Lung Cancer

After having a CT scan (a scanner through a hoop that makes a 3D picture) through your doctor or through the national lung health check programme, your scan will be reviewed by a member of our team. Depending on the results of the scan, you may be reassured and discharged (if no sign of cancer) or may be referred to our MDT.  If the scan shows another abnormality that isn’t cancer we may send you an appointment to see a different group of doctors.

Lung cancer is sadly difficult to diagnose, so your pathway may be different from another person’s, and you may have more or fewer appointments, but here is a general example of what to expect:

First Clinic Visit – you will be asked to attend our lung clinic at City Hospital either face to face or by phone and will be introduced to one of our respiratory doctors and one of our lung cancer nurse specialists. In this clinic visit, we will discuss with you why you have been referred to the clinic and what may be the cause of any symptoms you have. We will explain the results of your initial scan, what additional tests we recommend and answer any questions you have.

A nurse will discuss prehabilitation (this means getting as fit as you possibly can before you starting treatment, more details about this are below) with you at this point, and set you goals for you to aim for in between tests and clinic visits.

Second Clinic Visit – the MDT (Multi-Disciplinary Team) will discuss the results of your first set of tests and in your second visit to clinic we will tell you these results, and what they mean. At this point, your doctor will likely talk about doing a biopsy to make sure we know for certain what the area in your lung is. You can ask more questions at this point, and a nurse may review your prehabilitation goals.

Third Clinic Visit – After the MDT has seen the results of your scans and biopsies, they may decide on a diagnosis, and discuss what treatment will be best for you.
A doctor or a nurse will give you these results and get your feelings about how you want to proceed, whether you want treatment or would rather not at this point. If you agree, you will be referred to the specialist team who will carry out your treatment, whether this is surgery, radiotherapy or chemotherapy. Your treatment team will take over your care at this point. 

The MDT (multi-disciplinary team) is a group of clinicians who meet up weekly and will look after you and discuss your health in detail. You do not attend these meetings. 

The aim of the MDT is to get the best outcome for patients by sharing knowledge and expertise and making joint decisions that guide us to the correct diagnosis and treatment. The discussions are confidential and information contained in them will only be shared with the staff involved in your care. 

The group is made up of:

• Respiratory physicians – doctors who are experts in the diagnosis and management of lung cancer.
• Oncologists - these are doctors who specialise in the treatment of cancer.
• Thoracic surgeons – these are doctors who specialises in operating on organs within the chest.
• Radiologists - doctors who understands and interprets any scans or x-rays you have had.
• Histopathologists – doctors who use specialised equipment to examine any tissue removed during biopsies. This allows the whole team to diagnose the type and extent of the problem and also helps when planning further treatment. 
• Palliative care nurse or doctor -professionals who are experts in controlling any symptoms and managing end of life treatment
• Lung Cancer Nurse Specialists - (also known as your lung nurse) - can provide support, advice, explanations and information about your appointments, tests, treatment and cancer. Your lung nurse will act as a link between you and the rest of the team, and discuss any of your concerns with you, and will continue to support you before, during and after your treatment.
  They will also aim to get you as fit as possible before your treatment, which is known as prehabilitation.
• MDT co-ordinators – these are professionals who make sure that the meetings run smoothly and ensures that everything is kept in order.

In the meeting, your team will look at your medical notes and any relevant tests, scans etc that you have had. As a team, they will decide on the best treatment plan for you, based on your results, taking into account the type of cancer you have, your general health and any other important issues. Your team may decide that you need to have further tests or be referred to other members of the healthcare team.

If the type of cancer or condition we suspect is less common, you may be discussed at a regional MDT. This is similar to our Nottingham City Hospital MDT but has input from experts in that field. An example of this is the Mesothelioma MDT which is based in Leicester but covers the whole East Midlands.

There are many different tests that can be done to investigate a possible lung cancer. Which tests you have will depend on you, your health and how your doctor thinks is best to work out whether you have cancer or not.
You will always be able to have the final say on whether you want to go ahead, or to not have any of these tests. If you do need to have any of these tests, your doctor and nurse will give you more detailed information.
Here are some of the main tests that we will ask you to have

