An X-ray can help healthcare professionals find non-small cell lung cancer tumors and gain a deeper understanding of them. The healthcare team will also need other imaging and tests for a complete diagnosis.

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. It accounts for about 80% to 85% 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.

An X-ray is usually the first test when medical professionals consider NSCLC. X-rays can find tumors and determine their size, location, and other important characteristics.

While you’ll need a range of other tests to confirm and stage NSCLC, there’s still a lot of information your healthcare professional can learn from an X-ray.

A chest X-ray can’t diagnose NSCLC. However, it can provide important information that your healthcare team can use to determine whether you need more tests.

An X-ray can show an unusual mass, its location, and whether the cancer might have spread to nearby areas. If lung cancer is suspected, then other tests, such as a CT scan, PET scan, or biopsy, will be necessary to confirm the diagnosis and identify the specific type of NSCLC.

Common types of NSCLC include:

Healthcare professionals may see several irregular findings associated with NSCLC on a chest X-ray. These include:

  • Bronchial stenosis: Bronchial stenosis is a narrowing of the airways (bronchial tubes) that connect the lungs to the 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 may indicate whether 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 2023 study found that chest X-rays miss approximately 90% of lung cancers. Reasons for this may include:

  • Image quality: Black and white X-ray images are not very high resolution, and it can sometimes be difficult to detect subtle details.
  • Obstruction: Bones or other body parts can sometimes block smaller tumors, making them difficult to see.
  • Positioning: A lot depends on whether the X-ray technician positions you correctly so 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 shows an unusual mass, 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 alone can’t show the stage of cancer. For that, healthcare professionals usually use more detailed testing, including CT, PET, MRI scans, and biopsies.

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.

Before your X-ray, you’ll need to undress from the waist up. You’ll receive an exam gown to wear. You’ll also need to remove any jewelry.

You’ll stand between the X-ray machine and the plate that creates the images during your X-ray procedure. The X-ray technician will ask you to move into different positions throughout the procedure so the machine can capture different views of your chest.

The technician will help you get into different positions so the machine can capture images of the sides and front of your chest. They might also ask you to make slight movements, such as raising your arms, rolling your shoulders, or taking a deep breath and holding it.

X-rays are usually quick and painless. You won’t feel the X-ray machine taking images.

If you’re unable to stand or complete the movements, you may be able to sit or lie flat. If you’re concerned about standing during the X-ray, talk with your healthcare professional ahead of time. They might be able to direct you to a facility with mobility accommodations.

A member of your healthcare team will contact you once the results of your chest X-ray are ready. They’ll let you know the results and discuss the next steps. This might involve scheduling more tests or waiting for the results of other tests you’ve already had.

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’re pregnant, it is important to let your healthcare professional and the X-ray technician know. You can still have a chest X-ray, but the technician will take steps to ensure your stomach isn’t exposed to radiation.

An X-ray alone isn’t enough to diagnose non-small cell lung cancer. In addition to reviewing your complete medical history and smoking habits, you’ll have a range of other tests to confirm the diagnosis.

Common tests to diagnose lung cancer include:

  • CT scan: A CT scan produces detailed 3-dimensional images that allow for a closer look at tumors. With the help of a contrast dye (usually given intravenously), it can show the size, shape, and location of tumors more clearly than an X-ray.
  • PET scan: Your healthcare team may request a PET scan at the same time as a CT scan. Before a PET scan, you’ll have an injection of a special dye containing a mildly radioactive tracer that can help highlight areas where cancer might have spread.
  • MRI: An MRI uses magnetic fields to produce detailed images of the inside of your body. Healthcare teams often use them to check whether lung cancer has spread into the 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 at the end of the tube makes seeing inside your lungs possible. They can also collect samples of fluids and tissues for testing.
  • Thoracentesis: Thoracentesis is a procedure that collects fluid from the space 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.

A chest X-ray is an important part of the lung cancer diagnostic process. An X-ray cannot confirm a diagnosis on its own, but it can provide useful information about what other tests are needed to make an NSCLC diagnosis.

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