Cancer Keys: Differentiation of the Cs in Lung Cancer: Cancer vs COVID-19

Potential pitfall:

Overlapping lung cancer and COVID-19 symptoms means that the message to patients about early diagnosis is negated by the messages necessary to control the COVID pandemic.

Helpful hint:

Consider the following action if a patient presents with features more suggestive of lung cancer and overlapping symptoms of a cough, breathlessness and fatigue:

  • Arrange an urgent nasal/oropharyngeal swab for SARS-CoV-2 PCR and if negative:
  • Refer for Chest X-ray or direct to lung cancer service for CT and triage on the National Optimal Lung Cancer Pathway
  • If PCR positive, manage according to current COVID-19 guidelines and review after 2 weeks if hospital admission not required; consider 2 week wait referral in patient recovered from COVID-19 in whom lung cancer suspected
  • If symptoms require urgent attention, consider emergency admission

Please note: the NICE NG12 guideline recommends offering an urgent chest X‑ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms including a cough, fatigue and shortness of breath.

References:

Evison, M. et al (2020) Differentiation of the Cs in lung cancer: Cancer vs Covid-19. Available at: https://www.healthylondon.org/wp-content/uploads/2020/03/Differentiation-of-the-Cs-in-lung-cancer_-Cancer-vs.-COVID.pdf (Accessed 29 June 2020).

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