Mesothelioma Legal Advice

Many patients find that they have lung cancer either because they present symptoms such as persistent coughing and wheezing, sometimes coughing up blood or pain the chest and stomach.This usually prompts further investigation of the chest, requiring an x-ray (which may also occur as part of a routine health check) and the testing of sputum samples.

At this point, depending on the results, more investigations will be necessary.

Detailed Diagnosis

The purpose of a chest radiograph or x-ray, is to detect enlarged lymph nodes in the chest or the existence of a mass in the lungs.  More advanced techniques can be used to provide much more detailed information and include the following:

CAT Scan or CT Scan – a CT Scan is a computer assisted examination which provides a cross-sectional image of the body under examination;

MRI Scan – a Magnetic Resonance Imaging (MRI) scan uses hydrogen ions within the patient’s body which respond to magnetic fields when they are applied to the body or in this case, the chest.A computer will then use the results to create a chest image which allows for precise location of any mass which has been detected and whether it involves the lungs;

Bronchoscopy – this involves an examination of the airways (the windpipe and lung branches) and is usually conducted by a pulmonologist ( a physician who specializes in respiratory diseases).  The examination may involve the taking of a swab from these areas or a biopsy (the removal of a tissue sample);

Needle Biopsy – a physician inserts a needle using the results of a CT Scan to guide where the needle, so a sample of tissue may be removed from the mass which has been detected; the tissue samples obtained are then “smeared” on a microscope slide and examined by a histopathologist to detect whether or not the cells are cancerous; and

Bone Scan – this test may be undertaken to check whether any cancer cells have spread (known as “metastasized”) to the bones from the original tumor.

A technological advancement is the CT/PET fusion imaging scan – this diagnostic tool uses an injected sugar solution which contains a radioactive element to highlight any cancerous mass.  Cancer tumors are very fast growing and use a lot of energy so they rapidly absorb the sugar solution which is accumulates around and within the tumor.  When a scan is then performed, the concentration of the radioactive sugar is detected and provides the location and detail of the cancer tumor.  It should be borne in mind that there are other tissues which will cause the sugar solution to accumulate such as a bacterial infection, so even this test is not conclusive.

Once lung cancer has been diagnosed, the team of oncology physicians treating the patient will review the results to assess the treatment options for the lung cancer and to check whether any spread of the disease has occurred to other parts of the body.Where it is found the disease has not spread to other parts of the body, then a surgical inspection can take place to assess the disease in detail around the lungs, heart, windpipe and tissues of the chest.  In addition, extensive blood tests will take place to look for cancer “markers” which are usually proteins that are associated with the development of lung cancer.

Lung cancer may be treated by a variety of therapies which are frequently used in combination to provide an optimal outcome.  Surgical resection is the process by which the tumor is surgically removed, and this is usually recommended when the cancer has not metastasized (or spread) beyond the lung into other parts of the body.

There are several options for performing a resection which can involve minimally invasive surgery or a full operation. Which technique is used will depend on a variety of factors, notably the size and stage of the cancer and whether the tumor is accessible to the surgeon.

A thoracotomy is performed by the surgeon making an incision through the chest wall and a median sternotomy is performed by entering the chest cavity through the breastbone.Both of these methods are commonly used in lung cancer surgery but they do involve considerable patient discomfort and extended stays in hospital with a longer recovery period.

Alternative surgical procedures include an anterior limited thoracotomy (ALT) which involves a small incision to allow entry, again through the front of the chest.  It should be stressed that the incision is considerably smaller than in a standard thoracotomy or median sternotomy.  An alternative is the anterior axillary thoracotomy (AAT) which involves a small incision on the chest front but near the underarm and finally, there is the postero-lateral thoracotomy (PLT) which involves an incision the back or side of the of the patient’s trunk.

Even with these improved surgical techniques, a patient will experience considerable pain if the operation involves opening the chest (sometimes referred to amongst doctors as “chest cracking”).
As a consequence of the extended recovery times and patient discomfort, surgical techniques have been developed which do not involve full-blown surgery – these are the so-called, minimally-invasive techniques.

Video-assisted thoracoscopy (VAT) uses a high powered video camera and hi-definition screen combined with diagnostic scans, such as CT or PET scan, to target the tumors in the patient’s lung.  The incision required is much smaller and there is no need to open the chest cavity which results in much less discomfort for the patient and greatly reduced recovery periods.  Using the video display, the surgeon is able to resect the tumors which have been identified during the diagnosis and staging phases.

Some doctors do caution the use of VAT however, as a traditional thoracotomy may reveal tumors and other undiscovered metastasized cancers.  If these remain undiscovered the cancer can return and the patient will become ill again and for this reason, VAT is usually recommended for early stage (I & II) cancers and which have not spread to other parts for the lungs and body.

It is quite usual for any surgical procedure to be accompanied by a phase of chemotherapy or radiation treatment to ensure that the patient’s cancer has been completely removed or killed off.  How the treatment proceeds and at what stage a particular therapy will be recommended will be determined by the type and stage of lung cancer a patient has got.