• CT scan – Also known as a Computed Tomography scan, this is an imaging test that uses X-rays and computer technology to create cross-sectional pictures of inside your body. It’s like taking slices of your body to see what’s happening inside your body without having surgery. The scanner is a hoop shape and the scanner will go over your body once.
  You may have already had one of these before, but they are sometimes used to see if there has been any change since your last scan
• Lung Function – These are a series of medical tests that help your clinician work out how well your lungs are working. They measure different aspects of your breathing, such as how much air you can breathe in and out and how efficiently your lungs exchange oxygen and carbon dioxide. This helps the team plan your treatment that works best for you.
• PET scan - Also known as a Positon Emission Tomography scan, is similar to a CT scan. This scan involves injecting you with a slight radioactive dye (which will show any areas of your body that is using a lot of energy) and then the hoop scanner will create cross sectional pictures of your body and this may show your doctor potential tumours. It can give more information than a CT scan about whether an abnormality is concerning or not.
• EBUS – Also known as Endobronchial Ultrasound. This is a medical procedure which combines an endoscopy with ultrasound technology, which allows doctors to view the insides of your airways and see structures such as lymph nodes. The doctor is then able to take samples of any suspicious areas which helps doctors diagnose lung cancer.
• Lung Biopsy – This is a procedure normally done by a radiologist, and they may use a CT scanner or ultrasound scan to help to find exactly where to take a biopsy from. This is done by giving you numbing medicine to the biopsy area and then a needle is inserted to take samples. This may be done more than once, depending on how many abnormal areas there are.
• Thoracosopy – This is a small surgical procedure that allows doctors to look inside your chest wall, and take biopsy samples if needed. It can also be used to drain any fluid that shouldn’t be in the area and make it easier for you to breathe. It is done by giving numbing medicine to part of your chest, the doctor will then make a small cut and put in a thoracosope into your chest, like a thin telescope.

There are different kinds of treatment that you may be offered. These will depend on the size of the tumour, and if/where it has spread to. You may be offered one treatment, or more than one shortly after another.
The clinicians will offer you the treatment they think is most suitable for you based on your general health, but you will always have the final say on what treatment you decide to have.

• Surgery – a surgeon may offer you a clinic appointment to discuss what they propose to do, what the benefits are and what the risks are. They will also tell you about what to expect if you agree to surgery, such as how long the operation will take, how long you will have to spend in hospital and how long will the recovery time be.
• Radiotherapy – An oncologist may offer you a clinic appointment to talk about radiotherapy, which is high energy rays to target and kill cancer cells or shrink tumours. This kills the cancer cells while aiming to keep the surrounding tissue healthy.
  Your radiotherapy treatment may vary from another person’s radiotherapy, so it is best to speak to our radiotherapists and talk about the benefits, the risks and what to expect if you go forward with this.
• Chemotherapy – An oncologist may offer you an appointment to talk about chemotherapy, which is treatment that uses drugs to stop the growth of cancer cells. These drugs can be given through injection or orally, and they travel throughout your body and target rapidly developing cancer cells. While chemotherapy can be effective at treating cancer, it can also affect healthy cells.
  Your oncologist will discuss this with you in detail at your appointment, and you will be given an opportunity to ask any questions.
• Best Supportive Care – You may decide that you don’t want to go through any treatments for your lung cancer and would prefer not to have to deal with any more tests. Or the MDT may decide that in your specific case that treatment may cause more harm than benefits. In this case, you may be offered an appointment with the palliative care specialists, who are experts in controlling any symptoms you have and making sure you are comfortable at home. Many people decide this option, and it is completely up to you.   

As with all cancer treatments, there is constant research and innovation into how the NHS treats lung cancer to make sure that patients are getting the best outcomes they can possibly get. There are many different trials going on here in Nottingham, and you may be asked to take part in one. If your clinician thinks you are suitable for a trial, they will ask you how you feel about this and will give you more information about the trial. It will always be your decision if you want to go ahead with taking part in a trial.

Prehabilitation or as it’s sometimes called prehab, is a set of health goals and a programme with the aim of getting you as fit as you possibly can be before starting any cancer treatment. Research shows that if you are as healthy as possible through prehab, you are more likely to:

• Have more treatment choices
• Leave hospital sooner after surgery
• Cope better with side effects of treatment
• Have less side effects from treatment
• Have better long-term health

Your lung cancer nurse specialist will talk to you about prehab and they will coach you on how to improve your health, by setting you goals to do. Focusing on the goals they set you, in whatever time you have before you start treatment will be beneficial to you. Your nurse specialists will talk to you about the following key areas 

• What you’re eating and help with your weight
• Exercise and physical activity (how much of the day you spend doing things)
• Mental wellbeing and self-care
• Stopping smoking and reducing your alcohol intake

If you are interested, watch the short video here: Prehab and Me

Once you come to one of our clinics you will be offered a range of support by our clinicians. But before then, you can still access further support from a range of services such as 

Lung cancer | Macmillan Cancer Support (a variety of advice and information about lung cancer)

Home - Roy Castle Lung Cancer Foundation (the leading lung cancer charity in the UK)

Maggie's Nottingham | Maggie's (maggies.org) (a charity that supports everyone affected by cancer)

Prehab and Me (further information about prehab)