Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. It accounts for about 80 to 85 percent of all lung cancer cases. Lung cancer occurs when tumors form in your lungs.

Though more common, NSCLC is typically less aggressive than small cell lung cancer (SCLC). Still, some forms of NSCLC can spread quickly to other parts of your body if untreated. Early diagnosis is key to improving your outlook.

Doctors usually use an X-ray to detect the disease. X-rays can find tumors and determine their size and location.

There is still a lot of information your doctor can learn from an X-ray, even if you need a range of other tests to confirm and stage NSCLC.

“A chest X-ray can’t tell you if you have lung cancer. It can provide important information to your doctor that can help determine if you need more tests.”

A chest X-ray can show where in your lungs the tumor is growing. It can also help determine the type of NSCLC. Common types of NSCLC include:

There are several features of the disease on a chest X-ray. These include:

  • Bronchial stenosis. Bronchial stenosis is a narrowing of the airways (bronchial tubes) that connect your lungs to your trachea. NSCLC tumor growth can sometimes cause bronchial stenosis. This is often an indicator of squamous cell carcinoma.
  • Decreased lung density. Decreased lung density can be a sign of lung cancer. But it can also be a sign of conditions such as pneumonia and respiratory distress.
  • Hilar mass. A hilar mass is a growth at the entrance to the lungs. It often indicates lung cancer but can be benign in some cases. When hilar masses are cancerous, they can make surgery more complex.
  • Solitary pulmonary nodule (SPN). An SPN appears as a round or oval spot on a chest X-ray. They’re often noncancerous but can also be an early sign of lung cancer.
  • Pleural effusion. Pleural effusion is a buildup of fluid in the space between the lungs. Pleural effusion may be due to inflammation, trauma, or other respiratory conditions. But when pleural effusion is present along with a lung tumor, it indicates that cancer cells have moved into the space between the lungs.
  • Non-resolving pneumonia. Non-resolving pneumonia is sometimes one of the first symptoms of lung cancer. This is common in a group of adenocarcinomas previously called bronchoalveolar carcinoma.
  • Metastasis. If cancer has metastasized, it has spread to other parts of the body. X-rays can show if tumors have spread to nearby structures like your lymph nodes. This can affect your outlook and surgical options.

While chest X-rays can provide useful information, they are also limited in several ways. A 2019 review found that chest X-rays miss 2 out of every 10 lung cancer cases. Reasons for this may include:

  • Image quality. Black and white X-ray images don’t have a very high resolution. It can sometimes be difficult for even a trained radiologist to detect subtle details.
  • Obstruction. Doctors can easily miss smaller tumors if bones or other body parts block them from view. A 2017 study suggested that chest X-rays miss 45 to 81 percent of cancers in the upper lobes of the lung, where the collarbone might block them.
  • Positioning. A lot depends on whether the X-ray technician positions you properly so that they can obtain the best quality image.

Other conditions may look similar to cancer on an X-ray. For example, a lung abscess may also appear as a light gray mass on an X-ray image.

If a chest X-ray detects cancer, staging is an important part of the diagnostic process. Staging is an indication of how much the cancer has spread. The stage of the cancer has an impact on your treatment and outlook.

“Chest X-rays don’t give enough information to stage your cancer The part of the process that involves scans is later.”

A chest X-ray is an outpatient procedure. You won’t need to stop taking any medications before the procedure, and you’ll be able to drive yourself to and from your appointment.

You need to undress from the waist up before your X-ray. You will receive a gown for the exam. You will need to remove jewelry.

You will stand between the machine and the plate that creates the images. The X-ray technician will ask you to move around so the machine can see different parts of your body.

The technician will help you get into the right positions so the machine can take pictures. They might ask you to make small movements, such as raising your arms, rolling your shoulders, or taking a deep breath.

“X-rays are painless. You won’t feel the machine taking pictures.”

“If you can’t stand or complete the movements, you can lie down. Talk to your doctor before the X-ray if you are concerned about standing. They might be able to point you to a facility that has mobility accommodations.”

Once the results of your chest X-ray are available, your doctor will contact you. They will let you know the results and discuss the next steps. You could either wait for the results of other tests you have already had or schedule more tests.

The chest X-rays are safe. The process will expose you to a small amount of radiation, but it is not enough to affect your health. If you have regular chest X-rays, you can wear a protective apron during the procedure to protect yourself from radiation.

“It is important to let your doctor and X-ray technician know you are pregnant. The technician will make sure your stomach isn’t exposed to radiation if you have a chest X-ray.”

Non-small cell lung cancer can be diagnosed with an X-ray. You will have a range of other tests to confirm the diagnosis, including reviewing your medical history and smoking habits.

Lung cancer can be diagnosed with common tests.

  • CT scan. A CT scan produces detailed 3-dimensional images that allow doctors to look closely at tumors. Sometimes, a dye, given by injection or orally, can highlight tumors and other abnormalities.
  • PET scan. Doctors may request a PET scan at the same time as a CT scan. Before a PET scan, you’ll have an injection of a form of sugar that is mildly radioactive, and that will collect in cancer cells. This can help highlight areas cancer might have spread.
  • MRI. An MRI uses magnetic fields to produce detailed images of the inside of your body. Doctors often use it to see if lung cancer has spread into your bones.
  • Sputum cytology. Sputum cytology examines the mucus you cough up. You’ll collect samples three mornings in a row and submit them to a lab for testing.
  • Biopsy. A biopsy removes a small amount of tissue for examination under a microscope. This can help determine the subtype of NSCLC. Biopsies could be a surgical procedure, or they may involve a specialized needle to remove a sample of the tumor.
  • Bronchoscopy. Bronchoscopy uses a long, thin, tube inserted down your airway and into your lungs. A light on the end of the tube allows doctors to see inside your lungs. They can also collect samples of fluids and tissues for testing.
  • Thoracentesis. Thoracentesis is a procedure that collects fluid from the space in between the lungs. It uses a long needle inserted into the wall of your chest. The fluid is then analyzed and checked for cancer cells in a lab.

“Lung cancer diagnostic procedures include a chest X-ray. An X-ray can provide useful information about a diagnosis, but it can’t confirm it on its own. It can show the location of a tumor.”

A chest X-ray can help your doctor decide on treatment options. You will need other tests to confirm the findings, but a chest X-ray is the first step.

Early diagnosis is the key to improving your outlook with NSCLC. The 5-year survival rate for localized NSCLC is 8 times higher than it is if your cancer has spread.

If you’re at high risk for NSCLC, talk with your doctor about yearly screening with a chest X-ray and low dose CT scan.