Patients going through the Lung Optimal Pathway
Date issued: August 2022
Review date: August 2024
Ref: A-457/SS/Oncology/Patients going through the lung optimal pathway v2
PDF: Patients going through the lung optimal pathway final August 2022 v2.pdf [pdf] 169KB
You have been referred to the chest clinic urgently because your GP is concerned about some changes which have been happening to you, or about changes that have been noted on your chest X-Ray and CT scan.
We understand this can be a very worrying time for you; you have been referred so that we can investigate your symptoms quickly. This information has been designed to guide you through what may happen at this appointment. This information leaflet is a guide to inform you about what may happen at this appointment and what tests or investigations may be arranged for you in the future. You will be given more detailed information about each test as it is arranged.
Chest clinic appointment
Having attended the radiology department, the chest clinic team will review your questionnaire, CT scan and blood tests the following day to decide upon a plan. You will be contacted that afternoon by the Pathway Navigator. In most instances, you will be invited to chest clinic or booked in for a telephone appointment.
We will try to co-ordinate tests where possible to ensure that we come to a diagnosis and have all the information necessary as quickly as possible. In some cases this may involve tests following a morning clinic visit which may mean being in the hospital all day.
What will happen at this appointment?
You will be seen by one of the Respiratory Consultants, or another senior doctor from the respiratory team together with one of the lung cancer specialist nurses. They will listen to your story, look at your chest X-Ray and CT scan, examine you and explain the findings to you. They may decide that more tests or investigations are needed to find out exactly what is going on.
Spirometry
On arrival to the chest clinic, you will have this simple breathing test to assess the volume of your lungs. The test measures how much air your lungs hold and how elastic they are. It may be necessary to arrange more detailed breathing tests.
What other tests might be arranged on the same day?
PLEASE TELL US OF ANY BLOOD THINNING
DRUGS YOU ARE ON, AS PRIOR TO ANY BIOPSY YOU WILL NEED TO HAVE STOPPED THESE DRUGS AS PER THE INSTRUCTIONS GIVEN.
Bronchoscopy
This procedure examines the airways in your lungs using a small, flexible tube. Your hospital doctor will explain why it may be necessary to have this done. The bronchoscopy is performed in the Planned Investigation Unit (PIU) on Level 5 Terence Lewis Building. A member of staff from PIU will contact you with arrangements.
You will be in the Department for about half a day and will then be able to go home.
You must have someone to take you home and stay with you overnight as you will be given sedation.
You will need to have nothing to eat and drink from 9am and sips of water until 11am.
Endobroncial Ultrasound (EBUS)
This procedure allows your hospital doctor to look into your lungs (similar to a bronchoscopy) but then takes samples of the glands in the centre of the chest using the aid of an ultrasound scan.
The EBUS is performed in the Planned Investigation (PIU) Unit on Level 5 Terence Lewis Building. You will be in the Department for about half a day and will then be able to go home. A member of staff from the Chest Clinic will contact you and go through the arrangements. You must have someone to take you home and stay with you overnight as you will be given sedation.
For a morning procedure list you will need to have nothing to eat and drink from midnight and sips of water until 6am.
For an afternoon procedure list you must have nothing to eat and drink from 09:00am and sips until 11:00am.
Pulmonary function test
Although you will have done the simple breathing test in the clinic, your hospital doctor may require more detailed information about how well your lungs are working. Pulmonary function tests give more detailed information about several aspects of how your lungs are working and may help guide decisions about the need for any further investigations or treatments.
Ultrasound and Fine Needle Aspiration
(FNA)
Your hospital doctor may suggest that you have an ultrasound to check your lymph nodes. If any of the nodes in your neck look abnormal, they may suggest you have a fine needle aspiration. A fine needle aspiration is a quick, simple test. A doctor puts a fine needle into the lymph node following local anaesthetic before withdrawing a sample of cells into the syringe. This may be done as part of your clinic appointment and you will be able to go home straight afterwards.
Pleural aspiration
A pleural aspiration is the removal of fluid from around the lung with the aid of an ultrasound. A diagnostic pleural aspiration takes a small volume (usually 20- 100ml) of fluid to allow tests to be performed on the fluid. A therapeutic aspiration removes a larger volume (up to 1.5 litres) to improve breathlessness in addition to allowing tests to be performed on the sample taken. This procedure may be done as part of your clinic appointment and following a chest X-Ray you may go straight home.
