Basic Science

Basic scientific research is leading the way in establishing new ways to modify disease processes, improve survival and improve quality of life. Intensive efforts are underway by researchers to better comprehend the genetics of many diseases in respiratory and pulmonary vascular disease.

Rapid Access Lung Cancer Unit

Evidence has shown that early referral and rapid access to diagnostic and staging facilities for suspected lung cancer cases can improve short and long term survival and the persons quality of life.

The rapid access lung cancer unit at the Centre for Lung Health provided well defined care pathways on diagnosis, work up and treatment.

The unit will provide the following facilities:

A CXR is available on a walk in basis if there is a clinical suspicion by GP that the person may have a lung tumour.

Alternatively

If a CXR has been performed in a local hospital and is suggestive of a lung tumour of and or the clinical suspicion is high then an out patient appointment will be available within a week on request from A+E or GP services.

On attendance at the unit the

CXR is reviewed
Full medical history is taken
Any underlying conditions or co-morbidities ( some conditions can dictate against the use of particular therapies)
Bloods are reserved (Full Blood Count, Renal, Liver, Bone, Coagulation),
ECG
Pulmonary function testing
Weight loss ascertained & documented

Further tests that are required to diagnose and stage the disease are organized on Day 1 and are concluded within a week of referral.

They include the following:

CT Thorax
CT upper abdomen,
Bronchoscopy to obtain tissue diagnosis
Additional investigations in selected patients as indicated (click here to view: how is lung cancer diagnosed)

To provide a seamless, efficient and effective care pathway for patients, assessment, diagnosis, staging and multidisciplinary work up is performed within a 4 week period.

Lung Cancer

What is lung cancer?

Lung cancer is one of the most common forms of cancer in Ireland, accounting for about 20% of all deaths from cancer each year. It is the leading cause of cancer deaths in men and the second most common cause (after breast cancer) in women. Cases of lung cancer have fallen slightly in men but appear to be on the increase in the female population. Lung cancer rates in women are double the EU average. Lung cancer is uncommon before the age of 40 years however rated rapidly rise between the age of 65-70 years.

What causes lung cancer?

It has been shown that cigarette smoking is the main cause of developing lung cancer. The more cigarettes smoked per day and the earlier in life a person started smoking, the greater the risk of developing the disease. At least four out of five cases of lung cancer are due to cigarette smoking hence in the majority of cases, this disease is preventable. The risk of lung cancer for an ex-smoker fall to the same level as a non-smoker after 15 year

Exposure to passive smoking has also been shown to increase the risk of developing lung cancer. Living in an environment with a high level of air pollution or working with substances such as asbestos may cause some cases of lung cancer.

What are the symptoms of lung cancer?

Typically the early signs of lung cancer can go undetected as it is only in the later stages of disease that people present with symptoms. The first and most common symptom is the development of a cough. This typically occurs in about 80% of people who present with lung cancer.

Other symptoms include:

Coughing up blood (haemoptysis) as the as the disease progresses.
Breathlessness and wheezing.
Fatigue.
Weight loss.
Chest pain.
Repeated bouts of pneumonia
Hoarseness.
Pain in the shoulder, arm or hand.

How is lung cancer diagnosed?

Currently over 75% of lung cancer cases present in late stage disease. Diagnosing lung cancer early in the disease process is difficult because many of the symptoms of lung cancer resemble those of severe lung disease-chronic obstructive pulmonary disease (COPD). Indeed, most lung cancer patients will also have COPD because both conditions are mainly caused by smoking; although only 1%-2% of COPD patients will go on to develop lung cancer. However, the doctor will examine the individual and order one or more of the following tests:

Chest x-ray - this is the first step in the investigation.
Specific blood tests
Pulmonary Function testing to assess lung capacity
ECG
CT (computed tomography) scans of the chest — this will provide necessary information on whether the tumour has spread. This should be performed before bronchoscopy to provide direction on where best to take biopsies from.
Sputum analysis - (phlegm coughed up from the respiratory tract) can be examined for cancer cells ( cytology)
Bronchoscopy –Tissue biopsy is obtained at this time and information necessary for staging the disease.
A CT guided biopsy allows biopsy to be taken in more difficult areas.
Specific blood tests may reveal certain substances, which are produced by a cancer tumour.
Biopsies are taken form lymph nodes to determine if the cancer cells have spread.

Following the results of the above investigations, additional tests may be required in a select number of people before treatment is decided upon.

MRI of chest is performed in select cases where surgery is a consideration and there is a suggestion of spread of disease in to near by structures.
CT scan of brain if neurological symptoms exist
If CT scan is negative and neurological symptoms still exist the an MRI of brain id carried out
Isotope bone scan is performed if symptoms of bone pain exist.
Ultrasound of abdomen
PET Scan

How is lung cancer treated?

The treatment choices available to those diagnosed with lung cancer and the long-term survival depend on the type of cancer (small cell, non small cell), location and size of the tumour, lymph node involvement and whether the cancer has spread to other parts of the body such as the bone, the nervous system.

Small cell lung cancer respond best to treatment with chemotherapy whereas other types of lung cancer (often referred to collectively as non-small cell cancer) are treated more effectively with surgery or radiotherapy. Any treatment strategy will typically incorporate surgery, radiation or chemotherapy, or a combination of these.

There are very clear guidelines for those suitable for the surgical option as the tumour must not have spread outside of the chest wall and the patient must not have severe lung disease such as bronchitis, COPD, heart disease or any other underlying illnesses (co-morbidity) which would put him/her at high risk to survive surgery.

Facts:

Lung cancer is the most common cause of cancer death in men

It is the second most common cause of death in women

90% of lung cancer cases are caused by cigarette smoking

Over 75% of cases present in late stage disease

Survival rates for lung cancer after five years are poor.

Early assessment and diagnosis means more options for treatment and the greater chance of successful treatment

Surgery is only a treatment option for a small number of people

The majority of people with lung cancer receive will benefit from symptom control that improves their quality of life.

Given the low success rate in curing lung cancer, prevention is the best hope of limiting the condition.

If you smoke- STOP!

Find additional information on respiratory disease areas