Recognising Lung Cancer in Primary Care

Abstract

Significant advances in the management of both early and advanced stage lung cancer have not yet led to the scale of improved outcomes which have been achieved in other cancers over the last 40 years. Diagnosis of lung cancer at the earliest stage of disease is strongly associated with improved survival. Therefore, although recent advances in oncology may herald breakthroughs in effective treatment, achieving early diagnosis will remain crucial to obtaining optimal outcomes. This is challenging, as most lung cancer symptoms are non-specific or are common respiratory symptoms which usually represent benign disease. Identification of patients at risk of lung cancer who require further investigation is an important responsibility for general practitioners (GPs). Diagnosis has historically relied upon plain chest X-ray (CXR), organised in response to symptoms. The sensitivity of this modality, however, compares unfavourably with that of computed tomography (CT). In some jurisdictions screening high-risk individuals with low dose CT (LDCT) is now recommended. However uptake remains low and the eligibility for screening programmes is restricted. Therefore, even if screening is widely adopted, most patients will continue to be diagnosed after presenting with symptoms. Achieving early diagnosis requires GPs to maintain an appropriate level of suspicion and readiness to investigate in high-risk patients or those with non-resolving symptoms. This article discusses the early detection of lung cancer from a primary care perspective. We outline risk factors and epidemiology, the role of screening and offer guidance on the recognition of symptomatic presentation and the investigation and referral of suspected lung cancer.

Value of circulating tumor cells in the diagnosis and treatment of solitary pulmonary nodules

“…At present, lung cancer can be screened mainly through cexfoliative cell examination of sputum (low sensitivity), chest X-ray examination (high false negative rate), LDCT (high false positive rate and high radiation exposure), and lung biopsy (invasive procedure, and the accuracy may be influenced by sample insufficiency) (7)(8)(9)(10)(11)(12). In 2013, liquid biopsy was defined as a non-invasive procedure for earlystage cancer screening.…”

Suspected Cancer Symptoms and Blood Test Results in Primary Care Before a Diagnosis of Lung Cancer: A Case–Control Study

“…Despite significant advances in the treatment landscape in oncology, achieving early diagnosis remains critical to improving outcomes for patients. However, this remains challenging, particularly in lung cancer where many early symptoms (such as a persistent cough) can be common and nonspecific [12]. GPs, as the gatekeepers to secondary care in the UK, have an important role to play in identifying at-risk patients who require further investigation, however, GPs have reported they often require high levels of suspicion to refer patients on to specialist respiratory consultations [13].…”

Respiratory Tract Disorders Associated with Changes of the Mucous Membrane in Workers often Exposed to Pathological and Toxic Factors

“…In COPD an airflow limitation is associated with abnormal inflammatory response of the lung to toxic particles or gases causing inflammation and destruction of alveolar septa leading to emphysema [38]. Use of bronchodilators including β2agonist salbutamol, anticholinergic ipratropium bromide, β2agonists salmeterol and formoterol, theophylline for COPD treatment can be combined with inhaled corticosteroids for greater efficacy and fewer side effects [39].…”