Investigations: staging and operability of lung cancer


All tumours have to be staged before a final treatment plan can be agreed. This means measuring the tumour, defining its exact position and relation to other thoracic structures or organs and to find out if the tumour has spread into the regional lymph nodes or into other organs such as the lung, liver or brain .

Following your initial staging, you may be referred directly for an operation (lung resection) or for chemotherapy or/and radiotherapy.

Alternatively, your consultant may estimate that there is not enough information on your tumour and may want to obtain more tissue or a more accurate diagnosis in order to establish a therapeutic plan. 

In most instances, if the diagnosis of malignant tumour is proven, your consultant will refer you for a PET-CT (Positron Emission Tomography) before the operation. PET-CT is now widely used to rule out distant metastasis (cancer spread) and occult malignant disease (microscopic cancer) in the chest before you have an operation

Alternatively, you may need to have a minimally invasive procedure done under IV sedation or general anaesthesia to stage your tumour before you have a curative procedure:

At present EBUS-TBNA is the most used procedure to stage lymph nodes. It has been routinely performed at the Cromwell Hospital for years and is offered routinely two days a week as an outpatient procedure. Videothoracoscopy (Video-Assisted Thoracic Surgery - VATS) or Mediastinoscopy are the most commonly used surgical diagnostic procedures to obtain tissue from your tumour or lymph nodes if all other techniques have failed to give a precise diagnosis. Most of these diagnostic procedures can be performed as day-case procedures, or may involve an overnight stay in hospital.

If your procedure is performed under general anaesthetics, we will assess your lung function, your cardiac function (ECG and echocardiogram), fitness for surgery and perform some routine blood tests.

 

Low-dose CT Lung Cancer Screening

We do offer a rapid-access screening for lung cancer. Patients who have a significant smoking history, particular exposure (asbestos) or familial history can have a low-dose chest CT and specialised thoracic consultation organised the same day.