Lung Cancer: Tests After Diagnosis
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Lung Cancer: Tests After Diagnosis

After a diagnosis of lung cancer, you will likely need other tests. These tests help your healthcare providers learn more about the cancer. They can help show if the cancer has grown into nearby areas or spread to other parts of the body. The test results help your healthcare providers decide the best ways to treat the cancer. If you have any questions about these or other tests, talk with your healthcare team.

The tests you may have can include:

  • Lab tests of biopsy or surgery samples

  • CT scan

  • MRI

  • Positron emission tomography (PET) scan

  • Bone scan

  • Endobronchial or esophageal ultrasound

  • Mediastinoscopy or mediastinotomy

  • Bone marrow biopsy

Lab tests of biopsy or surgery samples

Lung cancer is often diagnosed by removing a small piece (sample) of a tumor during a biopsy. Tests are then done to find out what kind of lung cancer it is. If non-small cell lung cancer (NSCLC) is diagnosed, special lab tests may be done on the biopsy samples. These tests are done to see if the cancer cells have certain gene changes (mutations). This is called molecular testing. It helps your healthcare provider know if certain types of cancer medicines are likely to work to treat the cancer.

Imaging tests to look for cancer spread

CT scan

During a CT scan, X-rays are used to scan a part of the body such as the chest or belly (abdomen), to create detailed pictures. When you have lung cancer, these pictures help your doctor see where the cancer is in your chest. They also show if the cancer has spread to nearby lymph nodes or to other organs near the tumor. 

MRI

An MRI uses magnets, radio waves, and a computer to create detailed pictures of the inside of your body. An MRI may be used to find out if cancer has spread to your bones or brain. If it has, an MRI can also show the size of it and how far it has spread. In rare cases, your doctor may also ask for an MRI of your lungs if the results of an X-ray or CT scan aren't clear. In some cases, a contrast dye is put into your blood before getting the scan. 

PET scan

A PET scan can give the doctor a better idea of whether an abnormal area seen on a CT scan or other imaging test is a tumor. A radioactive sugar is put into your blood before the scan. It collects in very active cells, such as cancer cells. These areas can then be seen on the scan.

The PET scans your whole body. So this test is often used to look for spread of the cancer to lymph nodes or other parts of the body. A PET scan is very useful if your provider thinks the cancer may have spread, but doesn't know where. The picture is not as detailed as a CT scan, so a PET scan is often used along with a CT scan to look for tumors. 

Bone scan

A bone scan is a lot like a PET scan. But it uses a different radioactive substance that collects in changes in your bones. This may be a sign that the cancer has spread there. A bone scan looks at your whole skeleton. It's done mainly when your doctor thinks the cancer may have spread to your bones, but other tests aren't clear. Bone scans aren’t often needed if you've already had a PET scan. This is because both tests tend to show the same type of results.

Procedures to look for cancer spread 

Endobronchial or esophageal ultrasound

These tests can be used to look for cancer that has spread to lymph nodes or other problems in the area between the lungs (mediastinum). 

A long, thin, lighted tube (bronchoscope) is used to do an endobronchial ultrasound. It's put in through your mouth or nose and into your windpipe (trachea). The bronchoscope is fitted with an ultrasound transducer at its tip. The transducer gives off sound waves and picks up the echoes as they bounce off body tissues. The echoes are converted by a computer into an image on a computer screen. The transducer can be pointed in different directions to look at lymph nodes and other structures in the mediastinum. If the doctor sees suspicious areas such as enlarged lymph nodes, a hollow needle can be passed through the scope to get biopsy samples of them. The samples are then sent to a lab to be looked at under a microscope.

An endoscopic esophageal ultrasound is much the same. It can also be used to look at lymph nodes in the mediastinum. But for this test, the scope is passed down the swallowing tube (esophagus) instead of the windpipe.

Mediastinoscopy or mediastinotomy

These tests can also be used to look at the lymph nodes between the lungs. While an imaging test, like a CT scan, may show enlarged lymph nodes, a biopsy must be done to find out if they have cancer in them. 

These tests are done by a surgeon. A small cut is made in the front of your neck for a mediastinoscopy. A small cut must be made in your chest, between your ribs, for a mediastinotomy. A thin, lighted scope with a small camera on the end is put in through the cut. It is used to look at the center of your chest and the lymph nodes there. Special tiny tools can be passed through the scope to remove tissue. The removed tissue is sent to the lab to be checked for cancer.

Bone marrow biopsy

This test is not used nearly as often as some of the others. But you may need it if you have small cell lung cancer (SCLC) and the doctor wants to see if the cancer has spread to the bone marrow.

Working with your healthcare provider

Your healthcare provider will talk with you about which tests you will have. Make sure to get ready for the tests as instructed. Ask questions and talk about any concerns you have.

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Lu Cunningham
Online Medical Reviewer: Richard LoCicero MD
Date Last Reviewed: 11/1/2018
© 2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare provider's instructions.