Lung cancer unfortunately is one of the most common causes of cancer in the UK. The most
common symptoms of lung cancer are having a cough that often lasts for more than three
weeks, coughing up blood, feeling breathless while having a severe pain in the chest. In
addition, sometimes patients with lung cancer have a loss of appetite and because of this,
can also lose a considerable amount of weight. It is important to know however that it is
perfectly possible to have a lung cancer without any symptoms at all.
In the UK, approximately 85% of cases of lung cancer are directly linked to exposure to
tobacco. So smoking is still unfortunately one of the commonest causes of lung cancer.
In addition, exposure to dust such as asbestos and in particularly the gas radon also predisposes
to lung cancer. What we’re increasingly recognising however
is that people who have never smoked or have no obvious exposure to either asbestos or
radon are also developing lung cancer. And this proportion of patients who have never smoked
in developing lung cancer appears to be increasing.
Unfortunately in my clinical practice, far
too often I hear that lung cancer is a death sentence. This is very much not the case with
modern treatments. If we’re able to detect lung cancer early enough, we can offer treatments
such as surgery and high doses of radiotherapy which have been shown to cure lung cancer
in the majority of patients. The key however is detecting the disease at a stage that is
early enough for those treatments to be applied.
In the UK, it’s very common for patients
to have a CT scan carried out of their neck, chest and upper abdomen as an initial
investigation. They will then commonly see a respiratory specialist like myself who would
take a history from the patient to clarify what their risk factors may be for lung cancer
and importantly to learn about their symptoms and also their wishes as a patient.
We would then as the next step want to carry out a biopsy test. This will tell us exactly
first of all whether it is a lung cancer and secondly, if it is a lung cancer, what type
of lung cancer it may be. We may then want to do a third test which would be a PET CT
scan which may help to clarify the extent to which the cancer has spread if at all.
Once we have all of this information together including the extent to which the cancer has
spread along with the type of cancer we’re dealing with, it is then important to sit down
and discuss the treatment options with the patient.
The endobronchial ultrasound or EBUS has become a very important procedure for the diagnosis
and staging of lung cancer. It is now routinely performed to obtain biopsies on patients in
the UK and worldwide for diagnosing lung cancer. The procedure itself is relatively straightforward.
It is done in an outpatient setting with the patient receiving an injection as a sedative.
This means that they are very calm and relaxed but still easily rousable. A spray is usually
applied to the back of the throat to make the throat numb and then a small telescope
is introduced via the mouth into the lungs. This is not a painful procedure. There is
coughing involved but this is mitigated by the operator using local anesthetic. Once
the telescope is inside the lungs, the operator is able to take an ultrasound probe and have
a close look at all lymph nodes within the centre of the chest. Once they have identified
an area that they wish to sample, under direct vision of the ultrasound, they’re able to
take biopsies from the lymph nodes within the centre of the chest.
A procedure will take typically 30-40 minutes and is generally well-tolerated. The patient
would then recover for an hour or two within the hospital unit before being discharged
home. The results from the procedure are generally extremely good. And we would expect a positive
answer from at least 9 out of 10 procedures. The procedure is also extremely safe and well
tolerated and complications are extremely rare.