Once people begin to experience symptoms they initially attend upon their GP. If the GP is concerned that symptoms could be linked to lung cancer they will refer the patient for an urgent chest x-ray. Once the GP has received the x-ray report they will review same and depending on the contents of the report will depend on how to proceed. If the x-ray suggests possible lung cancer the GP will then proceed to make an urgent referral to a chest specialist.
The specialist, at the hospital, will enquire about the patients’ general health and their previous medical history.
There are a number of tests that may be carried out to assist in the diagnosis of lung cancer, they are:
CT (computerised tomography) Scan
This scan is painless, taking between 10-30 minutes. In this time a series of x-rays are taken, which then build up a 3D image of the inside of the body. In some circumstances it may be necessary to have a drink or an injection of dye, this allows a particular area to be seen more clearly.
A PET-CT scan is a combination of a CT scan and a PET (positron emission tomography) scan.
A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body. A PET-CT scan gives a more detailed picture of the body.
When having a PET-CT scan a mildly radioactive substance is injected into the vein, after a least an hour after the injection the scan is carried out, usually taking 30-90 minutes. The scan can give accurate information about the size of the cancer, whether it has spread and examine the area post treatment to ascertain whether there is any scar tissue or whether any cancer cells are still present.
A bronchoscopy is carried out by a doctor or specially trained nurse. They will guide a thin, flexible tube known as a bronchoscope into the lung airways and take samples (biopsies) of the cells. The bronchoscopy is carried out under local anaesthetic.
In some circumstances a rigid bronchoscope is used, in this instance a general anaesthetic is used.
A mild sedative will be given prior to the bronchoscopy, along with another medicine to reduce the production of natural fluids in the mouth and throat.
The bronchoscope can be used to take photographs and biopsies.
The lung biopsy is usually done during a CT scan. A local anaesthetic is used to numb the area, a thin needle is then passed through the skin and into the lung. Throughout the procedure x-ray is used to check the needle is in the correct place.
Some may have a sample of cells taken from lymph nodes in their neck, this is known as a fine needle aspiration.
In some circumstances after a lung biopsy or fine needle aspiration of lymph nodes in the neck, a small amount of people may develop air between the layers covering the lungs (pneumothorax). Symptoms of a pneumothorax include sharp chest pain, breathlessness and a tight chest.
If the initial tests continue to suggest that lung cancer may be present the specialist may order further tests. These tests can include:
- Endobronchial ultrasound scan (EBUS)
- Endoscopic ultrasound (EUS)
- MRI scan
- Abdominal ultrasound scan
- Isotope bone scan
- Lung function tests
These tests will confirm the diagnosis of lung cancer and what stage it is at, it will also ascertain if the cancer has spread to another part of the body.