Lung Cancer
Lung cancer - investigations
To help to diagnose lung cancer doctors recommend various investigations. Chest x-rays, sputum tests and blood tests are very common. Most people remembered other investigations such as bronchoscopy, lung biopsy, computer tomography (CT scan), positron emission tomography (PET) - CT (a PET scan combined with a CT scan), bone scan, and lung function tests. While some people felt anxious about tests, others found slides or pictures of their internal organs fascinating.
Recalls having many x-rays and blood tests.
Recalls having many x-rays and blood tests.
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No, no I just, I had the CT scan and obviously I'd had had a number of chest x-rays and I continue to have x-rays while, even while I was in hospital, every day I had an x-ray.
And numerous blood tests?
And numerous blood tests yes.
For somebody who's a bit nervous about having a blood test would you mind explaining in detail what it's like to have a blood test?
(Laughs) well the, they have this little container with a needle in it and, which is sheathed and then they screw in a different coloured like small test tube with a coloured cap and this determines what you're having the blood tested for, I think there's four or five different colours. And so they can actually do different tests with the same needle and they just take that test tube out and put another one in and it's quite, they say a little scratch, it's a little bit more than that but nevertheless I don't find it painful. But I've been having that many over the past four years that my skin where they go in has got quite hard and so we change arms every so often and see if we can give the other one a bit of a rest. But both sides have now got hard. I mean I've had one a week for the past four years, so, well almost, and then several more when I was in hospital.
Describes his bronchoscopy, via the throat, which was painless, and which he found fascinating.
Describes his bronchoscopy, via the throat, which was painless, and which he found fascinating.
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And then a bronchoscopy.
Can you explain what that was like?
Yes I was dreading that and that turned out to be an extraordinarily interesting experience; to be pacified with a local anaesthetic and the injection of temazepan in the back of your hand. It's very comfortable, and I was curious and I was straining to watch it on the television screen, it was fascinating. They never could get to the tumour because that was, the tumour was located peripherally in the lung and therefore the tubes are too small for the passage of a camera but they knew pretty well where it was by then.
So what did they do exactly during the bronchoscopy?
They spray a local anaesthetic onto the back of your throat and they either pass it, the camera up your nose or back through your throat, in my case they went in the back of my throat. And they were intending to take a biopsy at the same time but they were able to take, they couldn't do that because they couldn't reach the tumour, but they took something called a flush down, they washed some of the lining of the lining of the lung with water which gives you a coughing reflex which is fascinating to watch on the screen. It's a violent, a very violent thing when your lung contracts and but the actual discomfort, I don't remember at all, I don't remember feeling any discomfort during the procedure and the staff around me were friendly, informal and chatty, the nurses, the technicians, the doctor, everybody. It was like something on a school project, just a fascinating thing, like being in a science museum or something.
Bronchoscopy allows doctors to examine, photograph and where possible take a tiny sample (biopsy) of tissue from inside the airways. The procedure does not always provide a conclusive diagnosis. A bronchoscope is a narrow, flexible tube, which is passed either up the nose, or through the mouth and then down the throat. Occasionally doctors need to use a rigid tube to reach parts of the lung, which may be a bit painful. Sometimes patients have a general anaesthetic for this type of bronchoscopy.
Describes having a hard tube passed down his windpipe for his second bronchoscopy.
Describes having a hard tube passed down his windpipe for his second bronchoscopy.
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But the results were not all that promising and they couldn't find anything so I was sent home. The fever didn't go. After a week, again I was admitted into hospital and this time the bronchoscopy was quite tough, they did tell me in advance that they were going to put a very hard tube, not like before, so they gave me local anaesthesia and took me to the theatre. Again they give little anaesthesia in the throat and put the hard tube, it was a bit painful but may be because of anaesthesia I didn't feel much. They did everything, this took about half an hour, and within another half an hour of rest I was taken back to the bed, but after two hours I started feeling a little bit of pain but that also they gave me some pain killers and it went off. But the results were very good, and in the evening I was told that we will get the full results two days later. After two days I was told that I had lung cancer and they'll call the specialist and senior doctors to come and see me again.
Before bronchoscopy many people felt frightened, but after it most said that the procedure did not hurt. Most were given a sedative that made them drowsy and a local anaesthetic, usually a throat spray, to make the procedure more comfortable.
Describes his bronchoscopy via the throat, which did not hurt.
