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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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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.
You may be asked to give samples of phlegm (sputum), which will be examined under a microscope for cancer cells – this is known as sputum cytology|.
You may also have a CT scan|, a PET-CT scan| and a bronchoscopy| to confirm a diagnosis of lung cancer. A CT scan uses x-rays to build up a three-dimensional picture of the inside of your body. A PET-CT scan is a CT-scan combined with a PET scan, which uses low-dose radiation to measure the activity of cells in different parts of the body. In a bronchoscopy, a thin, flexible tube is passed down your throat and into your lungs to examine them. Your doctor may arrange for you to have one or more of these tests at the hospital.
If the first tests suggest that you have lung cancer, your specialist may want to do some of the further tests described below, to confirm the diagnosis and to 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 treatment.
Sometimes these tests may be done again, during and after treatment, to check on your progress.
It will probably take several days to a couple of weeks for the results of your tests to be ready. These will show the grade and stage of the cancer. This information will be used by a team of doctors and nurses, known as the multidisciplinary team or MDT, to decide on the most appropriate treatment.
Waiting for test results can be a difficult time and you may need support from one of our cancer support specialists on 0808 808 00 00 or another support organisation|.
This uses a low dose of radiation to take a picture of the inside of the chest. It is painless and needs no special preparation. The test is carried out by a radiographer, usually as an outpatient appointment in the hospital’s x-ray department. Women should always tell their radiographer if there is any possibility they may be pregnant.
In this test, samples of your phlegm (sputum) are examined under a microscope for cancer cells – this is called sputum cytology.
The moist linings of the airways leading into our lungs produce small amounts of fluid, or secretions, which can be coughed up as sputum. Lung cancers usually develop in these lining tissues of the airways, so sputum which forms near the growth may contain cancer cells.
If sputum is collected, it can be examined under the microscope to see if there are cancer cells. It’s not a very specific or sensitive test so even if there aren’t any cancer cells it doesn’t mean there isn't a cancer. It’s not used on its own as a way of diagnosing lung cancer.
The test simply involves coughing up sputum into a container that your doctor will provide. It is then sent to the laboratory for examination. Often two or three separate samples taken on different occasions will be needed to give the best chance of accurate results.
A CT (computerised tomography) scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. It can be used to find the exact area and size of the cancer and whether it has spread beyond the lung. The scan is painless and takes 10–30 minutes.
CT scans use a small amount of radiation, which is 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. For a few minutes this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand.
You will probably be able to go home as soon as the scan is over.
Having a CT scan
View a large copy of the illustration showing someone having a CT scan|
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, which 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 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 cannot 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. It usually takes 30–90 minutes. You should be able to go home after the scan is over.
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 examines the insides of the lung airways and takes 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 will 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 which reduces 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. Using the bronchoscope the doctor or nurse can 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.
As soon as the sedation has worn off you’ll be able to go home. 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 hospital. You may have a sore throat for a couple of days after your test, but this will soon disappear.
This test is similar to a CT scan but uses magnetism instead of x-rays 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, for example a pacemaker, surgical clips, bone pins, etc. You should also tell your doctor if you have 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 will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is 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.
During this test, the doctor examines 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 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 to examine under a microscope.
In this test the doctor examines a different part of your chest. You’ll be given either a general or 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 biopsies of any abnormal areas or lymph nodes.
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 that the needle is in the right place. The doctors will take a sample of cells to be examined under a microscope. The biopsy is sometimes slightly uncomfortable, but it only takes a few minutes.
After a lung biopsy, a small number of people may develop air between the layers that cover the lungs. This is known as a pneumothorax. Symptoms of a pneumothorax 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 got a pneumothorax. Let your doctor or nurse know if you develop any of the above symptoms.
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 into 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 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.
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 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. The test takes less than an hour and you can usually go home on the same day.
Ultrasound uses sound waves to look at the liver and the other organs in the upper part of the abdomen. It’s the same sort of scan that pregnant women have.
Once you are lying comfortably on your back, a gel is spread on to 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 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 may 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 for you to have a course of radiotherapy, they may first ask you to have breathing tests to see how well your lungs are working.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.