Getting diagnosed with lung cancer

Tests for lung cancer

You usually have several tests to check for lung cancer. This might include all or some of the following:

a chest x-ray
CT or MRI scans
a liquid biopsy
a bronchoscopy
ultrasound scans
biopsies

Tests your GP might do

Most people start by seeing their GP. They can do some tests to help them decide whether you need a referral to a specialist. Your GP might send you for a chest x-ray.

Chest x-ray

A chest x-ray is a test that can help to diagnose lung cancer.

X-rays use high energy rays to take pictures of the inside of your body. They can show up changes in the lungs. Changes can be due to cancer but can also be caused by other lung conditions.

If you have symptoms that could be caused by lung cancer, your doctor will arrange for you to have a chest x-ray.

Tests your specialist might do

Depending on the results of your tests, your GP might refer you to a specialist. You might see a doctor specialising in breathing problems (respiratory physician) first. They usually do all the necessary tests until you have a diagnosis. If it is lung cancer, and it can’t be removed with surgery, they will refer you to a medical oncologist for lung cancer. This is a doctor who specialises in lung cancer.

The tests the specialists might do include:

CT scan with contrast
liquid biopsy
PET-CT scan
bronchoscopy
needle biopsy through the skin
surgical biopsy
neck lymph node ultrasound and biopsy
endobronchial ultrasound (EBUS-TBNA)
endoscopic ultrasound
mediastinoscopy
testing for gene mutations in lung cancer
bone scan
ultrasound
MRI

CT scan with contrast

A CT scan is a test that uses x-rays and a computer to create detailed pictures of the inside of your body. It takes pictures from different angles. The computer puts them together to make a 3 dimensional (3D) image. CT (or CAT) stands for computed (axial) tomography.

Doctors can use a CT scan to look for lung cancer. It can help them to:

diagnose and lung cancer
check whether cancer has spread to the liver, , lower part of the neck or in the chest

Find out about having a CT scan

Liquid biopsy

A liquid biopsy is a blood test that looks for tiny pieces of lung cancer in the blood. Cancers often release pieces of DNA into the bloodstream. This is also called circulating tumour DNA (ctDNA).

You may have this test if a CT scan showed that you might have lung cancer.

This test helps your doctor to:

understand more about the changes (mutations) of your cancer, in genes such as EGFR, ALK and K-RAS
decide on the best treatment for your cancer
start your targeted treatment sooner

Most people still need a biopsy after this test.

Sometimes it’s not possible to use a tissue biopsy. This can be when:

your doctor can’t take a sample because of where the cancer is
the sample isn’t suitable for testing

In these situations, the results from the liquid biopsy are enough to make decisions about your treatment and for you to start treatment.

A liquid biopsy is approved as a test for lung cancer in England. You may be able to have it at some hospitals in Wales as part of a research programme.

PET-CT scan

A PET-CT scan combines a CT scan and a PET scan. PET stands for positron emission tomography. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal.

A CT scan takes a series of x-rays from all around your body and puts them together to create a 3 dimensional (3D) picture.

A PET-CT scan for lung cancer can help to:

show exactly where the cancer is in your lung
see whether it has spread elsewhere in the body and to lymph nodes in the chest
know how aggressive the cancer is
decide which is the best treatment for your cancer
check whether your cancer has come back
plan radiotherapy treatment
show how well a cancer treatment is working

Bronchoscopy

A bronchoscopy is a test to look at the inside of the breathing tubes (airways) in your lungs.

You might have this test to allow your doctor to:

look for the cause of your symptoms
help your doctor see any areas that look abnormal on an x-ray or scans
take samples of cells

These samples might be a tissue sample called a biopsy. Or your doctor might take some cells with a small brush or a liquid to collect them.

Needle biopsy through the skin

This test is called a percutaneous lung biopsy. Your doctor takes a sample of lung tissue by passing a needle into the lung.

You might have this test if your doctor has seen an abnormal looking area in your lung or airways using a CT scan.

Find out about having a needle biopsy

Surgical biopsy

A surgical biopsy of the lung can help diagnose lung cancer. The surgeon carries out your biopsy in one of the following ways:

keyhole surgery, also called video assisted thoracoscopic surgery (VATS)
open surgery, through a small cut in the chest wall (small thoracotomy)

You might have this test if:

a CT scan has shown an abnormal area in your lung or airways
the area is difficult to sample, because of its position

Neck lymph node ultrasound and biopsy

Ultrasound scans use high frequency sound waves to create a picture of a part of the body. The ultrasound scanner has a microphone that gives off sound waves. The sound waves bounce off the structures inside your body, and the microphone picks them up. The microphone links to a computer that turns the sound waves into a picture.

You might have this test if your doctor has seen changes in the lymph nodes in your neck on a CT scan. It can find out if there are cancer cells in the lymph nodes.

Your doctor uses an ultrasound scanner to help them take a small amount of lymph node tissue using a fine needle.

Find out about having a neck lymph node ultrasound and biopsy

Endobronchial ultrasound (EBUS-TBNA)

An endobronchial ultrasound for lung cancer is also called Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA). This test uses a narrow flexible tube to look at the inside of the breathing tubes (airways) in your lungs. The tube has an ultrasound probe. It uses high frequency sound waves to create pictures of the lungs and structures outside the airway walls, such as the lymph nodes.

Your doctor can see any areas that look abnormal and take samples (biopsies) to test.

This test can show if an abnormal looking area is lung cancer and the size of the tumour. It can also show if the cancer has spread into other lung areas or outside the lung.

