Diagnosis of lung cancer

Best practice implemented at the HUG for the treatment of lung cancer specifies that when a patient is referred, for suspected or proven lung cancer, their clinical file is studied by a multidisciplinary team of experts. The first stage in this specialized treatment is to define the optimum diagnostic strategy for cases where suspected lung cancer must be verified or to establish the best therapeutic strategy for patients with a lung cancer diagnosis that has already been confirmed. In both these situations investigations are frequently required.

As a first step, or to complement the assessment provided by the patient, various examinations may be performed enabling the tumor and its extent to be better defined. The most frequent are:

• a fine-cut thoracic scanner (FR), with or without an abdomino-pelvic scanner extension
• a PET-CT (FR) full body scan for the extension
• a brain MRI (FR) for the extension.

To present a definitive diagnosis, in virtually all cases a sample (generally the size of a pinhead) must be collected from the diseased part of the lung identified on the imagery. The result of this biopsy will exclude or confirm whether lung cancer is present and in particular it will define the exact type in order to specify the most appropriate treatment. The biopsy may be :

• transthoracic, carried out under the control of a scanner
• transbronchial, via the airways/bronchi by bronchoscopy
• via surgical intervention

Sometimes samples from thorax lymph nodes need to be collected at the level of the lesions suspected elsewhere in the body. 

This is a surgical intervention carried out under general anesthesia by thoracic surgeons and is designed to collect all the suspect nodes identified in the thorax imagery. It not only enables, as does a bronchoscopy coupled to ultrasounds, a lung cancer diagnosis to be definitively defined (or overturned), but also and specifically to determine its stage (presence/absence of metastases). Performed routinely at the HUG, it requires a brief hospitalization in the Division of Thoracic Surgery.

Once the lung cancer diagnosis has been confirmed, the best treatment must be selected rapidly. The functional status of the lungs must be known in advance for all the treatments under consideration, so that the capacity of the lung to support the envisaged treatment can be assessed. Every patient to be treated must therefore possess a recent statement of their lung functionality. This is a non-invasive test performed using devices and tubes into which the patient must breathe and which measure all the air volumes entering and exiting the lungs.

If surgery is the treatment envisage in addition to lung functionality tests, other tests will be performed with a view to finding out more about the overall, cardiac and respiratory functionality of the patient and to better define the risk of the intervention. Such tests include a pneumological effort test during which the patient pedals on a bike whilst their oxygen needs are measured and an echocardiography to determine heart functionality.

At the pre-operation visit by the anesthetist, he/she will judge whether other tests are needed based on other potential diseases of the patient.