GEP Medicine in Society Handbook 2019/20
The Medicine in Society unit is the clinical contact module in Year 1 of the GEP course. Students will spend 12 days in primary care and 13 days in seconday care during the year.
5. Secondary Care Themed Days
5.7. Day 8 Theme: Respiratory
Introduction – Carcinoma of the lung is the commonest cancer worldwide, accounting for 1.2m new cases annually. Therefore, the World Health Organization (WHO) cites tobacco smoking as the foremost preventable cause of cancer globally. In the UK, incidence is estimated at ~40,000 with annual mortality recorded at ~35,000; it is the second most common malignancy after prostate and breast cancer in men and women, respectively. The overall prognosis remains very poor with a median survival of 4 months although this varies considerably depending on histological type and staging of the cancer.
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Case History: Mrs Khanom has never smoked in her life but when she complained of feeling breathless, her GP sent her for a CXR and to her surprise, she received an appointment through the post asking her to attend the hospital chest clinic the following week. At the clinic, she was told by a ‘Registrar’ that she has a lesion on her chest and will need to have a tube put down her nose. She returned 4 weeks later to clinic, after enduring the most unpleasant experience of bronchoscopy, to be told that she has cancer and that she now needs to see the cancer specialist. Her family, as bewildered as her, made an urgent appointment to see her GP, only to find out that her GP has not had any correspondence from the hospital regarding her diagnosis of cancer. |
With the Government driven two-week initiative for any patient suspected of having a cancer, the services and resources for the diagnosis and treatment of patients with lung cancer are receiving a much-needed boost. However with the present lack of specialist skills at all stages of this process, patients in the UK still have a poorer prognosis than in other developed countries around the world. During this placement you may have the opportunity to observe the management of a patient with suspected or confirmed lung cancer (however, the majority of such patients are managed as outpatients). This is often a very emotional and difficult time for patients, carers, relatives and indeed healthcare staff and you will need to use your own common sense and judgement with regard to patient privacy and space.
Learning Issues
- How may someone with lung cancer present?
- What are the possible abnormalities seen on the chest radiograph of a patient with lung cancer?
- Which members of the MDT are involved in support and counselling of the patients prior to, and after the confirmation of their diagnosis?
- What are the roles of the oncologist and the radiotherapist in the treatment of lung cancer?
- Why is the overall prognosis of patients with lung cancer so poor?
- Why is the incidence of lung cancer falling more slowly in women than in men?
- If you were the Minister of Health, what methods would you use to reduce the nation’s smoking habit, particularly that of the younger women? What evidence do you have for these methods?
Suggested Learning Tasks
- Record the conversation you had with a patient prior to diagnosis of their cancer: How are their carers and relatives coping?
- Record the conversation you had with a patient who has a confirmed diagnosis of cancer. How are their carers and relatives coping?
- Find out the role of the lung cancer specialist nurse
- What is the analgesic ladder? List the analgesics you have seen in use today and their indications.
- List five palliative measures that may be employed for patients with lung cancer.
- From your experiences today draw out a model of diagnosis and treatment for a patient with suspected lung cancer. You should include the various members of the MDT, the support services and the treatment options.
Reference
NICE guidelines for Lung Cancer:
