The first step is to analyse the associated symptoms and obtain all the relevant information about your lung cancer risk factors, such as smoking, occupational risks, and family history. After an interview (anamnesis) and chest X-ray the doctor will assess whether your case needs to be studied further with additional tests. Once diagnosed, a specialist will evaluate your overall state of health in order to select the best treatment strategy.
Tumours can be visualised, and their size and degree of extension estimated, with imaging tests. The specialist may request some of the following tests, which are painless and only require the administration of a contrast agent or tracer before the test.
A computed tomography scan (CT) of the chest. Provides a detailed image of all of the organs in the chest and abdomen (lungs, heart, the great blood vessels, airways, chest wall, pleura, lymph nodes, liver, suprarenal glands).
Positron emission tomography (PET-CT). Technique used to collect information to complement the chest CT scan. It requires the administration of a tracer which the tumour cells incorporate with a greater affinity than healthy cells. The tracer passes throughout the entire body and highlights the presence of tumours in any other areas of the body, e.g., in bones or the brain.
Brain CT scan. That are performed if the patient presents associated symptoms that suggest brain structures may also be affected. ody> ells. The tracer passes throughout the entire body and highlights the presence of tumours in any other areas of the body, e.g., in bones or the brain.
Whenever lung cancer is suspected, it needs to be evaluated through imaging tests (X-ray, CT or PET-CT). Once confirmed, a biopsy must be performed on a sample of tissue taken from the tumour to discover the shape of the cells and determine the most appropriate treatment.
The choice of biopsy technique will depend on the location of the tumour:
Fibre-optic bronchoscopy. An endoscope is introduced through the nose or mouth in order to view the inside of the pulmonary bronchi and, if the tumour can be located, to take a biopsy sample. The technique is performed with the patient under local anaesthetic. tumours in any other areas of the body, e.g., in bones or the brain.
CT-guided lung needle biopsy. If fibre-optic bronchoscopy does not lead to a diagnosis, then in some cases a very fine needle inserted through the chest can be used to collect a tumour biopsy sample. The needle is inserted under local anaesthetic and using CT imaging to guide the placement.
Endobronchial ultrasound (EBUS) and/or an endoscopic ultrasound (EUS) of the oesophagus. These newly developed techniques are used to take samples from the pulmonary lymph nodes by needle aspiration. This is done by introducing an endoscope through the mouth to collect samples from inside the bronchi (EBUS) or oesophagus (EUS). Both techniques are performed with the patient under general anaesthetic.
Surgical intervention. Surgery is only indicated when it has proven impossible to obtain a diagnostic sample through the above techniques. It requires a general anaesthetic and a hospitalisation period. tèsia general.
T stands for tumour diameter in centimetres and measures the size of the primary tumour and any invasion into neighbouring tissue. It varies between:
T1-T2 (tumours smaller than 7 cm).
T3 (tumours larger than 7 cm).
up to T4 (tumours which invade nearby structures, e.g., the great vessels, vertebral bodies or the oesophagus).
N stands for nodes or in the case of lung cancer pulmonary nodules. The lymph nodes form part of our immune system and in cancer patients they try to fight against the malignant tumour cells. Node involvement is classified as:
N0 there are no tumour cells in any lymph nodes.
N1-N3 tumour cells have invaded one or more nodes. Depending on the location of the nodes affected by tumour cells, the cancer is classed as N1 for ipsilateral hilar lymph nodes, N2 for ipsilateral mediastinal or subcarinal lymph nodes, and N3 for contralateral mediastinal or supraclavicular lymph nodes.
M stands for metastasis; M1 represents the presence of metastasis, M0 the absence. When metastasis is present, it is subdivided into M1a if contained within the chest or M1b if it affects any other organ apart from the lungs (e.g., bone, liver or brain).
In function of these factors each case of lung cancer can be grouped and classified into the following stages (7th Edition TNM):