Further tests after diagnosis

Your specialist may arrange further tests, to help confirm the lung cancer diagnosis and find out whether it has spread to any other area of the body. These tests build up an image of your lungs and the surrounding areas. The results will help your doctors find out the stage of the cancer and the best treatment for you. 

Other tests for lung cancer may include:

  • mediastinoscopy
  • thoracoscopy
  • endobronchial ultrasound scan (EBUS)
  • endoscopic ultrasound (EUS)
  • PET/CT scan
  • MRI (magnetic resonance imaging) scan
  • abdominal ultrasound scan
  • bone scan
  • lung function tests.

You may also have some of these tests during or after treatment. They can help your healthcare team to check your progress.

Waiting for your test results can be a difficult time. It may take a few days or a couple of weeks to get your results. During that time, it may help to talk to a friend or family member. You can also call one of our cancer support specialists on 0808 808 00 00.

Further tests

If the first set of tests show you have lung cancer, your specialist will want to do some further tests. These are done to find out the size and position of the cancer and if it has spread outside the lung or to other parts of the body. This is called staging and the results will help you and your doctor decide on the best treatment. Some tests may be repeated during and after your treatment.


Mediastinoscopy

This test allows the doctor to look at the area in the middle of your chest called the mediastinum and the nearby lymph nodes. These are the first areas that lung cancer may spread to.

You have this test done under a general anaesthetic during a short stay in hospital.

The surgeon makes a small cut in the skin at the base of your neck and passes a tube like a telescope through the cut into your chest. The tube has a light and camera at the end and that magnifies the areas it looks at. The doctor can see any abnormal areas and take samples of the tissue and lymph nodes (biopsies) to check for cancer cells.


Thoracoscopy

This allows the doctor to look at the pleura and other structures around the lungs. You can have it done under a general anaesthetic. It can also be done with a local anaesthetic to numb the area and a sedative to make you drowsy.

The surgeon makes a small cut in your chest wall and passes a tube called a thoracoscope (like the one we describe in a mediastinoscopy above) into your chest.

Your doctor can then take a biopsy of the pleura. Sometimes, doctors use a video camera to get a better view of the area surrounding the lung. This is called video assisted thoracospcopy (VATs).


Endobronchial ultrasound scan (EBUS)

This test may be done instead of a mediastinoscopy or thoracoscopy. Some people may have this test instead of a bronchoscopy or a CT scan and biopsy.

You can have it under a general anaesthetic, or using a mild sedative to help you to relax and feel drowsy.

The doctor passes a bronchoscope, which has a small ultrasound probe on the end, down into your windpipe (trachea). An ultrasound uses sound waves that are converted into a picture by a computer. This test can show the size of a tumour and if any nearby lymph nodes are bigger than normal.

The doctor can also pass a needle along the bronchoscope to take biopsies from the lung or nearby lymph nodes.

Having a biopsy can be uncomfortable but it shouldn’t be painful. Tell your doctor or nurse if you have any pain during or after the test so they can give you pain relief. It takes less than an hour and you can usually go home on the same day.


Endoscopic ultrasound (EUS)

This is similar to an EBUS and is also sometimes done as an earlier test for lung cancer. 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. 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 they can give you painkillers. This test takes less than an hour and you can usually go home on the same day.


PET-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 positron emission tomography (PET) 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. You may have to travel to a specialist centre to have one. You can't 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.


MRI scan

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, bone pins, etc. 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

Ultrasound uses sound waves to look at the liver and other parts of the body in the upper abdomen. 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.


Bone scan

This test shows abnormal areas of bone. You have a small amount of a mildly radioactive substance injected into a vein.

The level of radioactivity used in the scan is very small and doesn’t cause any harm.

You wait for 2–3 hours after the injection before you have the scan, which may take an hour. Abnormal bone absorbs more radioactivity than normal bone and shows up on the scan pictures.


Lung function tests

If your treatment involves surgery or radiotherapy to try to get rid of the cancer, your doctor will arrange breathing or exercise tests for you.

You have these to see how well your lungs are working.


Waiting for test results

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. Your specialist nurse or one of the organisations listed on our database, can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.

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