How are pulmonary function tests done?

What is a tomogram? Is it related to a CT scan?

A tomogram or laminagram is a special chest x-ray. If the regular chest x-ray shows a shadow in the lungs, tomograms can tell the physician more about the size, shape, or other characteristics of the lump. It is a series of pictures of various sections of lung tissue which when put together give a three dimensional picture of abnormal lung growth. In cases of benign lumps, the tomogram tells the doctor enough about the tumor so he can make the diagnosis based on the tomogram pictures alone. If the tomogram suggests that the lump is cancerous, more tests will be needed to narrow down the diagnosis. A CT scan computerized tomography is often taken.

What is a bronchogram? 

A bronchogram is another specialized x-ray examination which is sometimes used. A small amount of radio opaque dye is put into the bronchial tubes, and usually into the trachea after the area has been numbed. The patient is tilted into various positions to distribute the dye into the lungs and throughout the bronchi. X-rays are then taken.

What are pulmonary function tests? 

Pulmonary function tests (also called lung function tests) are given to measure your breathing and evaluate your ability to get oxygen into your blood. The tests measure the amount of air moving in and out of the lungs and indicate if there is an obstruction in the air passages. The tests give a baseline value of how well your lungs are presently functioning. The doctor will do these before the operation to be sure that your lungs are in good enough condition to keep you functioning even if a part of them is removed.

How are pulmonary function tests done? 

The test consists of various breathing exercises. It takes about 1 or 2 hours and will probably make you tired. You breathe pure oxygen. Then you have blood samples drawn. Cooperation is very important in this test, and you must follow the instructions closely. The tests themselves are painless but time consuming. In some places, radioactive materials and a camera or a computer are used in performing these tests.

Is a biopsy a necessary test? 

A biopsy is an essential test. It means obtaining and examining a piece of tissue under the microscope. The tissue can be obtained in many different ways, as discussed above. You should remember that not all spots on the lungs are cancerous. As a matter of fact, according to the Mayo Clinic, an estimated 50 to 60 percent of lung biopsies are benign or noncancerous, depending on age. If lung cancer has spread to the lymph nodes in the neck or to other body tissues, a specimen of these might be taken for biopsy. When the pathologist studies a biopsy specimen under the microscope, he can identify the cell type of lung cancer along with its degree of malignancy.

What is a mediastinoscopy? 

This is a minor surgical procedure that tells whether lung cancer has spread to the lymph nodes behind the breastbone in the area called the mediastinum. It is common for lung cancer to spread here first. The doctor passes an instrument through a small incision in the neck. You are anesthetized and asleep at the time. The nodes that are taken out are looked at by the pathologist. If they contain cancer, surgery may not be done. Radiation may be given instead to try to diminish or shrink the tumor tissue in the chest.

What is mediastinotomy? 

This procedure is similar to mediastinoscopy, except the incision is made either to the right or left side of the breastbone.

What is a sternotomy? 

This operation requires the midline splitting of the sternum and is sometimes used for patients who have lung disease which has spread. Some doctors feel that this surgical approach allows them to see both sides of the chest during the operation so that any undetected cancer can be found. Doctors who use this procedure report that recovery is rapid, there may be fewer breathing problems, and there is less postoperative pain.

What is thoracentesis? 

Fluid from the space between the lungs and the chest wall is removed by needle. A local anesthetic is applied to the skin where the needle will be inserted to minimize discomfort. Gentle suction draws the fluid through the needle into a syringe or bottle. There is then an examination of the fluid under the microscope to see if there are cancer cells. This test is usually used after other attempts to find cancer have failed. It can also be used to relieve pain or shortness of breath caused by the collection of fluid in the pleural space. This test can be done either in a hospital room or in an examining room.

What is a thorascopy? 

This surgical procedure is used for diagnosing cancer in the lung. The patient is anesthetized and asleep in the operating room. A small incision is made between two ribs, and a slender tubular instrument is inserted into the space occupied by the lung. The instrument is much like a fiberoptic bronchoscope. When the instrument slips into the lung cavity, the lung is deflated and the thorascope can be used to examine the entire surface of the lung for tumor growth as well as the lining of the chest wall. Suspicious tissue is snipped, withdrawn through the thorascope, and given microscopic examination. The lung is reinflated at the end of the procedure. The lung not being examined remains expanded and able to function during the entire procedure.

How A Pulmonary Function Test Works

Is magnetic resonance imaging being used to detect lung cancer? 

Investigators are conducting studies to evaluate the usefulness of this technique in staging lung cancer.

This seems like a lot of tests. Are they all necessary? 

Not all of the tests are done on all patients who are suspected of having lung cancer. However, it is important to have thorough testing and staging in lung cancer before any surgery is done. The time spent in doing diagnostic tests is time well spent. For example, if lung cancer has spread to the lymph nodes in the neck, to the opposite lung, or to other distant organs such as the liver or the brain, surgery alone will not cure it. Small cell cancer of the lung is rarely cured by surgery. For it, other forms of treatment chemotherapy and radiation must be relied on. Operations for lung cancer (thoractomy with lobectomy or pneumonectomy) are major surgery and are usually not performed unless the patient stands a reasonable chance for cure.


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