Diagnosing lung cancer
To make a diagnosis, the doctors try to find answers to the following questions: Where exactly is the tumor? To what type of cancer is it? How far has the disease progressed? For this they use different diagnostic methods.
First, the physician gets in conversation with the patient a picture of the history of his illness and the past history (anamnesis). For example, he asks about heart problems or diabetes (diabetes), lifestyle habits, potential workplace pollutants, and whether or not you smoke . The doctor then performs physical examinations . In addition to the diagnostic procedures described below, there are a number of supplementary examinations that can be used depending on the clinical picture before a planned operation.
In general, only the tissue samples from a lung reflection ( bronchoscopy ) or a fine needle biopsy show whether a benign or malignant tumor is present. Based on these samples, the doctor can also determine what type of tumor it is.
Bronchoscopy with biopsy
During bronchoscopy, the doctor slides the patient’s bronchoscope – a flexible, pencil-thick tube – into the larynx, trachea, and eventually into the large and medium bronchi, supine or through the nose . The aim is to take tissue samples from the suspect area. In advance, the patient receives a local anesthetic or anesthesia.
Computed tomography (CT)
The computed tomography is an imaging procedure that is additionally used for ultrasound. Using CT, doctors determine the exact extent of the tumor. You can see on the examination images whether he has already affected other organs or has formed metastases of a certain size. During the examination, an X-ray tube and a detector, which takes the pictures, revolve around the patient. From the data obtained, a computer later calculates cross-sectional images that represent possible pathological processes inside the body .
In fine needle biopsy, the doctor takes cells from the lungs, which are then examined microscopically. For this he pushes a fine needle through the chest wall into the suspicious area. Under vacuum, the tissue is sucked in, so that the doctor can win a small sample. In the procedure, the patient receives a local anesthetic and is monitored by computer tomography .
To get information about the tumor, the doctors take blood from the patient. The analysis results provide information about his general condition and the function of individual organs.
In the laboratory also will eject (sputum) analyzed by the patient when coughing releases: This contains cells that are derived from the lining of the bronchial tubes have replaced or other areas of the lung. In lung cancer, tumor cells may be in the sputum. To make a diagnosis, samples from at least three different days are examined in the laboratory.
Control of tumor markers
The blood of cancer patients has substances that are produced by the cancer cells themselves or by the healthy tissue in response to the tumor . Through a blood test, doctors can determine the concentration of these tumor markers. However, the known tumor markers do not permit any conclusion about a particular cancer type . Since they can be elevated even with a harmless inflammation, they are also useless in the context of early detection.
Physicians use the tumor marker control mainly to check the course of the disease and the success of therapy. If the tumor marker sinks during treatment, this is in most cases an indication of its positive effect.
Nevertheless, the absence of a tumor marker in the blood does not preclude a relapse. In addition, not all ulcers produce tumor markers. For example, they play a minor role in non-small cell lung cancer .
Magnetic Resonance Tomography (MRI), magnetic resonance imaging
The technique uses strong magnetic fields to create three-dimensional images of the body . Doctors use MRI as part of a lung cancer diagnosis, primarily for the search for tumor deposits in the brain. Similar to computed tomography, the patient lies here on a couch and is slowly moved into a tubular or, in the case of an open magnetic resonance tomograph, a horseshoe-shaped magnet. The physicians also use this procedure before an operation in order to differentiate the tumor from other body regions (for example, pericardium, vessels, spinal canal).
Magnetic Resonance Tomography can better visualize organs and tissue layers with no bone content than other imaging techniques. However, this does not apply to air-filled areas (lungs) or structures with low water content (bones).
As part of a mediastinoscopy the doctor examines the mediastinum area (mediastinum), which is between the two lungs. He sets a small incision above the breastbone and introduces a special optical instrument (mediastinoscope) behind the breastbone and in front of the trachea. There he takes tissue samples from lymph nodes, but also from other tissues. The patient receives a general anesthetic in advance . If a patient has already been diagnosed with lung cancer, physicians use this procedure to check whether the adjacent lymph nodes are tumor-free and that surgery is possible.
Positron emission tomography (PET)
The positron emission tomography is a method to tumors and metastases track. The patient first receives a low-level radioactive sugar solution. Since cancer cells have a high energy requirement, the radioactive sugar molecules accumulate there especially. Accordingly, the metabolism of the tumor tissue is particularly active – and doctors can see that later in the picture.
During the examination, the patient is slowly driven through a scanner ring. The device creates recordings of the entire body. Based on the distribution of the sugar molecules, a computer finally calculates a complex picture: The tumors stand out in color from the healthy tissue.
Doctors want to use bone scintigraphy to check whether metastases have formed in the bones of a patient . In the process, they also work with radioactively labeled substances that they inject the patient into the arm vein. These substances are taken up by the bones and accumulate especially where the metabolism is very active – in the cancer cells. On a so-called scintigram, the physicians will later look at how the radioactive substances have spread. From this they can draw conclusions about pathological changes in the bones.
Using X-rays , the doctor takes pictures of the patient’s chest . The pictures are taken in two levels (from the front and the side) and thus allow a three-dimensional representation. The examination serves to detect the tumor and to determine its exact position. In addition, the result helps to assess the overall condition of the lungs .
Ultrasound examination (sonography)
Physicians use this imaging technique to determine where the tumor is, how far it has spread, and whether it has affected adjacent lymph nodes . The ultrasound head of the device sends waves into the body. They are “swallowed” or thrown back by the tissue types to varying degrees. From the sound waves that arrive back in the ultrasound head, a computer calculates images that represent the respective tissue. The recordings that the ultrasound head sends out of the body are transferred to a monitor.
A common examination is also endobronchial ultrasound (EBUS). In this procedure, the physicians combine bronchoscopy and ultrasound by inserting an ultrasound probe at the end of the bronchoscope. In this way, lymph nodes in the mid- pelvic space can be visualized and tissue samples taken from there.
stage 4 lung cancer
non small cell lung cancer