Investigations and diagnosis

As part of the pathway for diagnosis and management of lung cancer, it may be necessary to be sent for a number of investigations. These investigations allow doctors to make a diagnosis and plan the best treatment options for you.

Diagnostic investigations may include:

• CT scan – a series of x-rays are taken to build up a three-dimensional picture of inside the body. The CT scan produces detailed images of many structures inside the body, including internal organs, bones and blood vessels. CT stands for Computer Tomography.
• PET CT scan – this is a more detailed scan. A PET-CT scan combines images from a positron emission tomography (PET) scan and a computed tomography (CT) scan that have been performed at the same time using the same machine.
• Bronchoscopy – this allows the doctor to examine, photograph, and when possible, take a tiny sample (biopsy) of tissue from the inside of your lungs/airways using a scope (small camera).
• 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 doctor will freeze the area for the procedure.
• Neck lymph node ultrasound and biopsy – the doctor uses an ultrasound scanner to help them take a small amount of lymph node tissue using a fine needle. The area will be numbed for the procedure.
• Testing for gene mutations – some lung cancer cells have changes (mutations) in their genes and proteins that make cancer grow and divide. The same tissue biopsy used to make the original diagnosis of lung cancer often has enough left-over cancer cells to do the molecular analysis to check for mutations. The most common mutations of non-small lung cancer are called:
  • the epidermal growth factor (EGFR) gene
  • the anaplastic lymphoma kinase (ALK) gene

Staging and grading of lung cancer

Your cancer specialist needs certain information about the cancer to decide on the most appropriate treatment for you. This includes the stage and grade of the cancer. The stage of a cancer describes its size, position and whether it has spread beyond the area of the body where it started.

For more information on the staging and grading of lung cancer visit the Macmillan Cancer Support website.

Results

The results of your tests, scans and investigations will be discussed at the lung cancer multi-disciplinary team (MDT) meeting. The MDT is a well-established group of specialists comprising of doctors, nurses, radiographers and other healthcare professionals who manage the treatment of lung cancers. The MDT ensures treatment options are discussed by all the experts and that decisions are agreed on an individual basis. The team will review all aspects of your care and recommend an appropriate treatment plan. A member of the team will discuss this with you.

A Lung Cancer Clinical Nurse Specialist is available to provide support and advice to you, your family and carers.

Macmillan Lung Cancer Nurse Specialists

The Macmillan Lung Cancer Nurses are specialist nurses based at Antrim Area Hospital and Causeway Hospital. They work in partnership with the respiratory, oncology and palliative care team, in hospital and community, and work closely with other health care professionals.

The Lung Cancer Nurse Specialists provide advice on symptom control, emotional support, and information and advice on all aspects of lung cancer to patients, families and carers, from the time of diagnosis, during and on completion of treatment.

They also support patients and families when their condition is palliative and work closely with community teams including GPs, District Nurses and the Specialist Palliative Care Team. The lung cancer nurses are available at respiratory and oncology clinics to provide support.

As part of the lung cancer pathway in the Northern Health and Social Care Trust the lung cancer nurses and other health care professionals deliver a Macmillan Pulmonary Prehabilitation Self-Management Programme for people diagnosed with lung cancer. The aim of the programme is to support people and their families and carers to prepare for potential treatments, and to help them achieve maximum benefit through physical activity, dietary support and psychological wellbeing. The team also facilitate a support group for patients and families.

Referrals can be made by the lung cancer nurse to other useful sources of help. These include counselling, complementary therapies or Macmillan Benefits Advice Service, which provides information on financial issues.