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History: Before starting any investigations, your health care provider will want a detailed medical and family history to help decide if you are at risk for developing lung cancer. Important information includes whether you are a smoker, live with a smoker, grew up with smoking parents or relatives, work in a smoky environment or are exposed to secondhand smoke frequently. Exposure to other hazards such as radiation, air pollution and asbestos are also significant pieces of information, because all these things will increase your chances of having lung cancer. Important family history includes whether any of your parents, aunts, uncles or brothers and sisters has or had cancer, especially lung cancer because there is a genetic element associated with cancer development. Other significant history details include what kind of symptoms you are experiencing, when they started, and how long they last.
If you have had close contact with anyone with tuberculosis or have been living in a place where tuberculosis is common you should tell your healthcare provider. Lung cancer and tuberculosis have very similar symptoms and can mimic each other but need to be treated very differently
Physical Examination:
Before doing any tests your healthcare provider will perform a physical examination looking for signs of weight loss and general debilitation. They will check the inside of the mouth, the tongue and the throat for signs of cancerous spread, infection or for other causes of the symptoms you are experiencing. Head and neck lymph nodes will be felt to see if there has been any cancerous spread there. The lymph nodes will feel stony and hard and be hard to move if they contain cancer. The liver will also be felt for any signs of cancer. If cancer has invaded the liver to a significant degree, it may feel hard and irregular.
Most importantly, the lungs are examined by percussion (tapping the back) and auscultation (listening with a stethoscope). This is done to look for signs of obstruction, which will make breath sounds reduced or may cause a wheeze; of congestion, which can cause wheezing, altered or reduced breath sounds); and of fluid in the lining of the lungs, which makes the lung areas sound dull when tapped and breath sounds reduced.
Investigations:
After a thorough history and physical examination, your healthcare provider may order one or more of the following tests to confirm the diagnosis and determine the type of lung cancer:
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Sputum cytology: Sputum (phlegm) coughed up over a few days is collected and examined under a microscope for cell identification. The cells, (which can be blood cells, skin cells, cells lining the airways, different types of lung cells and bacterial cells), will be carefully checked for signs of cancer or evidence of other diseases causing the symptoms. |
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Chest X-ray: An x-ray picture of the chest can reveal a lung tumour larger than one centimetre and gives an idea of its location but will not indicate what type of tumour it is. |
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Blood screening tests: These are done to assess the general health of the person suspected of having lung cancer, especially when determining his or her fitness for surgery if a tumour suitable for surgical removal is found. |
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CT scan (computed tomography): This is a more complex form of x-ray where a series of pictures like slices through the body are taken and put together by a computer to give a detailed picture of the area being examined. This method can detect tumours smaller than one centimetre and give a more exact picture of the location and possible spread of the cancer. |
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MRI scan (magnetic resonance imaging): Another even more advanced form of imaging done to give more detail of the tumour and surrounding tissues. |
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Bronchoscopy: Once a suspected tumour has been located by an x-ray, CT scan or MRI, a bronchoscopy may be performed. A flexible tube with a tiny telescope on the end is passed down through the nose and throat and into the bronchi (the main air passages) to search for the tumour. Once a possible tumour is located, a biopsy-where a tiny piece of tissue is cut off-will be performed so a pathologist can examine the cells. |
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Development of lung cancer comes from a weakening of the healthy energy that flows through the body. As previously stated, this mainly occurs when there is a deficiency of vital qi and imbalance of yin and yang. It manifests itself as one of the five syndromes previously described under the "symptoms" section.
Diagnosis in TCM is based on four important examination techniques. The first is "questioning." The TCM practitioner will want to know important information such as what your current complaints are, your past medical history, and family health history. The second technique is "observation." Looking at the physical features of the body such as the face, tongue, hair, nails, sputum and area of pain all give clues as to what the problem may be. The third technique is "hearing and smelling." Smelling the sputum and breath and listening to the sounds coming from the chest are important when evaluating lung cancer. The last technique used in examination includes "touching." Feeling the pulse is one of the cornerstones of TCM diagnosis and gives the TCM practitioner a lot of information about the imbalance occurring in the body.
If the TCM practitioner, suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she may recommend that the individual see a western doctor for further follow up. It is also not uncommon for a TCM practitioner to ask to see the blood work or x-rays that you have had performed to give the practitioner more information when forming a TCM diagnosis. The syndromes that are most commonly diagnosed with lung cancer include:
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Yin Deficiency and Interior Heat Syndrome |
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Spleen Deficiency and Phlegm Dampness Syndrome |
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Deficiency of Qi and Yin Syndrome |
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Deficiency of Yin and Yang Syndrome |
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Stagnation of Qi and Blood Stasis Syndrome |
When evaluating someone for lung cancer, it is important to make sure that it can be differentiated from the following health problems.
Pneumonia
This is an acute and febrile disease which is caused by a wind-heat pathogen (substance causing a disease). According to TCM, it develops in four stages: the defense (wei) stage, vital energy (qi) stage, nutrient (yin) stage, and blood (xue) stage. At the beginning there will be a fever and cough which are the defenses against the pathogens. As chest pain, coughing, and yellow thick sputum develop, the pneumonia goes into the qi stage. When the pathogens interfere with the body receiving nutrients, the pneumonia enters the nutrient stage, and symptoms such as a high fever or convulsions may occur. Finally, when the pathogenic factors enter the blood, lethargy, coma and even death may occur if it is not treated properly.
Lung abscess
It is usually caused by a pathogen that originates form outside of the body and also has an acute onset. Symptoms like sudden chilling, high fever, chest pain, increased sputum production with a fishy smell or thick bloodstained sputum, and a cough are usually present.
Lung tuberculosis
It is caused by weakness, a deficiency of qi and blood, and the bacteria Mycobacterium tuberculosis. Its main active manifestations are a chronic cough, heamoptysis (coughing up blood or bloody sputum), fever, night sweating, fatigue and weight loss.
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