Diagnosing lung cancer

Wednesday 30 June, 2010

Reviewed: Dr Nick Pavlakis, Medical Oncologist, Royal North Shore Hospital; Jocelyn McLean RN, MN (Res), Case Manager for Thoracic Surgery, Sydney South Western Area Health Service; Eileen Ryan, Consumer.

On this page: Symptoms | Health professionals you may see | How lung cancer is diagnosed | ‘Staging' the disease

Symptoms

The main symptoms of lung cancer are:

  • a new dry cough or change in a chronic cough
  • chest pain or breathlessness
  • repeated bouts of pneumonia or bronchitis
  • coughing or spitting up blood.

Lung cancer is often discovered when it is advanced. It is sometimes detected during routine tests. A person may have experienced symptoms such as fatigue, weight loss, hoarseness or wheezing, difficulty swallowing, or abdominal and joint pain.

Having any one of these symptoms does not necessarily mean that you have cancer. Some of these symptoms may be caused by other conditions or by side effects of smoking. Talk to your doctor to have symptoms checked.

Doctors and other health professionals you may see

Often your GP will arrange the first tests to assess your symptoms. This can be a worrying and tiring time, especially if you need several tests. If these tests do not rule out cancer you will usually be referred to a lung specialist. This specialist will arrange further tests and advise you about treatment options.

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This multidisciplinary team will meet regularly to discuss the most appropriate treatment plan for you.

The team will probably include:

Health Professional  Role
Respiratory physician Helps diagnose and stage the cancer and determine initial treatment options
Cardiothoracic (chest) surgeon Does some diagnostic tests and performs surgery
Medical oncologist Responsible for chemotherapy and following treatment options 
Radiation oncologist Responsible for radiotherapy
Nurses and cancer nurse coordinators Support and assist you through all stages of your treatment
Palliative care doctors and nurses Work closely with the GP and oncologist to provide palliative care
Dietitian Recommends an eating plan for you to follow while you are in treatment and recovery
Speech pathologist Helps with communication and swallowing
Social worker, physiotherapist, clinical psychologist and occupational therapist Advise you on support services, help you get back to normal activities and give guidance if you have any emotional, physical or practical problems.

 

How lung cancer is diagnosed

Your doctors will perform a number of tests to confirm your diagnosis and develop a treatment plan. Some of these tests can also show if the cancer has spread to other parts of your body.

Chest x-ray

This x-ray is a painless scan of the chest that can show tumours 1 cm wide or larger. Small, hidden tumours don't always show up on x-rays, so you may have further tests.

Sputum cytology

A sputum cytology test is an examination of liquid phlegm or mucus from your lungs (sputum).

You may be asked to collect sputum samples each morning at home. You can collect a sample by coughing deeply and forcefully. Collect any sputum that you cough up and store the sample in your fridge until you bring it to your doctor, who will check for abnormal cells.

Bronchoscopy

A bronchoscopy allows the doctor to look directly into the airways (bronchi). You will probably be given a light sedative. A local anaesthetic will also be sprayed on the back of your throat to numb it.

The doctor will insert a flexible tube called a bronchoscope through your nose or mouth and down your windpipe (trachea). The bronchoscope may feel uncomfortable, but it shouldn't feel painful.

During the bronchoscopy, the doctor will take a tissue sample (biopsy). If the tumour is near your main respiratory tract, the cells can be sampled using a technique called brushing and washing. ‘Washing' means that a small amount of fluid is injected into the lung and withdrawn for examination. ‘Brushing' is when the doctor uses a brush-like tool to remove some cells from the bronchi.

 Endobronchial ultrasound

An endobronchial ultrasound (EBUS) is a type of bronchoscopy procedure that allows the doctor to examine the airways (bronchi) and take tissue samples through the airways and windpipe (trachea). Samples may be taken from an adjacent tumour or lymph node.

The doctor will use a bronchoscope with a small ultrasound probe on the end. The bronchoscope will be put down your throat into your trachea. The ultrasound probe uses soundwaves to create a picture of the body and measure the size and position of the tumour.

