Unfortunately, most lung cancers first detected by plain chest x-ray have progressed to a stage which is not curable by surgery. The chest CT is more sensitive than the plain radiograph and should be considered in any suspicious circumstance. Bronchoscopy, is of course, a standard diagnostic tool for lung cancer. Referral to a pulmonary specialist for the early diagnosis of lung cancer makes good sense. Some modern developments include the use of hematoporphyrin compounds, plus laser light-assisted bronchoscopy for diagnosis of very early endobronchial lung cancers.
Many lung cancers have brain metastasis at the time of diagnosis.
The most sensitive tool in this case is a MRI with gadolinium enhancement. Since therapy of lung cancer that has metastasized beyond curability by surgery alone almost always involves a medical oncologist, it is probably better to make the referral to him prior to further expensive diagnostic testing. Attention should be paid to more unusual presentations of lung cancer such as those where the symptoms are only a complaint of hoarseness or shoulder pain. Any symptom described by the patient which is not immediately explainable by known physical phenomena should be heard with a concern of cancer. Any suspected involvement of lung cancer should be referred to a medical oncologist.