Diagnosis and treatment

Biopsies

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In order to determine if you have ALK+ NSCLC, your doctor will have performed a test called a biopsy.

A biopsy is a test where a small piece of the cancer is removed from your body, or cancer cells are collected from your blood or sputum, and various tests are run on it to determine what kind of cancer it is, and what treatments are likely to be most successful at treating it.

The below diagram shows you a common biopsy testing process – each clinic is different though, so you may have experienced a slightly different process to the one below.

Diagram showing the biopsy and testing process of NSCLC

After you have visited your doctor with some symptoms that you were worried about, they will have initially carried out some tests to look inside your lungs (for example, an x-ray or a scan - you can read more about these here)

At this stage, its likely that they will have noticed a tumour growing. To learn more about your cancer, they will probably also recommend that you undergo a biopsy.

In order to determine if you have NSCLC, doctors may recommend that you undergo a few tests, including a biopsy.1

Biopsies are often gathered using special biopsy needles in a number of ways, depending on where in the lungs the cancer is growing.2 The technician and doctor taking your biopsy sample will offer you anaesthesia (numbing) medicine, or a sedative (if you can take these) to help make sure you are as comfortable as possible throughout the biopsy process.

Some types of biopsies include:2

  • Transthoracic biopsy: a needle is pushed from outside of the body, through the chest, and into the tumour to remove some cells for testing
  • Thoracentesis: a needle is inserted, but this time it is used to collect fluid from around the lungs to analyse any cancer cells that may have leaked into this area
  • Transtracheal or transbronchial biopsy: a tube is passed down the windpipe, and a needle is used to take a sample through the wall of the windpipe

Biopsies may also be taken without a needle:2

  • Bronchial brushing and washing: in these cases a doctor passes a tube down the windpipe and then either uses a small brush to scrape away some tumour cells for testing, or washes the tumour with a saline (salt water) solution to collect the cells
  • Sputum cytology: a sample of any mucus that you cough up (known as sputum) can be analysed to see if there are any cancer cells present and test these

Sometimes performing biopsies such as the ones described above can be difficult. In these cases, the doctor might offer a blood-based test that looks for genetic material or cells from the NSCLC in a blood sample.3

Sometimes performing biopsies such as the ones described above can be difficult. In these cases, the doctor might offer a blood-based test that looks for genetic material or cells from the NSCLC in a blood sample.3

The sample of your blood or lung from the biopsy is sent to a specialist laboratory where they analyse the DNA and proteins in the cells.2 

The laboratory sends the results of your sample back to the doctor.

If the laboratory was able to get a result from the biopsy, a doctor will discuss these with you and talk about what the next treatment steps are.

In some cases, the biopsy may not have contained enough cells or DNA to get a good result. If this happens, then another biopsy may be needed.4 It may be the same type of biopsy as before, or a different one.

  1. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guideline in Oncology: Non-Small Cell Lung Cancer, Version 2.2019. 2018.
  2. American Cancer Society. Tests for Non-Small Cell Lung Cancer, 2017. Available from: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Last accessed August 2019.
  3. Foundation Medicine. FOUNDATIONONE®LIQUID. Available from: https://www.foundationmedicine.com/genomic-testing/foundation-one-liquid. Last accessed August 2019.
  4. Ofiara LM et al. Curr Oncol 2012; 19(Suppl 1): S16–S23.