Medical Oncologist
CION Cancer Clinics
Tests to check you can manage with one lung | CION Cancer Clinics
Before a pneumonectomy, your team checks that your other lung and your heart can carry the full load. The usual tests are spirometry, a gas transfer test, heart tests and often an exercise test or a scan of each lung's share. No single number decides. This page explains each test, the words on the report, and what happens if a result is borderline. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Which tests show whether you can manage with one lung?
- In what order are the tests usually done?
- What do the terms on the test report mean?
- What else is checked before the operation?
- What do families often misunderstand about these tests?
- What happens if the results are borderline or poor?
- Common questions about tests before pneumonectomy
The short answer
Which tests show whether you can manage with one lung?
Before a pneumonectomy your team checks that your other lung and your heart can carry the full load on their own. The usual tests are breathing tests, a test of how well oxygen passes into the blood, heart tests, and often an exercise test or a scan that shows how much each lung is doing.
Why the checks are stricter than for smaller lung surgery
After a lobectomy, part of the lung on that side keeps working. After a pneumonectomy nothing on that side is left. If the remaining lung is weak, the operation could leave you breathless at rest or dependent on oxygen. The tests exist to spot that risk before the operation rather than after it.
No single number decides
Each test gives part of the picture. The team combines the results with your age, your other illnesses, how active you are day to day and what the scans show. A borderline result on one test does not automatically rule you out, and a good result on one test does not automatically rule you in.
This page explains what the tests are for. It cannot interpret your own results. Your surgeon and chest physician will explain what they mean for you.The pathway
In what order are the tests usually done?
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Spirometry and gas transfer
You blow into a machine to measure how much air your lungs move and how fast. A second test, done at the same visit, measures how easily oxygen passes from your lungs into your blood.
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Estimating what will be left
Using those results and your CT scan, the team estimates how your breathing will be after the lung is removed. This estimate matters more than the result today.
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A scan of each lung's share
If the estimate is borderline, a perfusion scan may be done. A small amount of tracer shows how much blood flow, and so how much work, each lung currently handles.
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An exercise test
You may climb stairs, walk a set course or cycle on a machine while your breathing and heart are measured. It shows how your body copes with effort, which a sitting test cannot.
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Heart checks
An ECG, which is a heart tracing, and usually an echocardiogram, which is an ultrasound of the heart. More tests are arranged if these show a problem.
Not sure whether this applies to you?
Ask an oncologistOn your report
What do the terms on the test report mean?
- FEV1
- How much air you can blow out in the first second of a hard breath out. It is one of the main measures of lung function.
- DLCO or TLCO
- How well oxygen crosses from the air sacs into the blood. It can be low even when spirometry looks normal.
- Predicted postoperative (ppo)
- An estimate of what a result will be after the lung is removed. This is the figure the team focuses on.
- Perfusion scan
- A nuclear medicine scan that shows the split of blood flow between the two lungs.
- VO2 max
- The most oxygen your body can use during hard exercise, measured in a cycling test called CPET.
- Echocardiogram
- An ultrasound of the heart that shows its pumping and the pressure in the lung blood vessels.
Beyond the lungs
What else is checked before the operation?
Fitness for a big operation is about the whole body, not only the lungs.
Whether the cancer has spread
A PET-CT scan, and often a brain scan, look for spread elsewhere. Glands in the middle of the chest may be sampled with a needle through a camera in the airway, called EBUS.
Blood tests
Blood counts, kidney and liver function, sugar and clotting are checked. A low haemoglobin or high sugar is treated before surgery where possible.
Nutrition and weight
Recent weight loss and poor appetite slow healing. A dietitian may help you build up protein and strength beforehand.
Smoking and chest infections
Stopping smoking before the operation lowers the risk of chest problems afterwards. An active chest infection is treated first.
Tell the team about
- Any cough with fever or coloured phlegm
- Blood thinners and diabetes medicines
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Commonly believed
What do families often misunderstand about these tests?
"All these tests are just delaying the operation."
They are what make the operation safe to offer. A few extra days of testing are far less harmful than a major operation in someone whose remaining lung cannot cope.
"He can walk to the shop, so his lungs must be fine."
