Lung Cancer: Screening, Diagnosis, and Management for PLAB 1
This module covers the essential aspects of lung cancer relevant to the PLAB 1 exam, focusing on screening strategies, diagnostic approaches, and current management principles. Understanding these areas is crucial for assessing and managing patients presenting with suspected or confirmed lung cancer.
Lung Cancer Screening
Lung cancer screening aims to detect the disease at an early, more treatable stage. The primary method recommended in high-risk individuals is low-dose computed tomography (LDCT).
Low-dose computed tomography (LDCT).
Diagnosis of Lung Cancer
Diagnosing lung cancer involves a combination of imaging, laboratory tests, and tissue biopsy. The process aims to confirm the presence of cancer, determine its type, stage, and assess the patient's overall health.
The diagnostic pathway for suspected lung cancer typically begins with imaging. Chest X-rays can reveal abnormalities but are less sensitive than CT scans. A CT scan of the chest is often the next step, providing detailed images of the lungs and surrounding structures. If a suspicious lesion is identified, further investigation is required. This often involves bronchoscopy, where a flexible tube with a camera is inserted into the airways to visualize the lesion and obtain tissue samples (biopsy). For lesions not accessible by bronchoscopy, percutaneous needle biopsy may be performed under CT guidance. Histopathological examination of the biopsy is crucial for confirming the diagnosis and classifying the type of lung cancer (e.g., small cell lung cancer or non-small cell lung cancer, with subtypes like adenocarcinoma, squamous cell carcinoma, and large cell carcinoma). Staging investigations, including PET-CT scans and MRI, help determine the extent of the disease.
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Key Diagnostic Modalities
| Modality | Purpose | Key Information Provided |
|---|---|---|
| Chest X-ray | Initial screening/detection | Gross abnormalities, masses, effusions |
| CT Scan (Chest) | Detailed imaging | Nodule size, location, characteristics, lymph node involvement |
| Bronchoscopy | Direct visualization & biopsy | Tumor location in airways, tissue for histology |
| Percutaneous Biopsy | Tissue sampling | Histology for diagnosis, especially for peripheral lesions |
| PET-CT Scan | Staging & metastasis assessment | Metabolic activity of lesions, spread to distant sites |
Histopathological examination of a tissue biopsy.
Management of Lung Cancer
The management of lung cancer is multidisciplinary and depends on the type of cancer, stage, patient's overall health, and molecular characteristics of the tumor.
Treatment Modalities
Treatment options include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. The choice of treatment is tailored to the individual patient.
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A multidisciplinary team (MDT) approach is essential for optimal lung cancer management, involving oncologists, surgeons, radiologists, pathologists, and nurses.
Targeted Therapy and Immunotherapy
Recent advancements have revolutionized lung cancer treatment. Targeted therapies exploit specific genetic mutations found in cancer cells (e.g., EGFR, ALK inhibitors), while immunotherapies harness the patient's immune system to fight cancer (e.g., PD-1/PD-L1 inhibitors). These therapies are often used in conjunction with or as alternatives to traditional treatments, particularly for advanced non-small cell lung cancer (NSCLC).
Targeted therapy and immunotherapy.
Learning Resources
Provides comprehensive information on lung cancer screening guidelines, eligibility criteria, and the benefits and risks associated with LDCT screening.
Details the various diagnostic tests used to identify lung cancer, including imaging, biopsies, and staging procedures.
An in-depth resource for healthcare professionals covering the latest treatment options, including surgery, radiation, chemotherapy, targeted therapy, and immunotherapy for lung cancer.
The official UK guideline from NICE, offering evidence-based recommendations for the diagnosis and management of lung cancer in the NHS.
A patient-focused resource from the American Lung Association explaining lung cancer, its causes, symptoms, diagnosis, and treatment in accessible language.
Provides a clear overview of the diagnostic process and treatment options for lung cancer from a reputable medical institution.
While a specific video link is hard to guarantee, searching for 'PLAB 1 Lung Cancer' on YouTube will yield many explanatory videos from medical educators covering exam-relevant topics. This placeholder represents such a resource.
A review article from the New England Journal of Medicine discussing the importance of molecular profiling in guiding targeted therapy and immunotherapy for lung cancer.
A comprehensive overview of lung cancer, covering its epidemiology, causes, pathophysiology, diagnosis, treatment, and prevention.
Official guidelines from the Royal College of Radiologists, providing detailed information on the radiological aspects of lung cancer diagnosis and staging.