Describes his bronchoscopy via the throat, which did not hurt.
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Yes the bronchoscopies were very easy, very well done indeed by the doctor and his assistants. There was no pain attached, just a slight discomfort when they asked you to take some fluid to drink. You did not feel it going down at all and the end of the result was; they gave you [a sedative], just a, not even to put you to sleep really, just to quieten you, while they carried out the bronchoscopy. And from that, they were able to discover what it was.
Did they put the tube up your nose for the bronchoscopy to have a look?
No they put it down my throat which I assume was a small camera. But nothing went up my nose at all. And I just, as I say I had no idea what a bronchoscopy was and just as I say I was not put to sleep, I was just in a semi dazed sort of condition. I felt no discomfort at all with the camera going down into my tummy, down my throat, and I was very disappointed with the end results.
It went into your lungs I guess, the camera?
Yes, yes as far down as they could get it and after three bronchoscopies then they could not decide what the thing was. In the finish the specialist decided that he would have to operate to remove what was obviously a growth.
Describes her bronchoscopy via the nose and stresses that it did not hurt.
Describes her bronchoscopy via the nose and stresses that it did not hurt.
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A sedative is that?
Sedative yes to, they don't actually knock you out but you're not with it, you know what's going on but not really. It's a very, very strange sensation but not unpleasant. It doesn't hurt, you're told, you're given instructions what to do and as long as you follow those instructions to the letter it will not hurt. When they get to your vocal cords they stop and they'll ask you to swallow and then they go past your vocal chords so they don't do any damage and then they just keep asking you to swallow. They push the camera down and they can see, and me being a nosy person I was very annoyed that I couldn't see either (laughs). But no it was, it was not an unpleasant experience at all. It doesn't last very long, about 15 minutes you're in and out, you're, oh before they put the camera down which I forgot to say, before they put the camera down they do spray the back of your throat so that you have no feeling there, you can't feel the camera, you can't feel anything. So it doesn't hurt at all.
A few people recalled bad experiences. One man, who chose not to have a sedative, described having a bronchoscopy via the throat as 'horrendous'. However, he said that the discomfort soon passed.
Describes the 'horrendous' experience of having a bronchoscopy via the throat, without a sedative.
Describes the 'horrendous' experience of having a bronchoscopy via the throat, without a sedative.
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No I didn't have to. I had a camera inserted down, normally they take it through your nose.
Is this a bronchoscopy?
That's right, and you don't have too many problems but for some reason (laughs) the tubes in my nose are very narrow and they couldn't do it through my nose. The camera is about as thick as your little finger so it had to go down through my throat. And they place like a plastic tube in your throat so that you can't bite onto the camera and that was absolutely horrific. That was worse than anything I've ever had, because you're actually taking this into your lungs. And then they wash your lung out while they're doing this and they take the fluid back out of your lungs and then they send that fluid away for tests as well, as well as doing a very tiny little biopsy while they're in there. So that was horrendous.
It starts off with you can't eat or drink for probably about fourteen or eighteen hours prior to that. When you actually get to the hospital you have a choice, well you don't have a choice to start with because initially they're going to go down your nose so it doesn't affect the way you react, but as soon as they found out they couldn't go down my nose I then had a choice of whether I wanted to have an injection to sort of make me a little bit drowsy or just a throat spray that would you know dull my throat. Because as soon as the tube starts to go down your throat you want to heave as if you're going to throw up. And it's so difficult to swallow, keeping swallowing, as you're swallowing the tube is being pushed in. And it's very, very difficult not to do that.
So what did you choose?
I just had a throat spray. I've got a thing about, I don't drink at all, I never have drunk so I've got a thing about having all my faculties with me if you know what I mean. I don't like the idea of having an injection that would make me dopey and not know what's going on.
So what did it feel like going down?
It, the initial when it first goes into your throat it's not too bad because it's, as I say your throat is sort of numb but then once it's, starts going further down the back then you can actually feel it going down and it is very uncomfortable. But I must add that I am an exception because my nose is, the tubes in my nose are very small. Most people have it down through their nose and it doesn't bother them.
And then afterwards?
Yeah while it's happening it's like a drowning feeling, it is, it's an awful feeling. And you feel as if you're not going to be able to breathe ever again but it soon passes.
A woman, who also had the procedure without a sedative, had local anaesthetic injected via a needle directly into her throat. Her discomfort followed a junior doctor's five attempts to inject the anaesthetic.
