CANCER

        Further tests for lung cancer

Why you need more tests

If your tests show you have lung cancer, you may need further tests to see if the cancer has spread. These tests also help your doctor to decide on the best treatment for you. If you have not already had one you may have a PET-CT scan. Or you may have one or more of the tests below.

 

Endobronchial ultrasound scan

Doctors call this test an EBUS. You may have it under a general anaesthetic or may have medicine to make you drowsy. The doctor then gently passes a small bronchoscope into your mouth and down into the windpipe (trachea). It can pass into the smaller airway passages and create ultrasound pictures of the lung tissue and nearby lymph glands. So it can help to show the size of the tumour and whether the cancer has spread into any lymph nodes.
The doctor can pass a hollow needle down the tube to take an ultrasound guided biopsy of any enlarged lymph nodes or any lung tissue that looks abnormal. They call this a transbronchial needle aspiration (TBNA). This test usually takes less than half an hour.

 

Endoscopic ultrasound scan

Doctors call this test an EUS. You may have the test under a general anaesthetic or may have medicine to make you drowsy. The doctor gently puts a long, flexible tube with an ultrasound probe down your throat and food pipe (oesophagus). This creates ultrasound pictures of the area around the heart and lungs. So it can help to show if the cancer has spread into any lymph glands at the centre of the chest.
The doctor can pass a hollow needle down the tube to take an ultrasound guided biopsy of any enlarged lymph nodes or any lung tissue that looks abnormal. They call this a EUS guided fine needle aspiration (EUS guided FNA). This test usually takes less than half an hour.

 

Thoracoscopy

Doctors may use a thoracoscopy test instead of an endobronchial ultrasound scan or an endoscopic ultrasound scan to

• Find the cause of fluid on the lung (pleural effusion)
• Take tissue samples from the lung
• Take tissue samples from lymph nodes in the centre of the chest (mediastinum)

You have this test under sedation or sometimes a general anaesthetic. You will probably have about 2 or 3 cuts (incisions) in your chest on the side the doctor is checking. The doctor puts a thin, flexible tube into the cut. Through the tube, the doctor looks for anything abnormal and can take tissue samples (biopsies), or suck out a sample of fluid. They send the biopsies and fluid sample to the lab to be checked for cancer cells.
After the test, you usually have a tube into your chest (a chest drain) for up to a couple of days. The tube allows any fluid to drain out and the lung to fully expand. You may have gentle suction on the tube to help this happen. You will need to stay in hospital while you have the drain in.

 

Mediastinoscopy

This test examines the mediastinum. The mediastinum is an area in the centre of your chest, between your lungs, which contains

• The heart
• Main blood vessels
• Lymph nodes

You have to have a general anaesthetic for this test and so may have to stay in hospital for at least one night. The doctor makes a small cut at the base of the neck, and puts a small, flexible tube through the cut and into the mediastinum. The doctor can look through this tube to examine the area and can take tissue samples. The samples are examined under a microscope, to see if there are any cancer cells there.
When you wake up, you will have a small dressing over the cut where the tube was put in. Don't be afraid to say if you are feeling sore. Your nurses will give you painkillers. Once you have got over the anaesthetic, you will be able to go home. This will probably be the day after the test.

 

Liver ultrasound scan

You might have an ultrasound scan of your liver to see whether there is any sign of cancer there. An ultrasound uses sound waves to build up a picture of the inside of the body. It is painless and doesn't take long (probably less than half an hour). There is information about having an ultrasound scan in the cancer tests section.

 

Bone scan

A bone scan looks for signs of bone damage. The damage could be caused by wear and tear, arthritis, or cancer that has spread to the bones. Doctors use this test to check for any signs that the lung cancer has spread to the bone. There is information about having a bone scan in the cancer tests section.

 

Brain CT or MRI scan

With some types of lung cancer there is a chance that the cancer may spread to the brain. Your doctor may ask you to have a brain scan with either a CT scan or an MRI scan. The scans are painless and harmless. But MRI scans are very noisy and both scans involve you laying inside the scanner for some time.
If you are claustrophobic, do tell your doctor as you may want to have a sedative and this needs to be organised in advance. You will have an injection of dye before the scan to help show up any abnormal areas. There is information about these tests in the cancer tests section.

 

MRI scan

MRI scans build up pictures of an area of the body using magnetic fields. They are not often used for lung cancer unless the cancer is very close to the top of the lung. Cancers in this area are called pancoast tumours. You might also have an MRI scan if your doctor thinks that the lung cancer cells could have spread into the ribs or spine. There is detailed information about having an MRI scan in the cancer tests section.

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After the tests

Your doctor will ask you to go back to the hospital when your test results have come through. But this is bound to take a little time, even if only a few days. This is a very anxious time for most people. While you are waiting for results it may help to talk to your specialist nurse, or a close friend or relative about how you are feeling. Or you may want to contact a cancer support group to talk to someone who has been through the same experiences.

Treating lung cancer

 Lung cancer stages

 What staging is

The stage of a cancer tells you how big it is and how far it has spread. It is important because it helps your doctor decide which treatment you need. The tests and scans you have to diagnose your cancer give some information about the stage. Sometimes it is not possible to be certain about the stage of a cancer until after surgery.
There are different ways of staging lung cancer – they are the number staging system and the TNM system.

 

The number staging system

The number system divides the stages into 4 main groups
Stage 1 – the cancer is small and only in one area of the lung (localised)
Stage 2 and 3 – the cancer is larger and may have grown into the surrounding tissues and there may be cancer cells in the lymph nodes (locally advanced)
Stage 4 – the cancer has spread to another part of the body (secondary or metastatic cancer)
Doctors break down each of these stages of lung cancer into sub groups, such as stage 3a, 3b and so on. There is more detail about each stage of lung cancer and its sub groups on the next page in this section.

 

TNM staging system

TNM stands for Tumour, Node, Metastases. This staging system describes

• The size and position of the tumour (T)
• Whether cancer cells have spread into the lymph nodes (N)
• Whether the tumour has spread anywhere else in the body – secondary cancer or metastases (M)

The doctor gives each factor a number. So, a very small cancer which hasn’t spread is T1 N0 M0. A cancer that is larger and has spread into the lymph nodes and to another part of the body is T3, N1, M1.