Persistent cough and lung cancer

Are you concerned you might have lung cancer?

As a Consultant, I’m concerned when someone has persistent cough (which we describe as being more than three weeks), breathlessness, has been feeling very tired, is losing weight, has had a pain in their chest or shoulders, has experienced hoarseness or have been coughing up blood, especially if they are a smoker or have smoked in the past.

 

Persistent cough is the most frequent symptom that my patients present with, but lung cancer is usually not the cause of their cough and there are many other causes of coughing persistently. However as the prognosis from lung cancer is so much better when it is picked up early it is very important that we investigate those people with symptoms or risk factors.

 

You may be wondering how likely it is that you have lung cancer if you have a persistent cough This depends on a number of factors including your age, family history, any exposure to asbestos, whether you are or have ever been a smoker. 

 

If 100 people are referred using the standard referral criteria that are approved by NICE (that is having any of the concerning symptoms listed above, aged more than 40 years, and a smoking history) I would expect 5 of those people to have lung cancer.

 

This might seem low, but the early the diagnosis of lung cancer is critical because once the cancer has spread, it is very unlikely to be curable. The prognosis for late stage lung cancer is very poor, but diagnosis is important even in late stages as treatment can still improve prognosis.  This is becoming even more important as new cancer treatments are becoming available.

Some facts about smoking and lung cancer

 

89% of all lung cancer is preventable if you don’t smoke.

The risk of lung cancer adds up the more you smoke and never entirely goes away when you stop. The good news is, the risk does lessen the longer you’ve stayed off the cigarettes.

 

Having one hour of shisha smoking (hookah smoking) is equivalent to smoking twenty cigarettes.

 

Smoking cannabis with tobacco not only raises your risk of lung cancer, but has its own problems, including rapid development of emphysema.

 

We suspect that ‘vaping’ is less risky than smoking, but there is no data to be able to quantify the risks associated with vaping. In other words, quitting all sorts of smoking, including vaping is best for your health.

 

 

Diagnosing Lung Cancer 

 

If I am concerned by your symptoms, we’ll talk about your concerns, I’ll take detailed history including your smoking habits and any exposure to asbestos.

 

I’ll examine you by listening to your chest. I’ll also feel for any lumps or bumps in and around your neck.

 

We’ll then discuss whether you need some tests.    

These might be a CT scan (with or without a contrast injection), lung function testing (to measure how well your lungs work), and some blood tests. We can typically arrange to have these tests the same day or the day after.           

I can see you with the results within two or three days.

 

If there are any abnormalities, I can talk you through what I can see, what it might mean and the next steps. 

 

 

 

Further diagnostic tests might include:

 

  • PET scan: a kind of CT scan with special contrast that highlights problematic areas.        

  • Biopsy: we can’t tell 100% if an abnormality is lung cancer without sampling a bit of it. This can be collected various ways including a CT guide biopsy, or via bronchoscopy (which is a telescope looking into your lungs), or via EBUS.

  • EBUS: is like a cross between bronchoscopy and a diagnostic ultrasound. The special bronchoscope has a little ultrasound probe at its tip and enables us to sample lymph nodes in the chest with a needle.

 

Once we have collected a piece of tissue, it is sent to the laboratory, and histology doctors will examine it under the microscope. They will determine if there are cancer cells in the sample, and if there are, more tests will be done to determine exactly what sort of lung cancer it is. This is important as it will guide our treatment. 

 

Because there are several microscope tests that need to be carefully carried out, this stage of results can take up to two weeks.

 

 

 

Planning your lung cancer treatment 

 

Once I have all the information, if you do have lung cancer, in addition to seeing you very promptly, I will also bring on board the expertise of my colleagues at a multi-disciplinary meeting.

 

At this meeting I’ll be present with radiologists, histopathologists, oncologists and surgeons. We will review your results and discuss all the possible treatment options that are available to you. These MDT discussions are very important because they ensure all treatment options are carefully considered so you’ll get the best treatment possible.

 

Teamwork is vitally important in cancer care, and it is often missing in the private sector. In my NHS practice, I lead the lung MDT at Imperial, and work with leading experts in lung cancer treatment and I feel passionately about the benefits of MDT working in patient care.

 

Bringing it all together, I will take you through the staging of your cancer (i.e. how advanced it is), what it means and what treatment options are available and recommended. You and I will decide together how to proceed.

 

My aim is to make this worrying time as easy for you as possible.

I’ll help you to navigate the complicate pathway through to your treatment beginning.

 

If you are worried that you might have lung cancer I am here to help.

To book an appointment or to get in touch please email sbloch@denovomedic.co.uk or telephone 0208 004 6662.

Copyright © 2020 Dr Susannah Bloch

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