She had a bad experience having a local anaesthetic injected into her throat before her...
She had a bad experience having a local anaesthetic injected into her throat before her...
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Alright, we went into the theatre and I was lying flat, it looked like an operating table. The, presumably a doctor, she didn't look old enough to be one, they put an, (pause) injection into your throat. You're wide awake, there's, not given even anything to keep you calm, no sedatives or anything and I think it was her first day of ever doing them. She had five attempts at me, and by this time I wasn't very happy at all (laughs).
Was it an injection in your throat or a spray?
No the injection goes through into your throat, it's sort of, it's sprayed into and you've got to cough which that is then the anaesthetic for them to put the scope down.
So where does the injection go in?
Into your throat, [points to mid throat area] sort of yeah just below your voice box really.
How did that feel?
Painful, and of course with her having sort of five attempts at it, twice she tried with me lying down, then they sat me up and I had to put my head right back.
What was she trying to do, can you explain?
She was trying to get the needle into my throat, and in the end the consultant he said, "I'll do it." He was looking at the monitor, that was what he was there for to look at the monitor but he in the end didn't have much faith in her, I don't think that she was ever going to get it right. And of course I was getting very agitated by then and so he did it and he did it first time and I didn't feel a thing when he did it. I had to cough, which it's a real cough and splutter, which is the anaesthetic, that it just deadens your throat down and they put the scope down. You don't feel anything then at all.
Did anybody explain to you what was going to happen before you went down for the bronchoscopy?
No, whether that's a good idea or not I don't know because if I had to have to another one I should kick against it or say "Well if you're going to do it you'll have to put me out," because it was a terrible experience. But other people have had a lot more that I've spoken to since and you know it's not pleasant but they didn't have the experience that I had so
You're the first person that's told me that you've had an injection into the throat from outside. Other people have had sprays at the back of their throat.
Yeah, no this was, it went right, well I mean the bruise was there, sort of just down at the bottom, there.
Poor you.
I mean alright it didn't last long sort of twenty four hours later I was alright but I mean the bruise was still there (laughs) as if I'd been punched in the throat.
Some people had a different type of lung biopsy. A needle was passed through the back or chest wall into the lung or into the fluid round the lung. This was usually done during an ultrasound or CT scan. Normally local anaesthetic is used to make the procedure more comfortable; it can be painful if done without local anaesthetic. However, even with anaesthetic the procedure may be painful. Two women suffered a rare complication, a collapsed lung. (See also 'Pleural effusion and pleurodesis for lung cancer').
He chose to have a lung biopsy without a local anaesthetic because the doctor said it wouldn't...
He chose to have a lung biopsy without a local anaesthetic because the doctor said it wouldn't...
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His lung biopsy was very painful in spite of the local anaesthetic.
His lung biopsy was very painful in spite of the local anaesthetic.
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Her lung biopsy was not painful but she suffered a collapsed lung.
Her lung biopsy was not painful but she suffered a collapsed lung.
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During the biopsy Doris experienced a collapsed lung, which was painful.
During the biopsy Doris experienced a collapsed lung, which was painful.
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With my first biopsy, I was told all about it and I was told that it was only one in twenty that the lung could collapse with having the biopsy but as it happened it happened to me. And my lung collapsed so they had to insert a small tube in my shoulders, somewhere around my shoulder and they withdrawed just over a litre of fluid. Fluid or air I don't really know what they withdrawed but they did say just over a litre.
How was that? Were you-
It wasn't too bad, it wasn't, the biopsy itself was nothing. All you felt was just a sting but the withdrawing, that wasn't too bad neither after he'd got the little tube in that wasn't- it didn't feel at all bad. They're very nice though, They all these doctors and nurses are when they're dealing with you.
Did it worry you when they-
Well, when the lung did collapse it was very pain- it's painful but when, once they withdrawed the whatever they withdraw it goes back to normal and you feel quite alright. I was allowed to go home then straight away. So there's nothing to worry about with that.
So you were aware that something had happened?
Well, I was aware after they'd done the biopsy I was aware that something had happened because I felt in pain when I moved and they told me to sit still. So… That's all.
Almost everyone had a CT scan, which is done to see if the cancer has spread to other organs or blood vessels. Sometimes an injection or drink containing a dye is given to highlight other organs. This injection can cause a warm feeling in the genital area. CT scans are also done to help plan radiotherapy.