Everyday walking uses only part of your lung capacity. Losing a whole lung removes a large share of it. The tests measure reserve, which daily activity does not reveal.
"If she tries harder on the breathing test, the numbers will be better."
Full effort is asked for, and a good technician will repeat the blow until the results are consistent. Straining beyond that does not change what the lung can really do.
"A poor result means nothing can be done."
A poor result may rule out removing a whole lung. It does not rule out treatment. A smaller operation, radiotherapy or medicines may still be possible.
Being straight with you
What happens if the results are borderline or poor?
A borderline result starts a conversation, not a refusal. The team will usually look for ways to lower the risk, or look again at whether a smaller operation could still clear the cancer.
Getting fitter before surgery
Some people improve their results with a short period of preparation, called prehabilitation. It means regular walking or supervised exercise, breathing exercises, stopping smoking and better nutrition. Inhalers may be reviewed by a chest physician. Tests may then be repeated.
When the answer is no
If the tests show that losing a whole lung would leave you breathless at rest or put your life at high risk, the team will not recommend it. That decision is made to protect you. You may be offered focused radiotherapy, chemotherapy, immunotherapy or targeted medicines instead, depending on the type of cancer.
Asking the right questions
It is fair to ask which result worried the team most, whether a repeat test or preparation could change it, and what the alternatives would be. A second opinion is reasonable before a decision of this size.
Did you know
The breathing test result that matters most is not today's figure but the estimate of what will remain after surgery. Two people with the same test today can get very different answers, because their scans show a different share of work done by the lung being removed.
Questions we are asked
Common questions about tests before pneumonectomy
How long do the tests take to complete?
Breathing tests take less than an hour. The full set, with scans, heart checks and any exercise test, is often spread over several visits. Where possible, tests are grouped to cut travel from districts. Ask for a written list of what is booked, and bring every earlier report to each visit.
How should I prepare for a breathing test?
Wear loose clothing, avoid a heavy meal just before, and do not smoke on the day. You may be asked to hold certain inhalers beforehand. Follow the instructions from the lab exactly, and do not stop any other medicine unless your doctor tells you to.
Is the exercise test safe for an older person?
It is done under supervision with the heart and oxygen levels monitored throughout, and it can be stopped at any time. Staff will ask about heart problems first. If walking is difficult because of joints, say so, because a different test can be chosen.
Does the perfusion scan involve radiation?
Yes, a small amount. A tracer is injected into a vein and a camera takes pictures while you lie still. The dose is low and the tracer leaves the body quickly. Tell the staff beforehand if you could be pregnant or are breastfeeding.
Why am I being sent to a heart doctor?
Removing a lung puts extra strain on the right side of the heart, which pumps blood through the lungs. If the ECG or echo shows a weakness, raised lung pressure or a rhythm problem, a cardiologist checks whether it can be improved before surgery.
Can I improve my results before the operation?
Sometimes. Stopping smoking, walking daily, breathing exercises, treating a chest infection and eating well can all help. How much they change the numbers varies. Ask whether a short period of preparation and a repeat test is sensible in your case.
Can these tests be done near our home?
Basic spirometry, blood tests and ECGs are often available in district hospitals. Gas transfer, perfusion scans and formal exercise tests are usually in larger centres. Check with your surgical team that outside results are acceptable before arranging them.
Are the tests covered by Aarogyasri or insurance?
Tests done as part of an approved cancer surgery plan are often covered. Aarogyasri, CGHS, ECHS, EHS and most cashless insurers are accepted at CION. Some schemes cover pre-operative tests differently, so call the helpline with your card details and we will check.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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Sources
- NICE — Lung cancer: diagnosis and management (NG122)
- Cancer Research UK — Surgery for lung cancer
- NHS — Spirometry
- National Cancer Institute — Non-Small Cell Lung Cancer Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Fitness, tests and prehabilitationHow to get fitter before a big operationWhen is a whole lung removed?Why the team is considering this operationLeft vs right pneumonectomy: why it mattersWhy the side affects how much lung is lostPET-CT scan guideThe scan used to check for spreadPneumonectomyEvery page about whole-lung removal
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