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abdomen: A series of images are taken, which build up a three-dimensional picture of the inside of your body. This allows the specialist to gather more information about the cancer such as the exact location of the tumour in your lungs, whether nearby lymph nodes are affected, and whether the cancer has spread to other areas of the lungs and/or parts of your body. It is a painless procedure and usually takes about 10–30 minutes. • CT scan or magnetic resonance imaging (MRI) scan of the brain: This test allows doctors to rule out or confirm whether the cancer has spread to your brain. An MRI scan uses powerful magnetism to build up detailed images. You may be given an injection of dye into a vein in your arm to help the images show up more clearly. The scan won’t hurt but may be slightly uncomfortable as you will need to lie still inside the scanning tube for about 30 minutes. You will be able to hear and speak to the person doing the scan. 15 ESMO Patients Guide • Positron emission tomography (PET)/CT scan: A combination of a CT scan and a PET scan. PET uses low-dose radiation to measure the activity of cells in different parts of the body, so a PET/CT scan gives more detailed information about the part of the body being scanned. A mildly radioactive drug will be injected into a vein in the back of your hand or arm and then you will need to rest for about an hour while it spreads throughout your body. The scan itself will take 30–60 minutes and, although you will need to lie still, you will be able to speak to the person operating the scanner. A PET/CT scan is often carried out to detect whether the cancer has spread to the bones. Histopathology Examination of a biopsy is recommended for all patients with NSCLC as it helps to determine the best treatment approach Histopathology is the study of diseased cells and tissues using a microscope; a biopsy of the tumour allows a sample of cells to be closely examined. Examination of a biopsy is recommended for all patients as it is used to confirm a diagnosis of NSCLC, to identify the histological subtype of NSCLC, and to identify any abnormal proteins within the tumour cells that could help to determine the best treatment for you (Planchard et al., 2018). Techniques for obtaining a biopsy include: • Bronchoscopy: A doctor or specially-trained nurse examines the insides of the airways and lungs using a tube called a bronchoscope. It is carried out under local anaesthetic. During a bronchoscopy, the doctor or nurse will take samples of cells (biopsies) from the airways or lungs. • CT-guided needle lung biopsy: If a biopsy is difficult to obtain with a bronchoscopy, your doctor may choose to obtain a biopsy during a CT scan. In this procedure, you will have a local anaesthetic to numb the area. A thin needle is then inserted through your skin into your lung so that the doctor can remove a sample of cells from the tumour. This should only take a few minutes. • Endobronchial ultrasound-guided sampling (EBUS): This technique is used to confirm whether the cancer has spread to nearby lymph nodes, after radiological examinations have suggested that this might be the case. A bronchoscope, containing a small ultrasound probe, is passed through the trachea to see whether any nearby lymph nodes are larger than 16 Non-small-cell lung cancer normal. The doctor can pass a needle along the bronchoscope to take biopsies from the tumour or the lymph nodes. This test can be uncomfortable but shouldn’t be painful. It takes less than an hour and you should be able to go home the same day after it is finished. • Oesophageal ultrasound-guided sampling (EUS): Similar to EBUS, this technique is used to confirm whether the cancer has spread to nearby lymph nodes, after radiological examinations have suggested that this might be the case. However, unlike EBUS, the ultrasound probe is inserted through the oesophagus. • Mediastinoscopy: This procedure is more invasive than EBUS/EUS but is recommended as an extra test if EBUS/EUS does not confirm that the cancer has spread to nearby lymph nodes or if the lymph nodes requiring investigation cannot be reached by EBUS. A mediastinoscopy is carried out under general anaesthetic and requires a short stay in hospital. A small