Lung Cancer tests

There are many different tests and procedures that help doctors diagnose lung cancer, as well as finding out the best way to treat it. 

In this section, we’ll explain some of the most common tests, including:

• Chest x-ray
• CT scan (computerised tomography)
• Bronchoscopy
• PET scan (positron emission tomography)
• CT guided biopsies
• Endobronchial ultrasound (EBUS)
• Mediastinoscopy.

As everyone’s situation is different and everyone is treated as an individual, you might not need all of these tests. Your doctor will choose the most appropriate tests for you. If you have any questions or concerns, make sure you share them with your lung cancer team.

Chest x-rays

If your GP has any concerns about lung cancer, one of the first tests they may send you for is a chest x-ray. An x-ray takes pictures of the body’s internal structures and can sometimes show abnormalities such as inflammation, infection or growths. 

CT scan

A CT scan takes detailed, three-dimensional images of the inside of the body. These scans can help doctors check your cancer’s position and possible spread to other organs, and if it is affecting any lymph nodes or blood vessels. Sometimes an injection of a contrast dye is given to help highlight some of the blood vessels around the heart and chest.

During the scan, you’ll usually lie on your back on a flatbed that passes into the CT scanner. Simply put, the scanner is made up of a large rotating ring that moves around your body as you pass through it. It isn’t a tube so doesn’t surround your whole body at once, and you shouldn’t feel boxed in.

Bronchoscopy

A narrow flexible tube with a tiny camera on the front will be inserted through your nose or mouth and down into your lungs. This allows doctors to examine, photograph and, if any abnormal areas are seen, take a tiny sample of tissue (biopsy) from inside your lungs and airways.

Before this test, your throat will be sprayed to make it numb and a relaxing sedative will be given to you. Some people find the procedure a bit uncomfortable, and it may leave you with a sore throat for a few days. 

CT guided biopsy 

This procedure allows doctors get very accurate tissue or fluid samples from inside your lungs and airways. 

A doctor will pass a thin, hollow needle through the chest wall and into the lung and use a CT scan to guide the needle into the correct position to allow the biopsy to be taken. The biopsy can then be tested for cancer. 

MRI scan

MRI scans are similar to CT scans, but they use strong magnetic fields and radio waves instead of X-rays. This procedure is very safe and most people can have it, including pregnant women (though if you are pregnant you should let staff know).

An MRI scanner is a short cylinder, open at both ends. You will lie on a motorised bed that is moved inside the scanner. When it is working, the scanner makes loud tapping noises. This is just parts of the machine being turned on and off. 

You’ll either be given earplugs or headphones to wear so you can listen to music while the scan takes place. The scan can take up to an hour to complete. 

PET scan

PET scans show where there is active cancer in the body. This type of scan can also be used to investigate a suspected cancer if diagnosis has not been possible using other tests. The scan is painless and quiet. 

They are often used before lung cancer surgery and radical radiotherapy to make sure that curative treatment is possible.

You will be given an injection of a special dye, called a radiotracer, about an hour before the scan. This dye highlights active cancer cells. Though it is a radioactive chemical, it is considered safe to use and any radiation that your body receives is very small. 

Ultrasound 

An ultrasound is a painless scan that uses soundwaves to create an image of the inside of your body. It is frequently used to pinpoint fluid in the lung. Doctors can also use it to help them use a fine needle to get fluid samples from lymph nodes in the neck and near the collar bone (clavicle).

Endobronchial ultrasounds (EBUS) 

The test uses an ultrasound scanner to allow the doctor to look into your lungs and take samples to see if the cancer has spread. This procedure is not painful but you may have a sore throat for a few days.

A narrow flexible tube, called an endoscope, with a tiny ultrasound machine on the end is inserted through your mouth into your airways. Using the ultrasound to guide them, the doctor is able to identify the lymph nodes in the centre of the chest (mediastinum) or other areas of the lung that they want to test. 

A needle is then passed down the tube and through the wall of the airway into part of the lung to take samples of tissue for testing. This is known as transbronchial needle aspiration (TBNA). 

The needle may also be passed through the wall of the airway into the lymph nodes to take a sample of lymph fluid. This is known as fine needle aspiration (FNA). 

Thoracoscopy

This procedure involves a thin, flexible viewing tube, called a thoracoscope, being inserted through a small incision in the chest. The thoracoscope allows a doctor to look inside your chest at your lungs, the area between the lungs (mediastinum), and the membrane covering the lungs and lining the chest cavity (pleura). The doctor can also take tissue samples for testing.

Aspiration of pleural effusion

If you are experiencing a cough, shortness of breath or chest pain, your doctor may look to do a pleural aspiration. This will help them identify why there is fluid around the lung as this could be causing symptoms.

A needle or tube is inserted into the space between the lung and chest wall to remove fluid that has accumulated around the lung. 

Blood tests 

It is fairly standard to have a blood tests as this can help find out about your general health and possible spread of lung cancer. Blood tests can also check:

• how well your liver and kidneys are working 
• your body’s biochemical balance (for example, checking there is enough calcium and protein)
• any current infection or susceptibility to new infection
• low circulating oxygen level caused by anaemia 
• if you bruise or bleed easily.

Bone scan

A bone scan can help determine if lung cancer has spread to the bones.

Bone scans use a small amount of radioactive material, which is injected into a vein to highlight any areas of the bones that have been affected by cancer, trauma, or inflammation. 

Lung function test 

A lung function test checks how well your lungs are working, how much air you can breathe in and out, and how much oxygen your lungs can absorb. It is a simple test which usually involve blowing into a mouthpiece.

These tests may help decide if you are fit enough for surgery or radiotherapy, or if you have any ongoing lung conditions, such as emphysema. 

Lung perfusion scan 

These scans produce a picture of blood flow to and around the lungs and can help assess how the cancer is affecting your lungs. 

A small amount of radioactive material, called an isotope, is injected into a vein in your hand or arm. You will then be positioned under a special camera that can detect the isotope in the blood vessels in your chest and lungs and a series of photographs are taken. 

Mediastinoscopy

A mediastinoscopy is a surgical procedure used for examining lymph nodes under the breastbone (sternum). 

For this test, you would need a general anaesthetic and a short stay in hospital. It may leave a small scar. Your doctor may want to do this procedure to make sure your cancer is suitable for surgery.