A bronchoscopy allows your doctor to look directly at the voice box, windpipe and bronchial air passages. The test involves passing a bronchoscope (a long, thin, flexible telescope with a bright light on the end) into your lungs either through your mouth, or, more commonly, through your nose. Looking down the bronchoscope, the doctor can get a clear view of the lining of the airways to check whether any disease is present. The diagram shows a bronchoscopy procedure.

  • The test usually takes ~20 minutes to complete


General Medical Assessment
Occasionally symptoms and illness may not clearly fit into a specific specialty or may span or involve more than one system.

A general medical assessment will includes review of past medical history, assessment of current clinical symptoms and review of medication, an examination and then appropriate investigations and implementation of treatment plan which may including medication, dietary advise, physical therapy and preventative approaches.

A medical assessment can be also be helpful when planning suitability for or optimization prior to surgical procedures or prior to initiation of cancer therapies.

Acute medical assessments may be undertaken when complications arise after surgery, complicate drug therapies or develop during or after oncological therapies. This may occur as an inpatient or outpatient.


Lung Cancer Screening
Lung cancer screening is not currently available through the NHS because it is expensive to screen all people over 55 who have been regular smokers. Most patients who have a private lung cancer screen have to pay for the procedure themselves, as insurance policies generally do not cover screening of any kind.
Who is eligible for lung cancer screening? Individuals if they are:

  • Aged between 55 and 75
  • Long term smokers (20 years +)
  • Have no obvious symptoms

Worrisome symptoms for further evaluation to exclude a lung cancer:

  • An unexplained cough that lasts more than three weeks
  • Coughing up blood
  • Persistent pain in the chest or shoulders
  • Breathlessness or difficulty breathing
  • Losing weight for no reason
  • Developing a hoarse voice that lasts more than three weeks

After a full consultation and examination patients have a chest X-ray in clinic and then a CT scan would be the next step. Further tests may then follow, depending on what was found in the CT scan:

  • A bronchoscopy with endobronchial ultrasound
  • Ultrasound-guided needle biopsy
  • CT-guided biopsy


Lung Biopsy

Percutaneous lung biopsy is a procedure in which a special needle is used to remove a small piece
of tissue from your lung for examination in the laboratory. This examination is usually done under
local anaesthetic using some form of imaging guidance, such as x-ray, CT (computed tomography)
scan or ultrasound.

If it is suspected that there is something wrong with the surface of your lungs, the lung tissue or the chest wall then a biopsy could be requested. An abnormality seen on a chest x-ray or a CT scan is the most common reason for a lung biopsy.
Having the test will help your doctor to make a correct diagnosis and plan the most suitable treatment
for you.



Dr Charlotte Rayner has developed a particular expertise in the management of patients who may have suspected cancer or who have developed medical complications related to cancer or the treatments given for cancer. As part of the service, Dr Rayner is able to undertake rapid assessment and diagnosis when such medical problems arise. Dr Charlotte Rayner advises and assists with the management of patients at the Cancer Centre London and chairs the acute oncology group there.

Cancer Centre London Website


Pleural Procedures
In some conditions there is a build up of fluid around the lungs this is called a pleural effusion. Following a clinical assessment and examination a chest X-ray may be used to confirm the presence of fluid. To assist with the diagnosis of the cause for the effusion, samples of fluid will be taken under guidance of either CT or ultrasound.

If a large amount of fluid is present this can cause breathing difficulties in which case the fluid can be drained. This is normally undertaken as a day case procedure.


Tuberculosis Screening

An assessment for prior tuberculosis exposure (latent TB) or active disease includes a full clinical history and examination. A chest X-ray, a Mantoux skin test and or an EliSpot blood test.

TB Vaccination can be given once latent TB or active Tb has been excluded.