/7 — studying, discovering, researching and treating each kind, and developing and delivering leading-edge therapies to stop it in its tracks.

Diagnostic Tests

When a patient first experiences lung cancer symptoms or has a positive screening result, one or more tests can help detect lung cancer and determine if it has spread. The first diagnostic tests ordered usually include:

Chest Radiographs

Using X-rays, a physician examines the lungs to look for abnormal areas.

Sputum Cytology

A pathologist uses a microscope to examine a sample of mucus or phlegm that the patient brings up by coughing.

An abnormal chest radiograph may lead to other tests to help physicians diagnose lung cancer. These tests may include:


A bronchoscope is a small, flexible tube with a tiny camera. A doctor inserts the bronchoscope through the nose or mouth and into the lungs while the patient is under light or general anesthesia. The physician also can use the bronchoscope to take a small tissue sample for biopsy.

Fine-Needle Aspiration

Also called trans-thoracic needle biopsy, this procedure involves placing a small needle through the chest and directly into the area of the lung that looks suspicious. The physician uses radiography or CT scanning to guide the needle into place and suction to remove a small amount of tissue to examine under a microscope.

Endobronchial Ultrasound

The physician uses ultrasound equipment to guide a biopsy (tissue sample) for lung cancer and to check for signs that the cancer may have spread to nearby lymph nodes.

Endoscopic Esophageal Ultrasound

An endoscopic esophageal ultrasound creates images of the stomach lining, esophagus and duodenum. A small, flexible tube is placed inside the esophagus, and high-frequency ultrasound waves create images that allow experts to examine any growths in the wall of the esophagus from the lungs or chest and also to examine lymph nodes in the chest.

Mediastinoscopy and Mediastinotomy

A mediastinoscopy is a surgical procedure to examine the space behind the breastbone in the middle of the chest (between the lungs). After the patient receives general anesthesia, the surgeon places something called a mediastinoscope through a small incision in the neck to take tissue samples from lymph nodes near the airways. With a mediastinotomy, the surgeon opens the space between the lungs, called the mediastinum. Both of these procedures are used to examine the lymph nodes near the chest.


A thoracentesis removes fluid from the space between the lungs and the interior chest wall, which is called the pleural space. The procedure involves placing a needle into the back of a patient’s chest wall through to the pleural space and collecting fluid, which then gets sent to the laboratory for analysis. When a patient has a lung disease, the space can fill with fluid and cause shortness of breath. Analyzing fluid from this space can help diagnose lung cancer.


In a thoracoscopy, a physician uses an endoscope (a small, flexible tube with a tiny camera on the end) to visually examine the lungs, pleura and mediastinum. The surgeon also can use the endoscope to remove a small sample of tissue for biopsy. Patients usually have general anesthesia for this procedure.

Diagnostic medical imaging exams might include the following:

  • Computed Tomography (CT) scanning, which use X-rays to capture cross-sectional images of the lungs
  • Magnetic Resonance Imaging (MRI) scans, which use powerful magnets to capture high-resolution images
  • Positron Emission Tomography (PET) scans, a nuclear medicine technology that finds spots of cancer activity in the body

Some of these imaging tests, such as CT and PET, might be used to see how well a patient’s lung cancer treatment is working.

Next-Generation Tumor Sequencing

At the OSUCCC – James, our leading-edge, treatment-planning approach begins with a genetic analysis of the tumor DNA, including something called “next-generation tumor sequencing,” and our experts perform this for every patient with advanced lung cancer.

This advanced technology pinpoints the genes that are actually driving the patient’s lung cancer, and our testing is among the most comprehensive available, testing for more genetic mutations and molecular changes than nearly any other hospital or commercial laboratory in the nation.

Additionally, detailed expert analysis enables our team of lung cancer sub-specialists to develop and deliver the most effective, targeted treatments for each patient’s unique lung cancer. In fact, our experts can often match patients to targeted treatments that are available only in clinical trials conducted at the OSUCCC – James.

Lung Cancer Staging

Lung cancer staging depends mainly on three things:

  • The size of the tumor
  • How much the tumor has invaded nearby normal tissues (such as the chest wall), and
  • Whether lung cancer cells have spread to lymph nodes or other parts of the body

Stages of Small Cell Lung Cancer

Most doctors describe small cell lung cancer in two stages:

Limited Stage

Cancer is found only on one side of the chest.

Extensive Stage

Cancer is found in the lung and also in tissues on the other side of the chest, in other organs or in fluid between the layers of pleura around the lungs and inside the chest.

Stages of Non-Small Cell Lung Cancer

Stages of non-small cell lung cancer are described using Roman numerals. Stage I is early-stage cancer, and stage IV is advanced cancer that has spread to other parts of the body, such as the bones.

Occult Stage

Tumor cells are found in sputum, but CT scans and other imaging tests don't show a lung tumor.

Stage 0

Abnormal cells are found only in the lung’s innermost lining. The tumor has not grown through this lining. A stage 0 tumor is also called carcinoma in situ. It is not an invasive cancer.

Stage IA

The lung tumor is no more than 3 centimeters across, and cancer cells have not moved into surrounding tissue or lymph nodes.

Stage IB

No lymph nodes have tumor cells. The tumor is more than 3 centimeters across or has grown into the bronchus or the pleura.

Lung Cancer Stage IA IB 

Stage IIA

The lung tumor is between 5 and 7 centimeters across, or cancer cells are found in nearby lymph nodes.

 Lung Cancer Stage IIA

Stage IIB

The tumor is more than 7 centimeters across or the cancer involves the chest wall, diaphragm, pleura, bronchus or tissue around the heart but not lymph nodes, or the tumor is between 5 and 7 centimeters across and cancer cells are in nearby lymph nodes.

Lung Cancer Stage IIB 

Stage IIIA

The tumor is any size, and lung cancer cells are found in the lymph nodes near the lungs and between the lungs, on the same side of the chest as the tumor.

Lung Cancer Stage IIIA 

Stage IIIB

The tumor is any size and lung cancer cells are found in the lymph nodes on the opposite side of the chest, and the tumor is in other nearby organs, such as the esophagus, heart or trachea, or tumors are found in more than one lobe of the same lung.

Lung Cancer Stage IIIB 

Stage IV

Malignant cells are found in both lungs, the fluid around the lungs or in other organs of the body, such as the brain, liver or bone.

Lung Cancer Stage IV 

If you have received a lung cancer diagnosis, or if you want a second opinion or just want to speak to a lung cancer specialist, we are here to help you. Call 800-293-5066 or 614-293-5066 to make an appointment.

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Patient Story

Patient Stories Jared Gordon

Jared Gordon

After tests revealed that Jared Gordon’s prolonged cold was in fact stage IV lung cancer, some doctors gave him only six months to live. Jared then turned to the OSUCCC – James for a second opinion.

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The James Cancer Hospital and Solove Research Institute

460 W. 10th Ave.

Columbus, Ohio 43210


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