Tests and Investigations

Tests and Investigations

Tests and investigations help to find out a number of different things, such as:

• if you have cancer
• if you do have cancer, what type, how far it has spread (its stage) and where it is
• what treatment you need
• how well your cancer is responding to treatment
• whether cancer remains after you have finished a course of treatment.

Most tests and investigations are carried out during an outpatient visit to the hospital. Many involve a short appointment with a specialist. You may have a range of tests and investigations at the same appointment. The choice of tests will vary according to your situation.

The main investigations performed are:

CT Scan

CT stands for computerised tomography. This is usually performed in Bournemouth. A CT scan, also known as a CAT scan, is a specialised X-ray test. It can give quite clear pictures of the inside of your body to give a more 3-dimentional view. In particular, it can give good pictures of soft tissues of the body which do not show on ordinary X-ray pictures. It will show possible cancer, its size and whether it has spread.

PET Scans

These are provided at Poole Hospital. Positron emission tomography (PET) scans are used to produce enhanced scan in addition to the CT scan. It includes an injection of a sugar-molecule with a small amount of radio-activity which shows which areas are active. It gives additional information to help the diagnosis and management. An advantage of a PET scan is that it can show how well certain parts of your body are working, rather that showing what it looks like. They're particularly helpful for investigating confirmed cases of cancer to determine how far the cancer has spread and how well it's responding to treatment.

Bronchoscopy

Bronchoscopy is a procedure that allows the doctor to examine your trachea(windpipe), bronchi (branches of the airway) and some areas of the lung. A short thin flexible tube with a mini camera built into its tip, called a 'bronchoscope', is used for this procedure. The bronchoscope is usually passed through your mouth, into your trachea and bronchi. The doctor can then get a clear view of your airways. During the procedure, the doctor may take samples of tissue (biopsy) or respiratory secretions for examination in the laboratory. It is usually performed as an outpatient but as you are sedated you will need a responsible adult available at home and cannot drive yourself for 24hrs.

Endobronchial Ultrasound

An EBUS is a procedure that allows the doctor to look into your lungs (similar to a bronchoscopy) but them to take samples of the glands in the centre of your chest (mediastinum) using the aid of an ultrasound scan, these glands lie outside the normal breathing tubes (bronchi).

Pleural Aspiration

Pleural aspiration is a procedure to remove fluid from the chest. In some conditions, fluid can collect between the outside of the lung and the chest wall which may make it difficult to breathe. In this event a pleural aspiration can be performed to relieve breathlessness. Pleural aspiration is also used to obtain samples of fluid, which can be tested to try and find out what has caused the problem. An ultrasound is performed at the same time to guide the procedure. This is usually carried out by one of the senior chest physicians and can be done as an outpatient.

Thoracoscopy

This may be carried out either at Poole (under sedation) or Southampton (General anaesthetic). A thoracoscopy is an examination of the inside of your chest cavity. The pleura (linings of the lung and the chest wall cavity), diaphragm (the large breathing muscle that separates the chest from the abdomen), and the outside edge of the lung will be seen. The thoracoscope is a long thin rod, about as thick as a pencil, with a bright light at the end. The thoracoscopist can take samples, such as biopsies (small piece of tissue) from the lining chest wall pleura, to help gain more information about your medical condition. They may also spray a substance (Talc) to seal the space and stop the fluid coming back. This usually involves being in hospital for a few days.

Lung cancer team

Information coming soon

About Your Appointment

You will be given an appointment within two weeks of us receiving your referral. It is important you come to this appointment as your GP has identified that you need to be seen urgently within the "fast track" scheme.

At this appointment you will be seen by a senior Chest Physician (Consultant, registrar or clinical assistant) who will review your symptoms, previous medical conditions and explain the plan for further investigations and any treatment proposed.

Additional tests including X-rays, heart tracings and breathing tests are commonly undertaken during this appointment so you may be in the department for up to 2 hours. The consultant may have already requested a CT scan which will be performed on a separate date.

Please make sure you bring a list of any medicines that you take. You may also want to bring a friend or relative with you, to help you remember the information you are given. If you have any questions, write them down and bring them with you.

Changing Your Appointment

If you need to cancel or change your appointment, please tell us as soon as possible using the number 01202 704859 so we can offer your appointment to another patient.

After your Appointment

After every outpatient appointment, your doctor will write a letter to your GP to keep them informed of your care. Please ask the doctor or nurse if you would like a copy of this letter. If lung cancer is confirmed you will meet with the lung cancer nurse specialist who will give you further written information.

If You Need Treatment

The treatment you are offered depends on the type of cancer, where it is, whether it has spread outside the lung, what symptoms you have and other medical problems you have. You will be offered the treatments which are thought to be best for you are the multi-disciplinary review.

Treatments for lung cancer includes curative or diagnostic surgery, radiotherapy or chemotherapy, or a combination of these or Best Supportive care (symptom control).

Most lung cancers are not operable but if you are offered surgery this is usually performed at Southampton in the Regional centre. Chemotherapy is provided in the Haematology and Oncology Day Unit in the Jigsaw Building at Bournemouth Hospital and Radiotherapy is provided by Poole Hospital.

We are always trying to develop the treatment of lung cancer. Your consultant may invite you to be part of a study or clinical trial. If so, your consultant will give you full details about the clinical trial. There will be plenty of time to talk about it with your doctors and our Research Nurses.

If you need to stay in hospital for investigation or management of your symptoms, your doctors will try to get you a bed in either Ward 2 or Ward 3 which are our Respiratory Wards.

After your course of treatment finishes, the doctors and nurses will offer to see you regularly to monitor your progress. They will discuss this with you.

Lung Cancer Support

If you are diagnosed with lung cancer or mesothelioma, the lung cancer nurse specialists who are available to provide you and your loved ones with advice, information and support throughout your treatment. They will give you the opportunity to discuss your diagnosis and any concerns you may have and can liaise with all the key people involved in your care.

Support is offered in a variety of formats including telephone consultations and Nurse led Clinics.

The Lung Cancer Nurse Specialists also facilitate a local Support Group where you can meet other patients and carers.

Lung Cancer

The aim of the lung cancer multidisciplinary team is provide a high quality multi-professional approach offering individualized care to diagnose and manage all patients with lung cancer.

Symptoms

If your GP thinks your symptoms may be due to lung cancer, you will be given an appointment to see one of our specialists within two weeks. This is called the "fast track system".

It is important to remember that these symptoms can be caused by conditions other than cancer. However, if you are experiencing any of these symptoms you should see your GP who may refer you for further investigation.

Symptoms of Lung Cancer

• a persistent or worsening cough
• coughing up phlegm that has blood in it
• repeated chest infections that do not respond to antibiotics
• facial and/or neck swelling
• breathlessness
• pain on coughing or breathing
• a hoarse voice
• loss of appetite or unexplained weight loss
• extreme tiredness or fatigue.

Lung Cancer

Lung cancer affects the lungs and airways connected to the lungs. There are two main types of primary lung cancer, which behave and respond to treatment differently:

• small cell lung cancer (SCLC)
• non-small cell lung cancer (NSCLC)

A less common type of lung cancer is called mesothelioma. This type of cancer affects the membrane which covers the surface of the lungs and lines the inside of the chest. It occurs in people who have been exposed to asbestos.

Lung cancer can start in the lungs (primary lung cancer) and can also spread to other areas of the body (secondary tumour or metastasis).

Making the diagnosis will include a full clinical assessment, targeted investigations and a review of the results by the Multi-disciplinary team.

Treatment options depend on the type of cancer, where it is, whether it has spread outside the lung, what symptoms you have and other medical problems you have.