After an EBUS, you may have a sore throat or cough up a small amount of blood. Tell your medical team how you are feeling so they can monitor you.

Fine-needle aspiration

Your doctor may be able to do a fine-needle aspiration biopsy. Only some tumours, like those in the outer parts of the lungs, can be sampled this way.

The doctor will use an x-ray machine to insert a needle through your chest wall into the tumour. A small piece of tumour can usually be removed with the needle.

The fine-needle aspiration is done in a hospital or radiology department. You will be observed for a few hours afterwards because there is a small risk of the lung being punctured during this procedure.

Mediastinoscopy

A mediastinoscopy is a procedure that allows a surgeon to examine and sample lymph nodes at the centre of your chest. A rigid tube is inserted through a small cut in the front of your neck and passed down the outside of your trachea. The surgeon will inspect the area between the lungs (mediastinum) and remove some tissue. This is usually a day procedure but some people need to say overnight in hospital.

Thoracotomy

A thoracotomy is an operation performed under a general anaesthetic. It is usually done if other tests fail to provide a diagnosis. Your surgeon will do this test to take a tissue sample (biopsy) or remove the tumour.

The operation can be done in two ways. The surgeon may be able to make some small cuts in your chest and insert a camera and surgical instrument called a thorascope. If this isn't possible, the surgeon will open the chest cavity through a larger cut on your back. You will probably stay in hospital for a few days while you recover.

Computerised tomography (CT) scan

A CT (computerised tomography) scan uses x-ray beams to take three-dimensional pictures of the inside of your body. CT scans are usually done at a hospital or a radiology service and can be used to identify smaller tumours than those found by x-rays. They can also show enlarged lymph nodes or tumours in other parts of the body.

You may be asked not to eat or drink for a few hours before the CT scan. An iodine contrast dye also may be injected into a vein in your arm to make the scan pictures clearer.

A CT scan is painless and takes about 10 minutes. You will lie on a table that slides in and out of a large, round scanner.

Before the scan, tell your health care team if you are allergic to iodine, fish or dyes. 

Other scans

A PET (positron emission tomography) scan is a specialised imaging test that is available at some major hospitals. It is useful in diagnosing lung tumours where a biopsy is not possible or inconclusive. A PET scan can also be used to stage lung cancer or find cancer that has spread to other parts of the body.

You will be injected with a radioactive glucose solution. It takes 30-90 minutes for the fluid to go through your body, then you will have a body scan. The scan shows ‘hot spots' in the body where the fluid has accumulated - this happens where there are active cells, like cancer cells

Other tests

You may also have some other tests, like blood and breathing tests, and bone, brain or MRI scans. For information, talk to your doctor or call the Cancer Council Helpline on 13 11 20.

 

‘Staging' the disease

Your doctor will assign a stage to describe the size of the cancer and if it has spread. This helps determine the best treatment.

Stages - Non-small cell lung cancer

Stage 1

Only one lobe of the lung is affected.

Stage 2

The tumour has spread to nearby lymph nodes, or the tumour has grown into the chest wall.

Stage 3A

Tumours have spread to lymph nodes in the centre of the chest (mediastinum).

Stage 3B

Tumours have spread more extensively to lymph nodes in the mediastinum, there is a collection of fluid in the pleural space around the lung, or there are tumours in more than one lobe.

Stage 4

The cancer cells have spread to distant parts of the body, such as the bones or liver.

 

Stages - Small cell lung cancer

Limited disease

The tumour can be found in only one lung and nearby lymph glands.

Extensive disease

The tumour has spread outside one lung or to other parts of the body.

 

Stages - Mesothelioma

Stage 1

Only one side of the chest is affected. The cancer isn't in the chest wall or lymph nodes.

Stage 2

The chest wall, oesophagus, heart or lymph nodes in the chest are affected.

Stage 3

The cancer has spread through the diaphragm into the abdomen, or to lymph nodes in other parts.

Stage 4

The cancer has spread to distant parts of the body.

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