Medical scan, tell your health care team if

Medicalimaging involves painless procedures that take pictures of the inside of yourbody. These scans can show if you have lung cancer and if it has spread. Thiswill help your medical team decide on the best treatment plan for you.Chest x-ray:An x-ray of the chest is a scan that can show tumours one centimetre wide orlarger. Small, hidden tumours don’t always show up on x-rays, so you may havefurther tests.CTscan A CT (computerised tomography) scan uses x-ray beams to takethree-dimensional pictures of the inside of your body. CT scans are usuallydone at a hospital or a radiology service and can be used to identify smallertumours than those found by x-rays. CT scans can also show enlarged lymph nodesor tumours in other parts of the body.

You may be asked not to eat or drink fora few hours before the CT scan. An iodine contrast dye also may be injectedinto a vein in your arm to make the scan pictures clearer. Before the scan,tell your health care team if you’re allergic to iodine, fish or dyes. A CTscan usually takes less than 10 minutes. You will lie flat on a table while theCT scanner – a machine that is large and round like a doughnut – rotates aroundyou.

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PET scan:A PET (positron emission tomography) scan is a specialised imaging test thatis available at some major hospitals. A PET scan can be used to stage lungcancer (see page 13) or find cancer that has spread to other parts of the body.To begin this procedure you’re injected with a radioactive glucose solution. Ittakes 30 to 90 minutes for the fluid to go through your body. Then you willhave a body scan.

It shows ‘hot spots’ in the body where the glucose hasaccumulated – this happens where there are active cells, like cancer cells.Diagnostic tests:Pathology:A pathologist can examine tissue samples to identify the type of lung cancer.Their first aim is to confirm, using a microscope, whether they can see cancercells.Sputumcytology: If you’re coughing up phlegm (sputum), your doctor may ask you tocollect phlegm samples at home by coughing deeply. You will be given acontainer to collect the sample, which you can then store in your fridge untilyou take it to your doctor. The sample of your phlegm is sent to a laboratoryto be tested for cancer cells.Biopsy:If a growth is found via diagnostic imaging, a sample of the tissue is requiredto confirm if the growth is cancerous. In this situation, your doctor mayrequest a biopsy.

A biopsy involves taking a small sample of tissue from thegrowth. A pathologist will examine the tissue under a microscope, and willsometimes perform further tests to determine if the cells are cancerous orbenign. There are several procedures for obtaining a biopsy and your doctorwill decide which one is right for you. One of the most frequently requestedbiopsies for lung cancer is a ‘core biopsy’ as it is an extremely accuratemethod of diagnosis. A radiologist uses an ultrasound or CT scan to locate thegrowth and inserts a small needle through the skin to take a core biopsy samplefrom the growth.

Before he or she performs the biopsy, you will be given alocal anaesthetic.Bronchoscopy :A bronchoscopy allows the doctor to look directly into the airways (bronchi)and, if required, biopsy samples of lung tissue. The procedure is performedusing a flexible tube called a bronchoscope, which is inserted through yournose or mouth and down your windpipe (trachea). The bronchoscope may feeluncomfortable, but it should not be painful. You will be given either a lightsedation or a general anaesthetic and the back of your throat is numbed with alocal anaesthetic. During the bronchoscopy, the doctor may take a tissue sampleif they can see something that looks like cancer. Even if the doctor can’t seean obvious tumour they will still take samples if they are suspicious ofcancer.

Tissue samples may be collected via a biopsy or by ‘washing’ or ‘brushing’.In washing, saline water is injected through the bronchoscope into the area orinterest and suctioned back. This process dislodges cells that can be analysedin the laboratory. Alternatively, a soft brush-like tool can be insertedthrough the bronchoscope to collect cells from the bronchi by brushing theairwayEndobronchial ultrasound (EBUS):An EBUS is a type of bronchoscopy procedure that allows the doctor to examineand take tissue samples through the airways (bronchi) and windpipe (trachea).Samples may be taken from an adjacent tumour or lymph node.MediastinoscopyA mediastinoscopy is a procedure that allows a surgeon toexamine and sample the lymph nodes at the centre of your chest.

A rigid tube isinserted through a small cut in the front of your neck and passed down theoutside of your windpipe (trachea). The surgeon inspects the area between thelungs (mediastinum) and removes some tissue. A mediastinoscopy is usually a dayprocedure, but an overnight hospital stay may be required. The scar on yourneck is usually quite small and will be coveredwith a dressing.ThoracotomyUsually a thoracotomy is done if other tests fail to provide adiagnosis. It’s an operation performed by a surgeon, under general anaesthetic,to take a tissue sample (biopsy) or remove the tumour.

The surgery can beperformed in two ways, either:• the surgeon makes some small cuts in your chest and inserts asmall camera and surgicalinstrument called a thoracoscope; or• the surgeon opens the chest cavity through a larger cut onyour back. Post-surgery, you will probably stay in hospital for a few dayswhile you recover.Mutation testingWithin each type of lung cancer there are subtypes. Several lungcancer subtypes can be classified by changes or mutations to specific genes. Bytesting for these gene mutations your doctor can tailor your treatment regimefor the best outcome.

For example, from clinical trials, we know that NSCLCpatients with certain mutations can significantly benefit from targetedtherapies while patients without these mutations gain more benefit fromstandard chemotherapy. For your cancer to be mutation tested, your doctor willrequire a tissue biopsy sample.