This information was reviewed by:
Gavin Wright, Chair of the VCOG Lung Committee & Thoracic Surgeon, St Vincent’s Health.
Doctors and other health professionals you may see
Video-assisted thoracoscopic surgery
Computerised tomography (CT) scan
Some people have no symptoms, but learn that they have lung cancer when they have a routine chest x-ray. Others realise that something is wrong when breathing symptoms get worse or a chest infection fails to get better quickly.
The most common symptom of lung cancer is a cough that won't go away or a change in a chronic cough. Shortness of breath, bloodstained sputum, chest pains and repeated bouts of pneumonia or bronchitis may also be signs of lung cancer. Other symptoms include fatigue, loss of weight, wheezing (due to a blockage in the windpipe), hoarseness or difficulty in swallowing.
There may also be symptoms that seem unrelated to the lungs. These may be caused by the spread of a lung cancer to other parts of the body.
Your doctor will examine you and refer you for tests to see if you have cancer. This can be a worrying and tiring time, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist, who will examine you and may ask you to have more tests. If you have cancer, one or more specialists will advise you about treatment options.
You should expect to be cared for by a team of health professionals from the relevant major fields (see following list). Ideally, all your tests and treatment will be available at your hospital. This may not be possible in some non-metropolitan areas.
Health professionals who care for people with lung cancer include:
Your doctor will first ask you about your past and current health, smoking and work history, and do a physical examination. They may suggest that you have some of the following tests.
An x-ray of the chest can find cancers as small as 1 cm.
It is a simple test. You will be asked to stand in front of a machine with your chest pressed to a plate and breathe in while pictures are taken. The radiation dose is low.
This test is an examination of sputum under a microscope to check for abnormal cells. Sputum is the thick fluid you cough up from your lungs.
Early-morning samples will be collected for several days. You will be asked to cough deeply to bring up sputum from your lungs. You can do this at home, storing the sample in the fridge before taking it to the doctor or pathology collection centre.
This allows the doctor to look at your lungs and take a sample of tissue (biopsy), if necessary. Tissue can be collected in a number of ways, including direct sampling of the lump, brushing, or washing the area and collecting the fluid (called ‘washings').
A flexible ‘telescope' the width of a pencil will be inserted into your nose or mouth, down the trachea and into the bronchus. You will have a light sedative and a local anaesthetic spray to the back of the throat. It can be uncomfortable but is not painful, and can be done as a day procedure.
This allows the doctor to take a sample of tissue from a lump that cannot be sampled using bronchoscopy.
It is usually done as an outpatient procedure. You will have a local anaesthetic. The doctor will insert a needle through your chest wall and into the lump, guided by x-ray pictures, and remove some tissue.
A procedure called thoracentesis also uses a fine needle. Instead of going into the lump, fluid from around the pleural cavity is sampled to check for cancer cells.
Sometimes suspicious lymph nodes can be sampled through the oesophagus or trachea using an internal ultrasound probe.
In this test, the doctor is able to look at lymph nodes in the centre of the chest, to see if they are affected by cancer.
The procedure is similar to bronchoscopy, but the tube is in-serted through a cut in the neck and fed down to the lymph nodes around the windpipe. The doctor can remove a sample of tissue (biopsy) if necessary. This procedure is done using a general anaesthetic. It is sometimes a day procedure, but can include an overnight stay in hospital.
This test allows the doctor to see inside the chest and take tissue samples if necessary. Instruments are inserted into the chest cavity through small cuts in the skin.
Often the doctor uses a very small video camera and is able to guide the instruments by watching the video screen. You may have up to three small cuts made in your chest, one for the camera and two for the surgical instruments. You will have a general anaesthetic and be in hospital for two or three days.
A CT scan is a type of x-ray that gives a cross-sectional picture of organs and other structures (including any tumours) in your body. It can be used to see smaller cancers than those found by x-rays. It can also show if lymph nodes are enlarged or if the cancer has spread to other organs.
CT scans are usually done at a hospital or a radiology clinic. It takes about 30 to 40 minutes to complete this painless test. You will be asked not to eat or drink anything before the scan, except for a liquid dye. This dye makes organs appear white on the scans that are taken, so anything unusual will show more clearly. You may also have an injection of dye to help show the blood vessels from other tissues.
You will be asked to lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. Most people are able to go home as soon as their scan is over.
There is a small possibility of the injected dye causing an allergic reaction. You should tell your doctor if you are allergic to iodine or contrast dyes, or if you are diabetic or have abnormal kidney function.
You may have some other types of scan.
A bone scan can show whether cancer has spread to the bones. In this test, a small amount of radioactive substance is injected into a vein. It travels through the bloodstream and collects in areas of abnormal bone growth. A scanner measures the radioactivity levels in these areas and records them on x-ray film.
Ventilation/perfusion lung scans can calculate how much lung function will be lost if lung tissue is removed.
Positron emission tomography, also known as a PET scan, involves the injection of radioactive glucose solution into the body. Because cancer cells use more glucose than most normal cells, the PET scanner will detect increased quantities of the radioactive glucose in those areas of the body where the cancer is. It scans the whole body, including the bones, but not the brain. It appears to be the most accurate method for detecting cancer spread to areas other than the brain.
You may also have blood tests and breathing tests. If surgery is an option, it is very important to measure your breathing capacity. People who smoke develop emphysema and may have a reduced breathing capacity.
The tests described on the previous pages show whether you have cancer. They will also show where the primary cancer is and whether the cancer cells have spread to other parts of your body. This helps your doctors ‘stage' the disease.
‘Stage' describes the extent of the cancer in your body. It helps show which treatment is needed. It is also a guide to prognosis.
Non-small cell lung carcinoma has the following stages:
Small cell carcinoma is staged in the following way:
Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you choose the best treatment for your situation.
