Lung cancer

Diagnosing lung cancer

See your GP if you have symptoms of lung cancer , such as breathlessness or a persistent cough.

Your GP will ask about your general health and what symptoms you've been experiencing. They may examine you and ask you to breathe into a device called a Spirometry , which measures how much air you breathe in and out.

You may be asked to have a blood test to rule out some of the possible causes of your symptoms, such as a chest infection .

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of lung cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected lung cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral .

Chest X-ray

A chest X-ray is usually the first test used to diagnose lung cancer. Most lung tumours show up on X-rays as a white-grey mass.

However, chest X-rays can't give a definitive diagnosis because they often can't distinguish between cancer and other conditions, such as a lung abscess (a collection of pus that forms in the lungs).

If your chest X-ray suggests you may have lung cancer, you should be referred to a specialist (if you haven't already) in chest conditions such as lung cancer. A specialist can carry out more tests to investigate whether you have lung cancer and, if you do,what type it isand how much it's spread.

CT scan

A computerised tomography (CT) scan is usually carried out after a chest X-ray. A CT scanuses X-rays and a computer to create detailed images of the inside of your body.

Before having a CT scan, you'll be given an injection of a contrast medium. This is a liquid containing a dye that makes the lungs show up more clearly on the scan. The scan is painless and takes 10-30 minutes to complete.

PET-CT scan

A PET-CT scan (which stands for positron emission tomography -computerised tomography) may be carried out if the results of the CT scan show you have cancer at an early stage.

The PET-CT scan can show where there are active cancer cells. This can help with diagnosis and treatment.

Before having a PET-CT scan, you'll be injected with a slightly radioactive material. You'll be asked to lie down on a table, which slides into the PET scanner. The scan is painless and takes around 30-60 minutes.

Bronchoscopy and biopsy

If the CT scan shows there might be cancer in the central part of your chest, you'll have a bronchoscopy. A bronchoscopy is a procedurethat allowsa doctor or nurse toremove a small sample of cells from inside your lungs.

During a bronchoscopy, a thin tube called a bronchoscope is used to examine your lungs and take a sample of cells ( biopsy ). The bronchoscope is passed through your mouth or nose, down your throat and into the airways of your lungs.

The procedure may be uncomfortable, but you'll be given a mild sedative beforehand to help you relax and a local anaesthetic to make your throat numb. The procedure is very quick and only takes a few minutes.

Other types of biopsy

If you're not able to have one of the biopsies described above, or you've had one and the results weren't clear, you may be offered a different type of biopsy. This may be a type of surgical biopsy such as a thoracoscopy or a mediastinoscopy, or a biopsy carried out using a needle inserted through your skin.

These types of biopsy are described below.

Percutaneous needle biopsy

A percutaneous needle biopsy involves removing a sample from a suspected tumour to test it at a laboratory for cancerous cells.

The doctor carrying out the biopsy will use a CT scanner to guide a needle to the site of a suspected tumour through the skin. A local anaesthetic is used to numb the surrounding skin, and the needle is passed through your skin and into your lungs. The needle will then be used to remove a sample of tissue for testing.

Thoracoscopy

A thoracoscopy is a procedure that allows the doctor to examine a particular area of your chest and take tissue and fluid samples.

You're likely to need a general anaesthetic before having a thoracoscopy. Two or three small cuts will be made in your chest to pass a tube (similar to a bronchoscope) into your chest. The doctor will use the tube to look inside your chest and take samples. The samples will then be sent away for tests.

After a thoracoscopy, you may need to stay in hospital overnight while any further fluid in your lungs is drained out.

Mediastinoscopy

A mediastinoscopy allows the doctor to examine the area between your lungs at the centre of your chest (mediastinum).

For this test, you'll need to have a general anaesthetic and stay in hospital for a couple of days. The doctor will make a small cut at the bottom of your neck so they can pass a thin tube into your chest.

The tube has a camera at the end, which enables the doctor to see inside your chest. They'll also be able to take samples of your cells and lymph nodes at the same time. The lymph nodes are tested because they're usually the first place that lung cancer spreads to.

Staging

Once the above tests have been completed, it should be possible to work out what stage your cancer is, what this meansfor your treatment and whether it's possible tocompletely cure the cancer.

Non-small-cell lung cancer

Non-small-cell lung cancer (the most common type)usually spreads more slowly than small-cell lung cancer and responds differently to treatment.

The stages of non-small-cell lung cancerare outlined below.

Stage 1

The cancer is contained within the lung and hasn't spread to nearby lymph nodes. Stage 1 can also be divided into two sub-stages:

stage 1A the tumour is less than 3cm in size (1.2 inches)
stage 1B the tumour is 3-5cm (1.2-2 inches)

Stage 2

Stage 2 is divided into two sub-stages: 2A and 2B.

In stage 2A lung cancer, either:

the tumour is 5-7cm
the tumour is less than 5cmand cancerous cells have spread to nearby lymph nodes

In stage 2B lung cancer, either:

the tumour is larger than 7cm
the tumour is 5-7cm and cancerous cells have spread to nearby lymph nodes
the cancer hasn't spread to lymph nodes, but has spread to surroundingmuscles or tissue
the cancer has spread to one of the main airways (bronchus)
the cancer has caused the lung to collapse
there are multiple small tumours in the lung

Stage 3

Stage 3 is divided into two sub-stages: 3A and 3B.

In stage 3A lung cancer, the cancer has either spread to the lymph nodes in the middle of the chest or into the surrounding tissue. This can be:

the covering of the lung (the pleura)
the chest wall
the middle of the chest
other lymph nodes near the affected lung

In stage 3B lung cancer, the cancer has spread to either of the following:

lymph nodes on either side of the chest, above the collarbones
another important part of the body, such as the gullet (oesophagus), windpipe (trachea), heart or into a main blood vessel

Stage 4

In stage 4 lung cancer, the cancer has either spread to both lungs or to another part of the body (such as the bones, liver or brain), or the cancer has caused fluid-containing cancer cells to build up around your heart or lungs.

Small-cell lung cancer

Small-cell lung cancer is less common than non-small-cell lung cancer. The cancerous cells responsible for the condition are smaller in size when examined under a microscope than the cells that cause non-small-cell lung cancer.

Small-cell lung cancer onlyhas two possible stages: