This leaflet tells you about the procedure known as a Mediastinoscopy. This is also known as Mediastinal lymph node biopsy.

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1 Patient Information Mediastinoscopy Introduction This leaflet tells you about the procedure known as a Mediastinoscopy. This is also known as Mediastinal lymph node biopsy. We hope it will answer some of the questions that you or those who care for you may have at this time. It is not meant to replace discussion between you and your doctor, but is a guide to be used along with what is discussed. What is a mediastinoscopy? A mediastinoscopy is a procedure to examine the Mediastinum. This is the area in the centre of your chest, between your lungs. During the test, your doctor may collect tissue samples which will be examined further in the laboratory. This is called a biopsy. Why do I need a mediastinoscopy? The more common reasons for a mediastinoscopy are: a) If swollen lymph nodes (glands) are seen on your X-ray or CT scan, some tissue may be taken to help find out whether they are due to inflammation or cancer. b) If cancer has already been diagnosed, a mediastinoscopy can help determine how far it has spread (the stage of the cancer). This information is important for offering the best treatment. Benefits of having a mediastinoscopy: 1) It can help diagnose infection, ruling out a cancer and allowing appropriate treatment. 2) It can help diagnose cancer, allowing appropriate treatment. 3) It can help to see how advanced cancer is. This would allow the best planning and co-ordination of your treatment.

2 Are there any alternatives to a mediastinoscopy? Other tests may give some information about your lungs and some can take smaller samples. However, while these will have been considered where possible, only a mediastinoscopy can allow the doctor to look at the lymph nodes that they need to and to get a sample big enough for what they need to help make a full diagnosis. What will happen if I decide not to have a mediastinoscopy? Without a mediastinoscopy, your doctor may not be able to find out the cause of your symptoms and it may not be possible to give you the correct treatment. If you decide not to have a mediastinoscopy, you should discuss this carefully with your doctor. Will I be awake during it? A Mediastinoscopy is always done under sedation (general anaesthetic). The sedative medication is administered into a vein and allows you to feel relaxed and to be asleep during the procedure. This means that the procedure itself will not be painful. You will be given separate information about anaesthetic. Do I need to avoid eating and drinking before it? Do not eat any food for at least 4 hours before the test. Do not drink anything for 4 hours before the test. Take any tablets which you need, with a drink, up to 4 hours before the test Take all other medicines such as inhalers at the usual times on the day of the test. What should I do before the mediastinoscopy? Before the test a doctor will explain the test to you. If you have any anxieties or queries at this stage, do not be afraid to ask. Please tell him/her (or his/her secretary) if you are taking any of the following drugs: Warfarin, Aspirin or Plavix (Clopidogrel) Any drug for treating arthritis. This includes: Voltarol (diclofenac) Indocid (indomethacin) Brufen (ibuprofen) Ketoralac Mobic (meloxicam) Celecoxib Advil Neurofen Feldene Vioxx (rofecoxib)

3 What happens during the mediastinoscopy? Even though this is a form of test or investigation, it is still a surgical operation. A cut is made an inch and a half (4cm) long, just above your breastbone. A telescope is fed through the cut and passed alongside your windpipe (this is called the trachea). The telescope is about the same thickness as your thumb. The tissues of the mediastinum are teased off the windpipe, allowing the telescope to be passed down to the level of the heart. Tissue samples are taken from the lymph nodes around the windpipe and sent to the laboratory for examination. It takes about 30 minutes with an extra 30 minutes needed for the anaesthetic. It is likely that you will be asked to come in the evening before the procedure and usually you will stay overnight. How will I feel afterwards? After the test there will be some pain around the cut and some tightness in the chest around the windpipe. Local anaesthetic will be injected around the cuts to tide you through the first hours. You will be given mild painkilling tablets to take home. You should not drive home. You may feel stiff and uncomfortable with some nausea in the 48 hours afterwards. You should be able return to work within a week. What are the possible side effects and complications? Operation complications Any surgical procedure has risks of injury, complication or even death. Mediastinoscopy complications can be: 1. Bleeding There will be some swelling and bruising around the cut for a few days. Bleeding may be a problem if you are taking drugs that thin your blood, have a hereditary bleeding condition or have kidney or liver failure. Blood transfusion is rarely needed. 2. Major bleeding Your major blood vessels (the aorta, pulmonary artery, vena cava and azygous vein) are close to where the operation is done. These blood vessels may get injured during the biopsy procedure. This can result in major, immediate blood loss. While we take careful precautions to avoid this complication and it is very uncommon, it can happen and you need to understand that you could require intensive care. It is possible to die from such major bleeding. Controlling the bleeding and repairing the injured blood vessels would mean a much larger cut to the chest (called a median sternotomy or thoracotomy).

4 3. Infection The incision (cut) can become infected. This would mean inflammation, swelling and discharge. Though it is not likely that it will get infected, the edges of your wound can become inflamed because of the contact with surgical instruments. If so, you may need to wear dressings for a few days. It is very rare that you have to wear dressings for longer than this. 4. Air leak from the lung It is possible that your lung could develop an air leak. This can be treated with a chest drain being put in place, and it would usually settle in a number of days. 5. Injury to the windpipe and other organs The windpipe and other organs near it may get injured. If the windpipe itself gets punctured, it can cause an air leak. If your oesophagus (gullet) is punctured, you would have to be fed by an intravenous feed (what is the common name for this) 6. Hoarseness If the nerve supplying the voice box (the recurrent laryngeal nerve) gets bruised, it would cause your voice to be hoarse. This usually recovers within 6 weeks but occasionally damage can be permanent. Anaesthetic complications can happen information about anaesthetic will be offered to you. Your doctor would not be recommending that you take the test unless the benefits outweighed the risks. If you are worried, then you should discuss it with the surgeon. When will I get the results? Biopsy results will not be available until about usually 7 10 days later. You will be given an appointment at the first available clinic to come and discuss the results when they are ready. At that stage, arrangements can be made for any treatment that you need. Glossary of medical terms used in this information Biopsy - A procedure in which a small piece of tissue is removed and examined under a microscope. Sedative - A drug with a soothing, or calming effect. Contact numbers: Royal Victoria Hospital Thoracic Surgical Ward 4a: Belfast City Hospital Surgical Ward 5 South: Royal Victoria Hospital Thoracic Secretaries: /2027

5 Important note It is important that you make a list of all medicines that you are and bring it with you to all your clinic appointments. This includes any herbal or alternative remedies. If you have any questions at all, please ask your hospital doctor or nurse. It may help to write down questions as you think of them so that you have them ready. It may also help to bring someone with you when you attend your appointments. About this Information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how it can be improved, please contact us via our website: HUhttp:// This leaflet is adapted, with permission, from information produced by Mr Kieran McManus, Consultant Thoracic Surgeon, Belfast Health and Social Care Trust. Developed October 08 by NICaN Lung Cancer Information Pathway group. For review October 09.