Further tests for lung cancer

If your tests show you have lung cancer, you may need further tests to see if the cancer has spread. These tests also help your doctor to decide on the best treatment for you. If you have not already had one you may have a PET-CT scan. Or you may have one or more of the tests below.

Doctors call this test an EBUS. 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 and create 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 enlarged lymph nodes or any lung tissue that looks abnormal. They call this a transbronchial needle aspiration (TBNA). This test usually takes less than half an hour.

Doctors call this test an EUS. You may have the test under a general anaesthetic or may have medicine to make you drowsy. The doctor gently puts a long, flexible tube with an ultrasound probe down your throat and food pipe (oesophagus). This creates ultrasound pictures of the area around the heart and lungs. So it can help to show if the cancer has spread into any lymph glands at the centre of the chest.

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

Doctors may use a thoracoscopy test instead of an endobronchial ultrasound scan or an endoscopic ultrasound scan to

• Find the cause of fluid on the lung (pleural effusion)
• Take tissue samples from the lung
• Take tissue samples from lymph nodes in the centre of the chest (mediastinum)

You have this test under sedation or sometimes a general anaesthetic. You will probably have about 2 or 3 cuts (incisions) in your chest on the side the doctor is checking. The doctor puts a thin, flexible tube into the cut. Through the tube, the doctor looks for anything abnormal and can take tissue samples (biopsies), or suck out a sample of fluid. They send the biopsies and fluid sample to the lab to be checked for cancer cells.

After the test, you usually have a tube into your chest (a chest drain) for up to a couple of days. The tube allows any fluid to drain out and the lung to fully expand. You may have gentle suction on the tube to help this happen. You will need to stay in hospital while you have the drain in.

This test examines the mediastinum. The mediastinum is an area in the centre of your chest, between your lungs, which contains

• The heart
• Main blood vessels
• Lymph nodes

You have to have a general anaesthetic for this test and so may have to stay in hospital for at least one night. The doctor makes a small cut at the base of the neck, and puts a small, flexible tube through the cut and into the mediastinum. The doctor can look through this tube to examine the area and can take tissue samples. The samples are examined under a microscope, to see if there are any cancer cells there.

When you wake up, you will have a small dressing over the cut where the tube was put in. Don't be afraid to say if you are feeling sore. Your nurses will give you painkillers. Once you have got over the anaesthetic, you will be able to go home. This will probably be the day after the test.

You might have an ultrasound scan of your liver to see whether there is any sign of cancer there. An ultrasound uses sound waves to build up a picture of the inside of the body. It is painless and doesn't take long (probably less than half an hour). There is information about having an ultrasound scan in the cancer tests section.

A bone scan looks for signs of bone damage. The damage could be caused by wear and tear, arthritis, or cancer that has spread to the bones. Doctors use this test to check for any signs that the lung cancer has spread to the bone. There is information about having a bone scan in the cancer tests section.

With some types of lung cancer there is a chance that the cancer may spread to the brain. Your doctor may ask you to have a brain scan with either a CT scan or an MRI scan. The scans are painless and harmless. But MRI scans are very noisy and both scans involve you laying inside the scanner for some time. 

If you are claustrophobic, do tell your doctor as you may want to have a sedative and this needs to be organised in advance. You will have an injection of dye before the scan to help show up any abnormal areas. There is information about these tests in the cancer tests section.

MRI scans build up pictures of an area of the body using magnetic fields. They are not often used for lung cancer unless the cancer is very close to the top of the lung. Cancers in this area are called pancoast tumours. You might also have an MRI scan if your doctor thinks that the lung cancer cells could have spread into the ribs or spine. There is detailed information about having an MRI scan in the cancer tests section.

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. While you are waiting for results it may help to talk to your specialist nurse, or a close friend or relative about how you are feeling. Or 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 people who can help and support you. They can put you in touch with a cancer support group. 

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 CancerChat, our online forum. Or go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.