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Diagnosing Lung Cancer
Diagnosing Lung Cancer
Contents
Chest X-ray
A chest X-ray is usually the 1st test used to diagnose lung cancer. Most lung tumours appear
on X-rays as a white-grey mass.
However, chest X-rays cannot give a definitive diagnosis because they often cannot
distinguish between cancer and other conditions, such as a lung abscess (a collection of pus
that forms in the lungs).
If a chest X-ray suggests you may have lung cancer, you should be referred to a specialist in
chest conditions.
A specialist can arrange more tests to investigate whether you have lung cancer and, if you
do, what type it is and how much it's spread.
CT scan
A CT scan is usually the next test you'll have after a chest X-ray. A CT scan uses X-rays and
a computer to create detailed images of the inside of your body.
Before having a CT scan, you'll be given an injection containing a special dye called a
contrast medium, which helps to improve the quality of the images.
PET-CT scan
You may have a PET-CT scan may be done if the results of a CT scan show you have cancer.
Before having a PET-CT scan, you'll be injected with a slightly radioactive material. You'll
be asked to lie down on a table, which slides into the PET scanner.
A bronchoscopy is a procedure that allows a doctor to see the inside of your airways and
remove a small sample of cells (biopsy).
During a bronchoscopy, a thin tube with a camera at the end, called a bronchoscope, is passed
through your mouth or nose, down your throat and into your airways.
The procedure may be uncomfortable, so you'll be offered a sedative before it starts, to help
you relax, and a local anaesthetic to make your throat numb. The procedure takes around 30
to 40 minutes.
Like a bronchoscopy, an EBUS allows a doctor to see the inside of your airways. However,
the ultrasound probe on the end of the camera also allows the doctor to locate the lymph
nodes in the centre of the chest so they can take a biopsy from them.
Lymph nodes are part of a network of vessels and glands that spread throughout the body and
work as part of your immune system.
A biopsy from a lymph node can show if cancerous cells are growing there and what type
they are.
Thoracoscopy
A thoracoscopy is a procedure that allows a doctor to examine a particular area of your chest
and take tissue and fluid samples.
Two or three small cuts will be made in your chest to pass a tube (similar to a bronchoscope)
into your chest.
A doctor uses the tube to look inside your chest and take tissue samples. The samples are then
sent to a laboratory for testing.
After a thoracoscopy, you may need to stay in hospital overnight while any fluid in your
lungs is drained.
Mediastinoscopy
A mediastinoscopy allows a doctor to examine the area between your lungs at the centre of
your chest (mediastinum).
For this test, you'll need to have a general anaesthetic and stay in hospital for a couple of
days.
The doctor will make a small cut at the bottom of your neck so they can pass a thin tube into
your chest. The tube has a camera at the end, which enables a doctor to see inside your chest.
They'll also be able to take samples of cells from your lymph nodes during the procedure.
The lymph nodes are tested because they're usually the first place that lung cancer spreads to.
During a percutaneous needle biopsy, a local anaesthetic is used to numb the skin. A doctor
then uses a CT scanner or ultrasound scanner to guide a needle through your skin into your
lung to the site of a suspected tumour.
The needle is used to remove a small amount of tissue from a suspected tumour so it can be
tested at a laboratory.
Risks of biopsies
Like all medical procedures, a lung biopsy carries a small risk of complications, such as a
pneumothorax. This is when air leaks out of the lung and into the space between your lungs
and the chest wall.
The clinician doing the biopsy will be aware of the potential risks involved. They should
explain all the risks in detail before you agree to have the procedure. They will monitor you
to check for symptoms of a pneumothorax, such as sudden shortness of breath.
If a pneumothorax does happen, it can be treated using a needle or tube to remove the excess
air, allowing the lung to expand normally again.
Staging
Once tests have been completed, it should be possible for doctors to know what stage your
cancer is, what this means for your treatment and whether it's possible to completely cure the
cancer.
Clinicians use a staging system for lung cancer called TNM, where:
T1 lung cancer means that the cancer is still inside the lung.
T1 is broken down into 3 sub-stages:
• there are cancerous cells in the lymph nodes located in the centre of the chest on the
same side as the affected lung, or
• there are cancerous cells in the lymph nodes underneath the windpipe
N3 is used to describe 3 possibilities:
• there are cancerous cells in the lymph nodes located on the chest wall on the other side
of the affected lung, or
• there are cancerous cells in the lymph nodes above the collar bone, or
• there are cancerous cells in the lymph nodes at the top of the lung
M
• M0 – the cancer has not spread outside the lung to another part of the body
• M1 – the cancer has spread outside the lung to another part of the body
Small-cell lung cancer
Small-cell lung cancer is less common than non-small-cell lung cancer. The cancerous cells
are smaller in size than the cells that cause non-small-cell lung cancer.
• limited disease – where the cancer is only in 1 lung and may be in nearby lymph nodes
• extensive disease – where the cancer has spread to the other lung, to lymph nodes that
are further away, or to other parts of your body
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