What other tests you may require on a different day
PET/CT scan
Positron Emission Tomography (PET) this is an imaging technique that uses small quantities of a radioactive tracer, similar to sugar to produce images that show up areas of your body where cells are more active than normal. More information will be given as you will be required to be nil by mouth prior to this procedure. The procedure will take about 2-3 hours and you must not come into contact with pregnant women or children for 6 hours.
CT guided lung biopsy
This test is usually done on an outpatient basis using a CT scan. Local anaesthetic is used to freeze the skin on the front or back of the chest. A thin needle is then passed through the chest wall and into the lung. The CT scan is used to guide the needle into the correct position to allow the biopsy to be taken. The doctors will take a sample of tissue or fluid to be tested. The biopsy is sometimes slightly uncomfortable, but it only takes a few minutes. After the procedure you will need to stay in hospital for a few hours to ensure that the lung has not been damaged. The procedure is undertaken on the Planned Investigation Unit on Level 5 Terence Lewis Building and specific preparation information will be given to you as required.
Echocardiogram (ECHO)
An ECHO is an ultrasound of the heart which gives us detailed information about the structure and function of the heart. The procedure will not need any preparation, it will take about 30 minutes and you will be allowed home straight afterwards.
Cardiopulmonary exercise test (CPET)
A cardiopulmonary exercise test (CPET) shows how your lungs, heart and muscles react together when you exercise. While you sit on a bike, we will measure how much air you breathe, how much oxygen you need, and how fast and efficiently your heart beats when you exercise. This will enable us to measure how well your body reacts under pressure to ensure your body would cope with an operation. This test will be done in the Outpatient Department Level 6 and will take about an hour. Your hospital doctor will explain about why he is arranging for any of these tests and investigations to be undertaken. It may be that there are other investigations that are necessary, and these will be explained to you as and when they are arranged.
What will happen next?
When the results of all your tests and investigations are available and complete, your hospital doctor will take them to a specialist meeting which happens once a week. This is called a Multidisciplinary Team (MDT) meeting.
The MDT is made up of a group of specialists including your doctor, other chest physicians, lung surgeons, pathologists (doctors who examine specimens), radiologists (x-ray specialists) and other specialist doctors and nurses.
At the MDT your symptoms, tests and investigations are reviewed and treatment options discussed. Any recommendation will then be discussed with you at your next appointment. You will be given time to consider these choices before a final treatment/management plan is decided. This ensures treatment and care is tailored to your specific and individual needs.
We understand that this can be a worrying time for you and your family. You are welcome to bring family or friends with you to your appointments if you would like to, it is sometimes useful to have more than one person listening to any explanations given.
Please feel free to ask any questions about any of the arrangements made for you, it is very important that you understand what is happening and why.
Useful Websites:
Plymouth Hospital NHS Trust – www.plymouthhospitals.nhs.uk and search under Lung
Cancer
Roy Castle Lung Foundation: www.roycastle.org
MacMillan Cancer Support: www.macmillan.org.uk
Mesothelioma UK: www.mesothelioma.uk.com
Useful telephone numbers
Chest Clinic:
Heather Gunaratne. Fast Track Coordinator.
Andy Stone Fast Track Administrator
Tel: 01752 433143/433142
Monday-Friday 08:00 – 16:00
Pleural Secretaries:
Elaine Cartwright Tel: 01752 431496
Mandi Sharp Tel: 01752 437573
Lung Cancer Nurse Specialists:
Mandy McLaughlin-Earp CNS Lead (Cancer Services)
Michelle Hessan CNS (Surgery)
Michelle Williams CNS (Cancer Services)
Stacey Atkins CNS (Cancer Services)
Christine Jones (Mesothelioma)
Tel: 01752 432383
Monday-Friday 08:30 - 16:30 (Answerphone available)
Lung Cancer Pathway Navigator:
Sally Snook
Tel: 01752 *438317/433265/07827271167
Monday-Friday 08:00 - 16:00 (*Answerphone available)
