How lung cancer is diagnosed

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1 This information is an extract from the booklet, Understanding lung cancer. You may find the full booklet helpful. We can send you a copy free see page 5. Contents At the hospital CT (computerised tomography) scan PET-CT scan Bronchoscopy Most people begin by seeing their GP when they develop symptoms. Your GP will examine you and arrange for you to have tests including a chest x-ray. If your GP thinks you have symptoms that could be caused by lung cancer, they will 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. You should be seen at the hospital within two weeks. In some circumstances the GP will make an urgent referral before the result of the chest x-ray is known. This means that you should be seen at the hospital within two weeks. The Department of Health has given the following guidelines to GPs to help them decide when to arrange an urgent referral. Macmillan and Cancerbackup have merged. Together we provide free, high quality information for all. Questions about cancer? Ask Macmillan Page 1 of 5

2 They 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. They should arrange an urgent chest x-ray for anyone: who complains of chest pain without any other obvious cause, such as an infection who has any of the following symptoms for more than three weeks: chest pain, breathing difficulties, weight loss, hoarseness, enlargement of the ends of the fingers (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. Usually you will see the specialist within two weeks of this referral being made. At the hospital At the hospital, 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 also be asked to give samples of phlegm (sputum), which will be examined under a microscope for cancer cells. This is known as sputum cytology. 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. 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 minutes. Page 2 of 5 Questions about cancer? Ask Macmillan

3 CT scans use 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. A CT scan takes minutes 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. 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 PET 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. Questions about cancer? Ask Macmillan Page 3 of 5

4 This type of scan may be done instead of a CT scan. It s usually done before a bronchoscopy (see below) 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 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. Bronchoscopy 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 Page 4 of 5 Questions about cancer? Ask Macmillan

5 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. More information and support If you have any questions about cancer, ask Macmillan. If you need support, ask Macmillan. Or if you just want someone to talk to, ask Macmillan. Our cancer support specialists are here for everyone living with cancer, whatever you need. Call free on , Monday Friday, 9am 8pm We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ Questions about cancer? Ask Macmillan Page 5 of 5

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