Patients experiencing increased breathlessness,
a new cough or one that has changed in nature,
haemoptysis, weight loss or fatigue will usually be
referred to the lung cancer team. These symptoms
are often accompanied by an abnormal
chest X-ray finding. X-rays are non-invasive,
inexpensive and relatively safe since they use
low doses of radiation. However, imaging is two
dimensional and provides limited information
so further investigations will be required. The
first investigation requested by the lung cancer
team is a computed tomography (CT) scan
of the thorax with contrast to show organs
and abnormalities more clearly. Imaging of
the liver and adrenal glands is also included.
CT, combined with the clinician’s assessment
of the patient’s fitness to undergo treatment,
will guide subsequent investigations. The
purpose of any further investigations is to
accurately diagnose and stage the cancer to
ensure appropriate treatment. Advances in
diagnostic and staging techniques mean that
investigations can be tailored to the individual
patient, with the intention of performing fewer
investigations, but more accurate staging and
histological sub-typing (NICE 2011) (Figure 1