It is my usual and customary practice to order a complete blood count and a panel of blood chemistry tests, as well as a blood level of the carcinoembryonic agent (CEA).
A chest x-ray and a computerized tomogram (CT) of the chest are important.
One of the biggest problems in treating lung cancer is that patients with lung cancer are almost always cigarette smokers, and cigarettes not only cause cancer, they also cause chronic bronchitis and emphysema as well as cardiovascular disease. For this reason, we do pulmonary function testing (PFTs) on all patients. If the patient has a severe reduction in PFT, surgery may not be safe, or the amount of lung that can be resected may be limited.
In a similar fashion, it is important in some cases to test cardiac function to be sure that there is no significant coronary artery disease that would increase the risk of surgery.
Arterial blood gases, pulmonary function tests and an electrocardiogram (ECG) need to be done.
This is the basic workup.
Depending on the results of the history and physical examination and the basic workup, other tests may be indicated, including
- magnetic resonance imaging (MRI) of the brain
- bone scan
- exercise pulmonary function testing
- a quantitative ventilation-perfusion lung scan
- treadmill exercise test
- doppler echocardiogram
- carotid doppler ultrasound
Another new test that is increasingly useful in the workup of pulmonary masses is the PET scan. This test uses an isotope of glucose to visualize the tendency of growing tumors to metabolize more glucose than normal tissues. PET scan can be used to help determine whether a spot on the lung is a cancer, and if a cancer, to determine whether i it has metastasized to other parts of the body. This test is still new, and doctors do not yet know how accurate is or what role it will play in the work-up of lung cancers. One thing that is sure is that the test is showing us areas of tumor, in some cases, that we could not otherwise find using older technology.
