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Early diagnosis of lung cancer is difficult because symptoms do not usually occur until the disease is more advanced. You may have felt well and your diagnosis may have come as a surprise to you and your doctor. Alternatively your doctor may have picked up signs of lung cancer during a routine physical examination and then ordered tests that found lung cancer.
Certain tests need to be performed so that your doctor is be able to diagnose lung cancer. The following is a description of some of the more common tests used.
Chest X-Ray
A chest x-ray is the most common test performed when lung cancer is suspected. It uses small amounts of radiation to take a picture of the inside of your chest, including the lungs. Tumours in your lungs can be seen on a chest x-ray. Your doctor may compare old chest x-rays with recent ones to see if the tumour is growing or shrinking.
Computed Tomography (CT) Scan
Computed tomography, also known as a CAT or CT scan, is another test used to help diagnose lung cancer. It’s similar to a chest x-ray but it gives a more detailed picture of the lungs. A CAT scan can detect extremely small tumours that may not be seen on a chest x-ray. Also, it may help your doctor determine whether or not the tumour has spread into the surrounding lymph nodes or other organs.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging, or MRI, is similar to a CAT scan, but it uses magnetic fields instead of radiation to create a picture. An MRI produces clear images of your internal body parts, including tissues, muscles, nerves, and bones. Your doctor can use these images to detect the presence of a tumour and to see if it has spread.
Positron Emission Tomography (PET) Scan
Positron emission tomography, or PET scan, determines the way the body’s cells take up sugar. Normal cells take in sugar and use it to make energy. Cancer cells usually take up more sugar than normal cells. If you are going to have a PET scan, your doctor will give you a special type of sugar before the test. The PET scan will detect the presence of tumours by detecting “hot spots,” which are bright coloured areas on the picture where the sugar has been taken up by cells. The more sugar the cells take up, the more likely they are to be cancerous.
A special type of PET scan is available, which involves the use of a special sugar called fluoro-deoxyglucose (FDG). This PET scan is useful in evaluating the extent of your cancer. The more FDG that is taken up by your lung tissues the more likely it is that the cancer is at an advanced stage. A PET scan using FDG is more accurate in determining the stage of your cancer than a CAT scan.
Sputum Cytology
In this test, your sputum (or mucous that is coughed up) is collected and examined under the microscope to look for cancer cells. The most accurate way to do this test is to collect and analyse early morning mucus for three days.
Biopsy
Scans allow your doctor to visualise the inside of your body to see a tumour but do not test the actual tumour for the type of cancer cells present. Therefore, these scans do not provide absolute proof that you have cancer. To confirm the presence of cancer, a sample of the tumour, or a biopsy, is necessary, which is then examined under the microscope. Biopsies can be obtained in several different ways depending on the location and the size of a tumour. Below are different ways a biopsy can be taken.
Procedures for Biopsy
Bronchoscopy
- Bronchoscopy allows the doctor to look at the inside of the lungs and airways. It is a procedure in which a hollow tube, called a bronchoscope, is inserted into the mouth, down the trachea, and into the airways
- A small camera on the end of the bronchoscope takes pictures and sends them back to a monitor so the doctor can see the airways
- There is also a small tool at the end of the tube, which is used to remove samples of tissue to check for presence of a tumour.
Transthoracic Needle Aspiration (TTNA)
- A needle is inserted through your chest wallto take a sample of tissue
- This test is used to take samples from tumours close to the chest wall.
Cervical Mediastinoscopy
- A small tube is passed through an incision at the top of the breastbone, in front of the trachea and into the mediastinum. A small camera at the end of the tube allows the doctor to see the lungs. A small tool is passed through the tube so it can take samples to detect the presence of a tumour or cancerous lymph nodes
- This technique is often used to biopsy lymph nodes around the lungs.
Endoscopic Lymph Node Biopsy
- A small tube is passed through your mouth and into the oesophagus. A small camera at the end of the tube allows the doctor to see the tissues. A small tool is passed through the tube so that it can take tissue samples of nearby lymph nodes.
Video-assisted Thoracoscopy (VATS)
- A tube containing a small television camera is inserted between your ribs through a small incision in the skin. This allows the doctor to look for a tumour. · This procedure also allows your doctor to remove a larger portion of the tumour for examination.
Exploratory Thoracotomy
- This is a surgical procedure where the doctor opens the chest to visually examine and remove the tumour
- If other biopsy techniques have failed, your doctor may use this procedure to remove the tumour and have it checked for cancer.
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