How lung cancer is diagnosed
Most people begin by seeing their GP when they notice symptoms. Your GP will examine you and arrange for you to have tests.
If your GP thinks you have symptoms that could be caused by lung cancer, they'll refer you for an urgent chest x-ray. They should receive the x-ray report within a few days and, depending on the result, they may then refer you to a hospital for specialist advice and treatment.
In some circumstances, the GP will make an urgent referral before the result of the chest x-ray is known. You should be seen at the hospital within two weeks of being referred.
The Department of Health has given the following guidelines to GPs to help them decide when to arrange an urgent referral:
GPs should arrange an urgent referral with a chest specialist for anyone over 40 who smokes, or has done previously, and has coughed up blood more than once.
An urgent chest x-ray should be arranged for anyone who complains of chest pain without any other obvious cause, such as an infection.
An urgent chest x-ray should be arranged for anyone who has any of the following symptoms for more than three weeks: chest pain; breathing difficulties; weight loss; hoarseness; ends of the fingers become larger or look more rounded (clubbing); swelling of the lymph nodes (glands) in the neck area; and coughing.
If the x-ray shows something that might suggest lung cancer, your GP will arrange an urgent referral to a chest specialist.
The specialist will ask you about your general health and any previous medical problems before examining you. If you haven’t already had one, a chest x-ray will be taken to check for any abnormalities in your lungs.
The following tests may be used to diagnose lung cancer. Your doctor may arrange for you to have one or more of them.
CT (computerised tomography) scan
A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection. You’ll probably be able to go home as soon as the scan is over.
CT scans can also be used to guide a biopsy, in which a small amount of tissue is taken to be examined under a microscope. A biopsy involves an overnight stay in hospital, but you’ll be told if this is planned.
This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, 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. PET-CT scans give more detailed information about the part of the body being scanned.
This type of scan may be done instead of a CT scan. It’s usually done before a bronchoscopy and a biopsy, as it can help guide the doctor or nurse to the right parts of the lung. A PET-CT scan can also provide information to help your doctors plan your treatment.
It can give accurate information about the size of the cancer, and whether it has spread beyond the lungs. It can also be used to examine any abnormal areas that remain after treatment to see whether they are scar tissue, or whether cancer cells are still present.
You won’t be able to eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. The scan is done after at least an hour’s wait, and usually takes 30–90 minutes. You should be able to go home after the scan.
PET-CT scanners aren’t available in every hospital so you may have to travel to have one. They are not always necessary, but you can discuss with your doctor whether one would be useful in your case.
During a bronchoscopy, a doctor or specially trained nurse will examine the insides of the lung airways and take samples (biopsies) of the cells. Normally a thin, flexible tube called a bronchoscope is used, and the test is carried out under local anaesthetic.
Sometimes a rigid bronchoscope is used instead. In this case, a general anaesthetic is given and you may have to stay in hospital overnight.
The CT or PET-CT scan will tell the doctors whether a bronchoscopy will be helpful. It will also guide the doctor or nurse to the abnormal area in the lung.
Before your bronchoscopy, you'll be asked not to eat or drink anything for a few hours. Just before the test, you may be given a mild sedative to help you relax and to relieve any discomfort. You’ll be given another medicine to reduce the production of natural fluids in the mouth and throat. This medicine can make your mouth feel dry.
Once you are comfortable, a local anaesthetic will be sprayed onto the back of your throat, making it numb. The bronchoscope is then gently passed into your nose or mouth and down into the lung airways. The doctor or nurse can look through the bronchoscope to check for any abnormalities.
The doctor or nurse can use the bronchoscope to take photographs and biopsies. The test may be slightly uncomfortable, but it only takes a few minutes.
You shouldn’t eat or drink for at least an hour afterwards, because your throat will be numb and there’s a risk of food and drink going down the wrong way into your windpipe when you swallow.
You’ll be able to go home as soon as the sedation has worn off. You shouldn’t drive for 24 hours after the test as you may feel sleepy, so you’ll need to arrange for someone to collect you from the hospital. You may have a sore throat for a couple of days after your test, but this will soon disappear.
This test is usually done in the x-ray department; most commonly during a CT scan. A local anaesthetic is used to numb the area. You’ll then be asked to hold your breath while a thin needle is passed through the skin and into the lung.
An x-ray is used throughout the procedure to make sure the needle is in the right place. The doctors will take a sample of cells to be examined under a microscope.
The biopsy may be uncomfortable, but it only takes a few minutes.
Some people may have a sample of cells taken from the lymph nodes in their neck, using a fine needle. This is called a fine needle aspiration.
After a lung biopsy or fine needle aspiration of lymph nodes in the neck, a small number of people may develop air between the layers that cover the lungs. This is known as a pneumothorax.
Symptoms include sharp chest pain, breathlessness and a tight chest. You may be asked to remain in hospital for a few hours after your biopsy to make sure that you haven’t developed a pneumothorax. Let your doctor or nurse know if you have any of the above symptoms.