How lung cancer is diagnosed
Usually, the first thing you do it see your GP, who will examine you. You may have to have blood tests done to check the overall state of your health. If your GP is unsure of what the problem is or if they believe it may be cancer, they will send you to a hospital for specialist treatment and advice.
Your specialist will ask you about your overall health and prior medical problems and will examine you. You may have to have blood work and x-rays to check on your overall health.
- Chest x-ray
You will have a chest X-ray done right from the start to examine your lungs for any abnormalities.
- CT (computed tomography)
A CT takes a series of x-rays, creating a 3-D image of the inside of the body. It takes from 5-15 minutes and is painless. A small amount of radiation is used, though it is very unlikely to cause you any harm. You will be asked to refrain from eating and drinking for at least an hour before the procedure.
You may be given a drink or an injection with a dye, which makes it possible to see certain areas more clearly. This may make you feel hot for a few minutes. It is important that you inform your health professionals if you are allergic to iodine or have asthma, as you may have a reaction to the injection.
A CT scan can also be given to help guide a biopsy, which involves taking tissue to be examined under a microscope.
Sometimes, a special kind of CT scan called a PET scan is performed when just a small area of the lung appears to be abnormal.
A bronchoscopy is a test in which a doctor looks at the inside of the airway (bronchi) and the lungs. A tube called a bronchoscope is used in this procedure, which is carried out while the patient is under local anesthesia. During a bronchoscopy, your doctor may take samples of cells (biopsies) of your lungs or airway.
Endoscopic procedures like this one are normally done in the hospital on an outpatient basis. You will be asked to refrain from eating and drinking for at least four hours before the procedure, and you will be given instructions about the medication you may be taking.
A local anesthetic administered as an aerosol spray may be used on the back part of the throat, or you may be given a sedative to limit your discomfort; sedatives are normally injected into a vein in the arm. In some cases, both methods are used.
An endoscopy can be uncomfortable, though it shouldn't be painful. Tell your doctor if you have chest pain during or after the procedure.
If you have been given a local anesthetic, you will have to stay in the hospital until the effect has worn off; this normally takes about an hour. You will not be able to swallow anything during this time.
Some people have a sore throat afterwards. This is normal and gets better in a couple of days. Tell your doctor if this isn't the case.
- Lung biopsy
You will first be given a local anesthetic to reduce the discomfort in the area. Your doctor will ask you to hold your breath for a few seconds while they pass a fine needle through the skin and lung. Using an X-ray image or CT scan, doctors ensure that the needle is in the correct place and then they take a sample of tumor cells so that the cells may be examined under a microscope to see if they shows signs of cancer.
Biopsy can be uncomfortable, though it only takes a few minutes.
One complication of lung biopsy can happen when air is let into the space between the layers that cover the lungs (collapsed lung). This is why you may have to stay in the hospital for a few hours after the biopsy is taken to ensure that there are no problems. Let your doctor or nurse know if you feel any pressure or acute pain in your chest or feel out of breath.
- Fine-need aspiration of the lymph nodes of the neck
Some people may have a sample of cells taken from the lymph nodes of their neck. A local anesthetic is given in the first place. Then, the doctor inserts a very fine needle in the lymph node to take a sample of the cells; this sample will later be examined under a microscope to detect cancer cells.
This test allows the doctor to observe the mediastinum and the surrounding lymph nodes, as these are the areas lung cancer may spread to.
This procedure is per under general anesthesia during a short stay in the hospital.
The surgeon makes a small incision in the skin at the base of the neck and inserts a small tube in the chest. The tube has a light and a camera on its end, making it possible for them to see any abnormal areas and then take tissue samples from the lymph nodes in these areas.
This lets your doctor see the pleura and other structures that surround the lungs. The surgeon makes a small incision in the thoracic wall and inserts a tube called a thoracoscope (such as the one described for mediastinoscopy) in the chest. Your doctor may take a biopsy from the pleura.
Sometimes, doctors use a video camera to get a better look at the area surrounding the lung. This is known as a video-assisted thoracoscopy.
- Endobronchial ultrasound
This test can be performed in place of a mediastinoscopy or thoracoscopy. Some patients may have this test instead of a bronchoscopy or a CT scan and biopsy.
It can be done under general anesthesia or using a mild sedative to help the patient relax and feel drowsy.
Your doctor inserts a bronchoscope that has a small ultrasound probe on its end into your trachea. An ultrasound uses sound waves that are transformed into an image on the computer. This test may show the size of the tumor and whether the surrounding lymph nodes are larger than normal.
Your doctor may also insert a needle through the bronchoscope to take biopsies of the lung and nearby lymph nodes.
Biopsies can be uncomfortable, though they shouldn't be painful. Tell your doctor or nurse if you experience any pain during the test or after it. The procedure takes under an hour, and patients can usually go home on the same day.
- Endoscopic ultrasound
This test is similar to an endobronchial ultrasound.
It is performed with the patient under general anesthesia or a mild sedative. During the procedure, the doctor inserts a small flexible tube (endoscope) through the esophagus. The end of the endoscope has an ultrasound probe that creates image of the area that surrounds the heart and lungs.
Your doctor may also insert a needle through the bronchoscope to take biopsies of the lymph nodes.
As in an endobronchial ultrasound, a biopsy may be uncomfortable but should not be painful. Tell your doctor or nurse if you experience any pain during the test or after it. The procedure takes under an hour, and patients can usually go home on the same day.
- PET/CT scan
This is a combination of computed tomography and positron emission tomography (PET). PET uses low doses of radiation to measure cell activity in different parts of the body. This test offers more detailed information on the part of the body being scanned.
You will not be able to eat for six hours before the test. A slightly radioactive substance is injected into a vein (normally the arm). This is followed by a wait of at least an hour before the examination, which takes between 30 and 90 minutes.
- MRI (magnetic resonance imaging)
This test uses magnetism to build a detailed image of one of the areas of your body. The scanner is a powerful magnet, which is why you will be asked to fill out and sign a checklist and provide your consent. As part of this consent form, you will be asked if you have any implants such as a pacemaker or surgical clips. You should also tell your doctor if you have ever worked with metals or in the metal industry.
Before the scan, you will be asked to remove all metal belongings, including jewelery. Sometimes, a contrast dye is given by injection in a vein of the arm to help the images come through more clearly.
You will have to remain very still during the test, which lasts about 30 minutes. The process is painless but can be somewhat uncomfortable, and some people experience a bit of claustrophobia. It is also quite loud, though you will be given earplugs or headphones.
- Abdominal ultrasound
Ultrasound uses sound waves to create images of the internal organs. It only takes a few minutes, and during the procedure a gel will be spread across your abdomen and then a small device will be passed over the area where the gel has been applied. This device emits ultrasound waves used to form an image of the organs that can be seen using a computer.