Endoscopic ultrasound

This test combines ultrasound and endoscopy to look at the areas around your food pipe. The main airway (wind pipe) is close to the food pipe.

To do the test your doctor uses a long flexible tube called an endoscope. It has a tiny camera and light on the end and an ultrasound probe attached. The ultrasound scan uses high frequency sound waves to create a picture of the inside of your body.

An endoscopic ultrasound can check whether lung cancer has spread into the lymph nodes in the centre of the chest close to the windpipe.

Find out more about having an endoscopic ultrasound

Mediastinoscopy

Mediastinoscopy is a test where your doctor makes a small cut at the lower part of your neck. They then put a long, thin, flexible tube called a mediastinoscope through the cut and into the mediastinum. The mediastinum is the centre of your chest and area between your lungs. It contains:

the heart
the main blood vessels
lymph nodes (glands)
the food pipe (oesophagus)

A camera at the end of the tube connects to a large screen so the doctor can see pictures of the inside of your chest. They can examine the area between your lungs and take tissue samples (biopsies) if needed.

You might have this test to see if cancer cells have spread into the lymph nodes around the windpipe.

Testing for gene mutations in lung cancer

Some lung cancers, such as non small cell lung cancer have changes in particular genes and proteins. These changes can be used as targets for specific drug treatments.

Genes are found on chromosomes within all cells. They tell the cell which proteins to make.

Scientists can look at lung cancer samples in the laboratory and search for gene changes (mutations) that change how the cancer grows.

Doctors use this information to plan the best treatment based on the genetic type of the cancer. This is called targeted cancer treatment or personalised therapy.

Gene changes in lung cancer

Some non small cell lung cancers have changes in genes that make the cancer grow and divide. This includes the:

KRAS gene
epidermal growth factor receptor (EGFR) gene
anaplastic lymphoma kinase (ALK) gene
BRAF gene
mesenchymal-epithelial transition (MET) gene
neurotrophic tyrosine receptor kinase (NTRK) gene
ROS1 gene
RET gene

Non small cell lung cancer cells can also have a higher than normal amount of PD-L1 proteins. PD-L1 proteins are also found on normal cells.

Your doctor might test for changes in one or more of these genes before you start treatment.

To have these tests, your cancer must be a non small cell lung cancer that has spread into the area around the lung or elsewhere in the body (an advanced cancer). Or you might have this test as part of a clinical trial.

The genetic mutation test

Doctors look for gene mutations in a tissue sample, usually taken during a needle biopsy. They use a sample they already have from your original cancer tests. Or they might use a biopsy from your operation if you had one. The testing is done in the laboratory.

Another test that looks for gene changes in cells is the FISH test. FISH stands for fluorescence in situ hybridisation.

Find out more about FISH testing

Research has found that some targeted cancer drugs work well for some people with certain gene mutations in non small cell lung cancer. These drugs change the way that cells work, and they help the body control the growth of cancer.

Find out about targeted cancer drugs

Find out about clinical trials for targeted lung cancer drugs

Bone scan

A bone scan is less often used nowadays to check for changes in your bones. You might instead have a PET or CT scan.

A bone scan can show changes or abnormalities in the bones. It is also called:

a radionuclide scan
bone scintigraphy
nuclear medicine bone scan

A bone scan can look at a particular joint or bone. In cancer it is more usual to scan the whole body.

A large camera (called a gamma camera) scans you and picks up radioactivity.

If there are changes on the scan, they may be called hot spots. These are not always cancer. Bone changes can happen for other reasons, like arthritis. You might need a CT scan to know exactly where these abnormal areas are.

Your specialist might ask you to have a bone scan to help work out whether your lung cancer has spread.

Ultrasound

You might have an ultrasound scan to look at organs in the abdomen, such as your adrenal glands or liver.

The ultrasound scanner has a microphone that gives off sound waves. The sound waves bounce off the organs inside your body, and the microphone picks them up. The microphone links to a computer that turns the sound waves into a picture on the screen.

Your specialist might ask you to have an ultrasound scan to see if your lung cancer has spread.

Find out more about having an ultrasound scan

MRI

An MRI is a scan that creates pictures using magnetism and radio waves. MRI scans produce pictures from angles all around the body and clearly show soft tissues. MRI stands for magnetic resonance imaging.

Doctors use an MRI scan to check whether:

lung cancer has spread to the brain
Pancoast tumours (superior sulcus tumours), a very rare type of lung cancer, have spread to a big nerve that goes into the arm (the brachial plexus), blood vessels or the spine

Treatment

The tests you have helps your doctor find out if you have lung cancer and how far it has grown. This is the stage of the cancer.

Read about the stages of lung cancer

This is important because doctors recommend your treatment according to the stage of the cancer.

Find out about the treatments for lung cancer

Coping with lung cancer

Coping with a diagnosis of lung cancer can be difficult. There is help and support available to help you and your family.

What is lung cancer?

Lung cancer starts in the windpipe (trachea), the main airway (bronchus) or the lung tissue. Cancer that starts in the lung is called primary lung cancer.

Symptoms of lung cancer

Lung cancer doesn't always cause symptoms in its early stages. Symptoms can include a cough that won't go away, coughing up blood and breathlessness.

Stages and types of lung cancer

The stage of a cancer tells you how big it is and whether it has spread. The type tells which type of cell the cancer started from.

Survival for lung cancer

Survival depends on many factors including the stage and type of your lung cancer.

Treatment for lung cancer

Your treatment depends on several factors. These include what type of lung cancer you have, how big it is and whether it has spread (the stage). It also depends on your general health.

Lung cancer main page