Describes what it is like to have a CT scan.
Describes what it is like to have a CT scan.
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Many people had lung function tests to see how well their lungs were working. This simple test usually involves blowing into a mouth piece.
Describes what happens during a lung function test.
Describes what happens during a lung function test.
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A few people mentioned other investigations, such as bone scan, brain scan, and magnetic resonance imaging (MRI scan). One woman described feeling a bit claustrophobic when she had an MRI scan.
Explains what it is like to have a bone scan.
Explains what it is like to have a bone scan.
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Describes what it was like to have a brain scan.
Describes what it was like to have a brain scan.
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How did they do that?
Well again it was exactly the same as the CT scan I had. It was instead of being a CT scan for the lungs it was a CT scan for the head. So you just laid on this table and the thing went back into the doughnut, not the tube, so you're not enclosed, light and airy, you just lay there and I looked up and I saw a red light going across like that, and the nurse said "Right when you're ready we'll take the pictures," and I said "Is it alright to keep my eyes open?" she said "Yes, it won't do any harm," and the red light went bum, bum, job done. No pain, no anything.
Right.
In fact it was more of a nuisance queuing outside to get into the actual you know queuing in the waiting room, that's more of a nuisance because you sit there for half an hour, the actual scan took about a minute or thirty seconds even.
Compares a CT scan with an MRI scan, which she found a bit claustrophobic.
Compares a CT scan with an MRI scan, which she found a bit claustrophobic.
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A few people described mediastinoscopy, a surgical procedure to examine the lymph nodes behind the lungs. One woman recalled a ventilation-perfusion scan (VQ scan). This studies air flow and blood flow in the lungs and is sometimes used to diagnose a pulmonary embolism (a clot in the lung). It can also help the surgeon to decide if the remaining lung will function well after surgery.
Describes what it is like to have a mediastinoscopy, which he had under a general anaesthetic.
Describes what it is like to have a mediastinoscopy, which he had under a general anaesthetic.
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Describes what is was like to have a VQ scan in the nuclear medicine department.
Describes what is was like to have a VQ scan in the nuclear medicine department.
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It did, I had a shadow on my x-ray, but they just said it was a shadow and it was the blood clots. They said it was pulmonary embolisms from the anaesthetic on the knee, from when I had my knee done. And I think that, that was one of my down falls, because I'd had the knee done I think they just automatically took it that, but when I went back to see the specialist and I actually said to him, "I've had CT scans, I've had VQ scans, can you tell me why all those never showed up the cancer?" and he said "It was because we weren't looking for it."And that's all it was, because they weren't looking for it so...
Yes I had a VQ scan. For that you have to go to the Nuclear Research Department, which I did. I wasn't allowed to have anything to eat or drink for so many hours before, and then they come out and they just put a blood, like an injection into your arm. And then they take you in and then they fit you up onto a video camera and you can actually see the screen and you can see your lungs actually working and you can see the dye going through the, to all the arteries in your lungs, and you could actually see where the mass was.
A man, who was later diagnosed with mesothelioma, described a thoracoscopy, which he had under a general anaesthetic.
One other investigation, positron emission tomography (PET scan), is sometimes used in the assessment of patients before operation. It is now common to have a PET-CT scan, a combination of CT scan which is used to build up a three-dimensional picture and a PET scan where a low-dose of radiation is used to measure the activity of cells.
Derick recalled what it was like to have a PET scan. He described it as quite a peaceful and...
Derick recalled what it was like to have a PET scan. He described it as quite a peaceful and...
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So then, it was suggested that I go for a PET scan, OK we’ll got for a PET scan. PET scan is when you are injected with a radioactive fluid, and you’re put into a room, lovely music, you get a choice of music, and the lights are dimmed and you have to lie still for an hour while this radioactive fluid gets round your system. That was OK, it was fine, yeah. It did relax me a little bit, but with all that was going on, the concerns are getting deeper and greater. I want someone to tell me what the problem is and nobody can at this point. So then, I’ve had an hour on the bed, and then I go in for this PET scan and I was again given a choice of music, because the PET scan takes quite some time to do. Err, it’s quite peaceful just lying there on a bed, just going through this scanner. There is no fear of scanners, they don’t hurt you, they don’t remove anything from you, you just lie there and, just sensation of moving backwards and forwards, it’s rather pleasant I found.
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Last reviewed May 2016.
Last updated May 2016.
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