Further tests for lung cancer
If the first set of tests suggest that you have lung cancer, your specialist may want to do some further tests.
This is to confirm the diagnosis and see if the cancer has spread to any other part of the body. This process is called staging and may take some time. The results will help you and your doctor decide on the best course of treatment.
Sometimes these tests may be done again, during and after treatment, to check on your progress.
During this test, the doctor will examine the area at the centre of your chest (mediastinum), and the lymph nodes closest to the lungs. These are often the first places that lung cancer spreads to, so they are usually checked for signs of cancer. The test is done under a general anaesthetic and will mean a short stay in hospital.
A small cut is made in the skin at the base of your neck, and a thin, flexible tube is passed into your chest.
The tube has a light and camera at the end and can magnify the areas it looks at. The doctor can see any abnormal areas, and may also take samples of the cells and lymph nodes (biopsies) to examine under a microscope.
This allows the doctor to look at the area of the pleura directly and at other structures around the lungs. The doctor can take further biopsies if required.
You’ll be given either a general anaesthetic or a local anaesthetic with a sedative to make you drowsy. A small cut is made in the chest wall, and the doctor puts a thin, flexible tube with a light and camera at the end (thoracoscope) into your chest. Your doctor can then take a biopsy of the pleura. Sometimes, doctors use a video camera to perform procedures like pleurodesis – this is called video-assisted thoracoscopy.
Endobronchial ultrasound scan (EBUS)
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This is a newer type of test that may be done instead of a mediastinoscopy or thoracoscopy. You’ll either have a general anaesthetic or you may be given a mild sedative to make you feel drowsy.
A thin, flexible, fibre-optic tube called a bronchoscope is passed into your mouth and down your windpipe (trachea). On the end of the bronchoscope is a small ultrasound probe. This produces sound waves that are converted into pictures by a computer. The probe is small enough to reach the smaller airways and can help to show the size of the tumour, and whether any of the nearby lymph nodes are enlarged.
The doctor can also pass a fine needle along the bronchoscope to take biopsy samples from the lung or the nearby lymph nodes. This procedure is called a transbronchial needle aspiration (TBNA).
Having a biopsy taken can be uncomfortable but shouldn’t be painful. If you have any pain during or after the procedure, let your doctor or nurse know as painkillers can be given.
The test takes less than an hour and you can usually go home on the same day.
Endoscopic ultrasound (EUS)
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This is very similar to an EBUS. While you are under a general anaesthetic or mild sedation, the doctor will pass a small, flexible tube (endoscope) through your mouth and into your gullet (oesophagus). An ultrasound probe on the end of the endoscope creates pictures of the area around the heart and lungs, and it can show if any of the lymph nodes in the centre of the chest are enlarged.
The doctor can pass a fine needle along the endoscope and take biopsies from the lymph nodes. As with an EBUS, having a biopsy taken can be uncomfortable but shouldn’t be painful. Let your doctor or nurse know if you have any pain during or after the procedure as painkillers can be given.
This test takes less than an hour and you can usually go home on the same day.
MRI (magnetic resonance imaging) scan
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This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet, so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins.
You should also tell your doctor if you’ve ever worked with metal or in the metal industry, as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it’s likely that you won’t be able to have an MRI scan. In this situation another type of scan can be used.
Before the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly.
During the test, you’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.
Abdominal ultrasound scan
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Ultrasound uses sound waves to look at the liver and the other organs in the upper part of the abdomen. It’s the same type of scan that pregnant women have.
Once you are lying comfortably on your back, a gel is spread onto the area to be scanned. A small device that produces sound waves is passed over the area and the sound waves are converted into a picture by a computer.
The test only takes a few minutes. An ultrasound scan is also sometimes used to look at the lymph nodes in the neck.
This is more sensitive than an x-ray, and it shows up any abnormal areas of bone more clearly. However, it isn’t always clear whether an abnormality is caused by cancer or other conditions such as arthritis.
A small amount of a mildly radioactive substance is injected into a vein, usually in your arm. Abnormal bone absorbs more radioactivity than normal bone, so these areas are highlighted and picked up by the scanner as ‘hot spots’. There is generally a wait of 2–3 hours between having the injection and the scan taking place, so you might like to take a magazine or book to pass the time. The level of radioactivity used in the scan is very small and doesn’t cause any harm.
If your doctor aims to remove the lung cancer using surgery, or is planning a course of radiotherapy for you, they may first ask you to have some breathing or exercise tests to see how well your lungs are working.
Waiting for test results
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Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready.
You may find it helpful to talk with your partner, family or a close friend. You can also talk things over with one of our cancer support specialists.