"Hello Mr JB, I am one of the doctors working on call tonight. I have called you to this quiet room because I have some news to tell you. I have just seen your X-rays and there seems to be some opacification in the right upper lobe of your lungs. There is many causes for that opacification; it could be a benign cyst, or tuberculosis, or pneumonia, but given your history of smoking and coughing out blood, we are looking at the possibility of cancer. We have to conduct further studies to confirm the diagnosis. What we would like to do is get your consent for the different proceedures to do that.

"First test is a sputum culture. What we will do is collect a sample of your sputum and send it for review under the microscope. Sometimes, some of the cancer cells may get coughed out, but we can also look for bacteria to check for TB.

"We also would like to get a CT scan of your chest, to have a better look at the opacification. We also can get a good idea of where it is and allows us to do the next test.

"If it is near the surface, we would take a sample through the outside of the chest wall. Or if it is deeper in the lungs, we would have to reach it through your airways, by bronchoscopy. Once we get a sample, we can make a more definite diagnosis. If it is cancer, we would also be able to stage the cancer.

"With the staging done, we can administer the appropriate therapy.