Lung cancer tests - what each one is for

About the tests we have arranged

We need to answer two questions before we can recommend treatment: what
exactly the abnormality is, and whether it has spread. Different tests answer
different parts of that, which is why there is usually more than one.

It can feel slow. Each test has to be done, reported, and then discussed by the
team, and the order matters because each one tells us where to look next.

CT scan
A detailed x-ray picture of the chest and upper abdomen, usually with an
injection of dye into a vein. It shows the size and position of the
abnormality and whether the lymph nodes are enlarged. It takes a few minutes.

PET-CT scan
A scan that shows how active tissue is, not just what it looks like. You are
given an injection of a small amount of radioactive sugar and rested quietly
for about an hour, then scanned. Cancer cells usually take up more of the sugar
and appear bright.

PET-CT is very good at finding areas we would otherwise miss, but inflammation
and infection also light up, so a bright area is not proof of cancer. That is
why we often still need a sample.

If you have diabetes, tell us, because the preparation needs adjusting.

Getting a sample

Looking at cells under a microscope is the only way to be certain what
something is, and modern lung cancer treatment depends on tests done on the
tissue itself. We choose the method that gives the most information with the
least risk, which depends on where the abnormality is.

Bronchoscopy: a thin camera passed into the airways, with samples taken from
inside them.

EBUS, or endobronchial ultrasound: a bronchoscopy with an ultrasound probe at
the tip, which lets us see the lymph nodes in the centre of the chest through
the airway wall and pass a fine needle into them. This is the standard way of
checking whether lymph nodes are involved, which matters a great deal for
treatment.

CT-guided biopsy: a needle passed through the skin into the abnormality, using
the CT scanner to guide it. Used when the abnormality is near the outside of
the lung. There is a risk of causing a leak of air from the lung, which
sometimes needs a drain and an overnight stay.

Draining fluid: if there is fluid around the lung, a sample is taken with a
needle and examined for cancer cells.

Other tests you may be offered

MRI of the head, to check whether the brain is involved.
Breathing tests and sometimes an exercise test, to see how well you would
cope with surgery or radiotherapy.
Blood tests, including kidney and liver function.

What happens to the results

Everything is brought together at a meeting called the lung cancer
multidisciplinary team, or MDT. Chest doctors, surgeons, cancer specialists,
radiologists, pathologists and specialist nurses meet weekly to agree a
recommendation, which we then discuss with you.

Your lung cancer nurse specialist is your point of contact throughout, and is
the person to ring with questions between appointments.

If you smoke

Stopping smoking now still helps, even at this stage. It reduces complications
from surgery, improves how well radiotherapy and chemotherapy are tolerated, and
improves outcomes. We can arrange support and medication straight away.