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Lung cancer tests

Usually you begin by seeing your GP, who will ask you about your general health and examine you. They may ask you to breathe into a small machine that measures how much air you breathe in and out. Your GP will then refer you to hospital for any X-rays or other tests you may need. You will be asked to go for a chest X-ray to check for anything that looks abnormal in your lungs.

Hospital tests

At the hospital the doctor will ask about your medical history and your symptoms. They will then probably arrange for you to have some tests.

You may have a CT scan that takes X-rays through sections of your body.

A test called a bronchoscopy looks at the inside of the airways. The doctor puts a narrow, flexible tube called a bronchoscope down your throat or nose and into the airway. You usually have this under local anaesthetic. But you may have a sedative or general anaesthetic. The doctor can take a sample of tissue (a biopsy) using the bronchoscope. 

You may have an endobronchial ultrasound scan, which combines a bronchoscope with an ultrasound scan probe. The ultrasound can help to show the size of the tumour and whether the cancer has spread into any lymph nodes. The doctor can also pass a hollow needle down the tube to take an ultrasound guided sample of cells (biopsy) from any enlarged lymph nodes or any lung tissue that looks abnormal.

Biopsy through the skin

For this test, the doctor uses a thin needle to take samples of lung cells to examine under the microscope. The doctor will ask you to hold your breath for a moment while they put the needle through the skin into the lung. The test can be uncomfortable but should only take a few minutes.

Neck lymph node biopsy

If a CT scan has shown changes in the lymph nodes in the neck, you may need to have a sample of cells taken from the nodes. Your doctor uses a fine needle to take a sample of cells. They may use ultrasound to show that the needle is in the right place.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Diagnosing lung cancer section.

 

 

Seeing your GP

Usually you begin by seeing your GP who will ask you about your general health and will examine you. They may ask you to breathe into a small device called a spirometer. The machine measures the amount of air you breathe in and out and also measures how quickly you breathe. They call this test spirometry.

Your GP will refer you to hospital for any X-rays or other tests you may need. You will usually be asked to go for a chest X-ray to check for anything that looks abnormal in your lungs.

Picture of chest X-ray

You may have some routine blood tests. Your GP may also ask you to give some samples of phlegm. They may send them to the hospital for you or may ask you to take them to the hospital. At the hospital the laboratory staff will examine the samples for cancer cells.

 

At the hospital

When you go to the hospital, the doctor will ask about your medical history and your symptoms. They will then probably arrange for you to have some tests, which may include any of the following.

 

CT scan

This is a scan that takes X-rays through sections of the body. The scanner feeds the pictures into a computer and they form a detailed image of the inside of your body.

You might have a CT scan done before having a bronchoscopy or biopsy. The scan can show the area where the cancer is. You will have an injection of dye before the scan to help show up any abnormal areas. We have detailed information about having a CT scan.

 

Looking inside the airways (bronchoscopy)

A bronchoscopy looks at the inside of the airways. Your doctor puts a narrow, flexible tube called a bronchoscope down your throat and into the airway. The tube has a light at the tip and an eye piece so that the doctor can see inside.

Diagram-showing-a-bronchoscopy

You usually have this test as an outpatient, or day case, under local anaesthetic. This means you are awake for the test, but your throat is numbed. If you are very anxious about having the test let your doctor know at least a week in advance. They may be able to arrange for you to have a general anaesthetic or an injection of a sedative into a vein. If you have an anaesthetic or sedative, you may need to stay in hospital overnight. This depends on the time of day you have the test and on your general health. 

If you are going to have sedation or an anaesthetic, your doctor will ask you not to eat or drink anything on the morning of the test. When you arrive at the outpatient department, a nurse may ask you to change into a gown or you may be able to stay in your own clothes. Then your nurse will show you into the test room. Once you are lying on the couch, you will have a sedative to help you relax. Just before the test, the doctor sprays a local anaesthetic onto the back of your throat.

The doctor puts a long, thin, flexible tube called a bronchoscope either down your nose, or into your mouth and down the airway. This will be a bit uncomfortable, but it doesn't last long. The doctor then looks for anything abnormal and can take tissue samples (biopsies) for testing. They can take photographs of the inside of your airways if necessary.

After the bronchoscopy, you will not be able to eat or drink anything until the local anaesthetic has worn off. Your throat will be too numb to swallow safely at first. The numbness usually passes off after about an hour. You should not drive until the day after the test because of the sedative. Someone should collect you from the hospital and make sure that you get home safely. You may have a sore throat for a couple of days after the test because of the tube, but it will soon go.

 

Endobronchial ultrasound

Doctors call this test an EBUS. It is like having a bronchoscopy with an ultrasound. You may have it under a general anaesthetic or may have medicine to make you drowsy. The doctor then gently passes a small bronchoscope into your mouth and down into the windpipe (trachea). It can pass into the smaller airway passages. The probe at the end of the tube creates ultrasound pictures of the lung tissue and nearby lymph glands. So it can help to show the size of the tumour and whether the cancer has spread into any lymph nodes.

The doctor can pass a hollow needle down the tube to take an ultrasound guided biopsy of any lung tissue that looks abnormal. They call this a transbronchial needle aspiration (TBNA). This test usually takes less than half an hour.

 

Biopsy through the skin

This type of biopsy is called a percutaneous lung biopsy. The doctor puts a thin needle through the skin and muscle of your chest to take samples of cells from the lung tumour. The area of the test depends on the position of the abnormal cells. 

The test can be uncomfortable. The actual biopsy only takes a few minutes but getting ready may take between 30 minutes and an hour.

You usually have this test in the X-ray department, ultrasound department, or a special procedures room. You have a local anaesthetic injection into the area where the needle is to be put in. The doctor will ask you to hold your breath for a moment while they put the needle through the skin into the lung. Once the needle is in, the doctor uses X-ray, CT scan or ultrasound to make sure the tip is in the tumour. The doctor then sucks out a sample of cells with a syringe. They send the cells to the laboratory for examination under a microscope.

After a biopsy through the skin your nurse will monitor you closely for a few hours. You may need to stay in hospital overnight. There is a small risk that the lung may collapse after the biopsy (pneumothorax). Let your nurse know if you suddenly feel breathless or dizzy.

 

Surgical biopsy

If it is difficult to get enough tissue using a biopsy through the skin, your doctor may do an open lung biopsy under general anaesthetic in a similar way to mediastinoscopy. Or you may have keyhole surgery (thoracoscopy) to get a biopsy.

 

Neck lymph node biopsy

If a CT scan has shown changes in the lymph nodes in your neck, your doctor may need to take a sample of cells from the lymph nodes. This checks whether any cancer cells have spread into the nodes.

You have a local anaesthetic injection into the skin over the lymph nodes. The doctor then puts a thin needle through the skin. They may use ultrasound to make sure the tip is in the right place. The doctor then sucks out a sample of cells from the lymph node with a syringe. They send the cells to the laboratory for examination under a microscope.

You can usually go home soon after this test. 

 

Getting the results

Your doctor will ask you to go back to the hospital when your test results have come through. But this is bound to take a little time, even if only a few days. This is a very anxious time for most people. You may have contact details for a lung cancer specialist nurse. You can contact them for information if you need to. 

While you are waiting for results it may help to talk to a close friend or relative about how you feel. You may want to contact a cancer support group to talk to someone who has been through the same experiences.

You can phone the Cancer research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. Our lung cancer organisations page gives details of other people who can help and support you. You can find details of counselling organisations in our counselling section. Our lung cancer reading list has information about books and leaflets about lung cancer and its treatment.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 28 March 2014