Globally lung cancer is the most commonly diagnosed of all types. In 2017 there were over 47,000 new cases reported in the UK1 and more than 470,000 new cases reported in Europe in 2018. It’s estimated there will be over 30,000 new lung cancer cases reported in the Arab region in 20202..
When a person has lung cancer, they have abnormal cells that cluster together to form a tumour. Unlike normal cells, cancer cells grow without order or control, destroying the healthy lung tissue around them. These types of tumours are called malignant tumours.
Usually, symptoms of lung cancer do not appear until the disease is already at an advanced stage. Even when lung cancer does cause symptoms, many people may mistake them for other problems, such as an infection or long-term effects from smoking. This may delay the diagnosis.
Early lung cancer diagnosis poses a difficult challenge
Due to the delay in symptoms appearing, lung cancer is often diagnosed at an advanced stage, resulting in a poor prognosis – the 5-year survival rate is currently 9% and caused an estimated 1.8 million deaths worldwide in 2018.
Dr Samuel Kemp, consultant respiratory physician at Royal Brompton Hospital, London, explains: “Lung cancer symptoms are notoriously vague. Symptoms such as fatigue, coughing, and weight loss often only appear in late-stage cancers.”
Low dose chest computed tomography (CT) screening has offered a promising improvement in lung cancer prognosis, with data indicating a 20% reduction in lung cancer deaths. However, almost a third of patients undergoing screening have at least one pulmonary nodule which requires further diagnostic assessment.
Risk factors
A person’s risk of developing lung cancer depends on many factors, including age, genetics and lifestyle. As we get older the risk of cancer increases, and according to the national cancer institute, one-quarter of new cancer diagnoses are in people aged 65 to 743. Everyday lifestyle choices such as eating a healthy diet, being more active, not smoking and maintaining a healthy weight are important ways to help reduce cancer risk.
Most people are aware there is an association between smoking and lung cancer, and anyone who has smoked for a long period of time will at some stage worry about lung diseases, particularly lung cancer.
Some nations report higher levels of smoking than others. For instance, while much of the Arab world is plagued by tobacco consumption, the use of tobacco products in Egypt is widespread. Approximately 22% of the population are current smokers. Approximately 20 billion cigarettes are smoked annually in the country4. According to the World Health Organization (WHO), 7 million deaths occur each year because of smoking.
Diagnosis – A safer approach
A lung nodule is a small abnormal area that is sometimes found during a CT scan of the chest. If the nodule has concerning features a biopsy will be taken to check it for cancer cells. Pulmonary nodules can be located anywhere in the airway, adjacent to the airway, or deeper in the lung tissue with no airway path leading into them. Thus, many physicians prefer using image-guidance.
The current gold standard for investigating pulmonary nodules is a CT-guided biopsy, also known as a percutaneous transthoracic pulmonary biopsy. This approach provides a sample to assist with diagnostic accuracy but can lead to significant complications such as a collapsed lung (pneumothorax), particularly amongst emphysema patients.
Thankfully, a new minimally invasive bronchoscopic technique is now available which enables safe access to pulmonary nodules even when they are beyond the limits of the airways. The innovative Archimedes® Virtual Navigation System uses advanced technology that integrates CT, pattern recognition software and fused fluoroscopy to provide three-dimensional, real-time airway imaging throughout the procedure. This method accurately locates the best path to access and biopsy the nodules, regardless of the size or location.
The advanced technology enables blood vessels to be identified to ensure a safe, path during the procedure. In addition, the Archimedes system assists respiratory physicians to identify multiple targets, regardless of location in the lung, to enable multiple biopsies to be performed with minimal additional risk. This allows for earlier diagnosis and treatment pathways.
Exciting new possibilities
“This is a really exciting new technology. We see it offering a safe alternative to the traditional CT-guided transthoracic approach – particularly for high-risk patients such as those with emphysema. We are therefore very pleased to be the first UK centre to offer this service at Royal Brompton Hospital,” says Dr Kemp. “It also has the potential to reduce waiting times for lung cancer biopsies, to hopefully improve outcomes for these patients.
“Additionally, due to existing conditions and older age, up to a third of patients with potentially curable lung cancer cannot undergo surgical resection. In future, we think this technology may go one step further and provide an opportunity to deliver local treatment to early lung cancers in these high-risk patient groups to offer a better chance of a cure.”
Nationally and internationally, lung cancer screening programmes are now widely available and can allow for diagnosis of cancers when they are most treatable, and surgery has a chance to be more curative. The earlier that lung cancer is detected, the greater the chances of successful treatment.
To find out more about Royal Brompton Hospital Private Care’s minimally invasive lung cancer diagnostics, please contact us on +44 (0)20 3131 0535 or email privatepatients@rbht.nhs.uk.
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1. www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer#heading-Zero
2. Elsayed I. Salim et al (Jan 2011). Lung Cancer Incidence in the Arab League Countries: Risk Factors and Control. Asian Pacific journal of cancer prevention: APJCP 12(1):17-34
3. www.cancer.gov/about-cancer/causes-prevention/risk/age
4. www.researchgate.net/publication/336964972_Lung_Cancer_in_the_Middle_East_and_North_Africa_Region
