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Tests to Determine Tumour Growth

Other tests used in diagnosing lung cancer include those that look directly inside the body (rather than from the outside, as with imaging tests), transferring images to a video screen for identification by specialised medical professionals. Biopsy samples may also be collected during these procedures. Some of the tests are described below.

Bronchoscopy

This test uses a “scope” (a flexible tube with the capacity to reflect and transfer images) which is passed directly down the trachea (windpipe) and into the various pathways of the bronchus (airway tubes leading into the lungs). The images seen by the bronchoscope are transferred to a screen, from which doctors can examine any areas of tumour growth, bleeding, dryness or excess fluid production. A biopsy may be taken using a very small, fine, scissor-like attachment found on the bronchoscope.

Prior to this examination, a local anaesthetic is sprayed on the back of the throat to allow the tube to be passed down without resistance from the patient. While this test is often uncomfortable, it is not painful.

Endobronchial ultrasound (EBUS)

An EBUS is a type of bronchoscopy procedure that allows the doctor to examine and take tissue samples trhough the airways (bronchi) and windpipe (trachea).  Samples may be taken from an adjacent tumour or lymph node. The doctor uses a bronchoscope with a small untrasound probe on the end.  The bronchoscope is put down the throat into the trachea.  The ultrasound probe uses sound waves to create a pitcure of the body and measure the size and position of the tumour.

Mediastinoscopy

This procedure is done under general anaesthetic and requires the expertise of a specialist cardiac surgeon. A small cut is made in the front of the neck and a tube is passed down the outside of the trachea (windpipe) so that the area surrounding the lungs (the mediastinum space) can be examined. In particular, the lymph nodes in the chest area are inspected and a biopsy may be taken to check for abnormal cells. Images are also seen via mediastinoscopy, with pictures transferred to a video screen.

Video-assisted thoracoscopic surgery

This is similar to mediastinoscopy, except that small cuts are made in the chest (rather than one cut in the neck) so the doctor can view areas surrounding the lungs and the outside of the lung themselves.

Thoracotomy

This is an operation performed by a surgeon under general anaesthetic and is usually done if other tests fail to provide a diagnosis. The surgery can be performed in two ways, either:

  • the surgeon makes some small cuts in your chest and inserts a small camera and a surgical instrument called a thoracoscope: or
  • the surgeon opens the chest cavity through a larger cut on the back.  A tumour may be removed during this procedure.

You will probably be required to stay in hospital for a few days after the surgery to recover.

Gene mutation testing

Within each type of lung cancer there are subtypes.  Several lung cancer subtypes can be classified by changes and mutations to specific genes.

By testing for these gene mutations your doctor can tailor your treatment regime for the best outcome.  For example, from clinical trials, we know that some NSCLC patients with certain mutuations can significanlty benefit from tageted therapies while patients without these mutations gain more benefit from standard chemotherapy.

For your cancer to be mutatuion tested, your doctor will require a tissue biopsy sample.