Lung cancer is diagnosed by several different methods and investigation is prompted as a result of routine x rays, or investigation due to persistent coughing or coughing up blood. This obviously needs to be confirmed so a variety of diagnostic tools can be used. Typically, diagnostic tools and procedures include:
CT Scan
PET Scan
Bronchoscopy
Needle Biopsy
Surgical biopsy
These tests may be used in isolation but usually they are applied in combination, including using all of them.
CT Scan
CT stands for Computed Tomography and uses x rays to provide an anatomic detail of the patient. It is non invasive and is risk free and pain free.
PET Scan
PET stands for Positron Emission Tomography and is a non invasive diagnostic tool which looks at the metabolic activity which is occurring in the patient’s body. Cancer is metabolically active and stands out amongst tissue which is less so. PET Scans are an excellent tool for determining whether the abnormality is cancerous (or malignant).
The procedure involves an injection of a glucose solution which is laced with a mildly radioactive tracer. The metabolically active cancer uses glucose to grow and takes it up so it is highlighted when we perform the scan. Typically, the results of the PET Scan are fused with those of the CT Scan to identify exactly where the metabolic activity is taking place within the lungs. As the lungs are primarily composed of air, this is metabolically inert so the tumor will immediately stand out, if indeed there is one. You should know that areas of the lungs which are inflamed or infected are also metabolically active, so a positive PET Scan does not mean you have lung cancer.
Bronchoscopy
This is a minimally invasive surgical procedure whereby a flexible fiber optic tool is passed down into the major airways. This involves passing a flexible tube down through either the nose of the mouth and then washings or biopsies can be taken for further analysis.
Needle Biopsy
Here a surgeon will use a CT Scan to direct them in the insertion of a needle into the abnormality’s location within the lung. The needle is used to remove some of the tissue associated with the abnormality and is then subjected to further analysis to determine whether it is cancer and malignant.
Surgical Biopsy
When a tumor is in an inaccessible location or is perhaps, too small to allow a needle biopsy to take place, then a surgical biopsy is required. This involves an incision between two ribs and the removal of part of the lung tissue upon which the tumor is located. Once removed, the tissue is analyzed further at the pathology lab to determine its origin.
Post Diagnosis: “Staging”
Once a diagnosis of lung cancer has been confirmed the next step in the process is to determine what stage of the disease the patient has. Staging refers to how much cancer the patient has actually got and the location within their body of a tumor or tumors. By staging the cancer, your doctor is able to determine the most appropriate course of treatment depending on whether the tumor size (T), whether it has spread to the lymp nodes (N) and whether it has spread elsewhere within the body or metastasized (M).
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