Lung Cancer Lesley Bishop Respiratory Consultant Lung Cancer

Lung Cancer Lesley Bishop Respiratory Consultant Lung Cancer Lead, PHT

Outline • • The Burden of Lung Cancer Early Diagnosis Initiative Lung Cancer Pathway How to Spot New Diagnostic Tools Histology – tissue is the issue Evidence behind lung cancer screening

The Burden of Lung Cancer • The second most common cancer in men and women – 1 in 18 women, 1 in 12 men • The number one cancer killer among men and women (worldwide and UK) – 24 % of men and 21 % of women with cancer • Median survival is 6 -12 months from diagnosis • 50% of patients have distant metastases at time of diagnosis CRUK

The Burden of Lung Cancer CRUK

The Burden of Lung Cancer CRUK

National Awareness and Early Diagnosis Initiative DH is working in partnership with Cancer Research UK, National Cancer Action Team, NHS and other stakeholders: • Raising public awareness of cancer symptoms and encouraging earlier presentation • Optimising clinical practice and systems • Improving access to diagnostics • Research, monitoring and evaluation

Pilot Lung Cancer Campaign Strategy • Objectives - Raise awareness that coughing for 3 weeks or more can be a symptom of lung cancer - Encourage those with symptoms to visit GP, to increase presentations - Increase number of lung cancers diagnosed at an earlier stage • Launch 8 May 2012 for 8 weeks

3 Week Cough Campaign

Pilot • For the 35 practices included in the evaluation, there were 670 more attendances for patients (aged 30+) with cough symptoms during the eight weeks from the start of the campaign in 2011 compared with 2010 – an increase of 23%. • average of 2. 4 additional visits per practice per week • Number of Cx. R’s increased 16% • Number of CT’s increased by over 15% • Expect 30% increase in 2 WW

Mr BG • 49 yo, presenting 1/11/2011 • Presented to GP 2/10/2011 with right neck/shoulder pain • MAU 17/10 and 21/10 • Diagnosed with pneumonia • Referred by GP to me • Ex smoker, quit age 46 (30 pack years) • ‘Fitness Freak’ • In the army 17/10/2011

Clinical Presentation • • Cough Weight Loss Chest/Shoulder Pain Dyspnea/Hoarseness Finger Clubbing Persistent infection Haemoptysis Shoulder Pain

RAT Tool

Mr BG • Bronchoscopy revealed Non Small Cell Carcinoma – Poorly Differentiated Adenocarcinoma – EGFR negative

Histologic Subtypes • Non Small Cell Lung Cancer 80% – Adenocarcinoma, Squamous Cell Carcinoma – Bronchoalveolar Cell Carcinoma • More heterogenous • Small Cell Lung Cancer 20 % – More aggressive – Melts with chemotherapy • Mesothelioma

Treatment • Chemotherapy – For patients with non-resectable disease – PS 0 -1 • Palliative Radiotherapy – For symptom control only • Palliative Care

PR

11/1/2012

2/3/2012

GP Respiratory/MDT Oncology & Surgery

In Portsmouth • 900+ fast track referrals per year • 300 lung cancer diagnoses per year • One Stop New Lung Cancer Clinic on Tuesday – CT – Respiratory Consultant – Lung CNS • Biopsy/Bronchoscopy by Friday • MDT and follow up next Wednesday

EBUS/EUS • • Procedure to investigate mediastinal masses Predominately used for lung cancer staging Approved by NICE 2008 Recommended by NICE 2011

Mediastinoscopy • • Gold Standard General Anaesthesia Can Only Reach a few LN stations Leaves scar Done in SGH Long Waiting Times Overnight Stay Required

Lung Cancer Outcomes • Clinical Outcome from Lung Cancer is directly related to stage at diagnosis – International Association for study of Lung Cancer (IASLC) – Revised 7 th Edition TNM 2009, Annals Thoracic Cardiovascular Surgery Stage Clinical Stage Pathologic Stage IA 50 73 IB 47 58 IIA 36 46 IIB 26 36 IIIA 19 24 IIIB 7 9 IV 2 13

LUCADA • National Lung Cancer Audit – Everything we do! • ILCOP – Improving Lung Cancer Outcomes – Sponsered by RCP

CS

Lung Cancer Screening • Cx. R – At least 7 large trials – no mortality benefit • Sputum Cytology + Cx. R – 2 large trials – no mortality benefit • More frequent Cx. R + Sputum Cytology – Mayo Lung Project – no mortality benefit • CT Screening…

Lung Cancer Screening • National Cancer Institute funded National Lung Cancer Screening Trial (NLST) • Low dose CT vs Cx. R – Over 53, 000 patients age 55 -74 with >30 py – 3 CT scans at 1 year intervals 20% decrease in mortality §High false positive rate §Overdiagnosis §Radiation induced cancers NEJM. 2011.

Lung Cancer Screening • Prevention, Prevention

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