IN a recent article I discussed the impact of the pandemic on all routine services, specifically cancer care.

At the start of the pandemic, routine cancer screening was temporarily suspended. This coupled with patients’ reluctance to “bother” doctors, and medics’ concern over referring patients at the height of a crisis created a perfect storm, which will sadly claim many extra lives over the next several years, due to late presentations and missing the window of opportunity to make an early diagnosis and commence treatment rapidly.

This is nowhere more clearly demonstrated than in the case of lung cancer, and it is not hard to see why. One of the main symptoms of both lung cancer and coronavirus is cough. Before the pandemic, a cough for more than three weeks, especially in a high-risk individual, would hopefully have triggered alarm bells for lung cancer. Yet since March 2020 many people with a cough have religiously followed the guidelines to self-isolate. Due to the strength of the public message, both clinicians and patients may have put Covid above cancer as their initial assumption, with individuals not coming forward even after a negative Covid test, despite the symptom persisting.

If your cough is persistent - make sure you check it out

If your cough is persistent - make sure you check it out

Lung cancer is a disease where timely diagnosis is of the utmost essence. This is clearly illustrated by statistics showing five-year survival of just over 50 per cent if diagnosed at stage one (the earliest phase), with this dropping to a barely believable three per cent if diagnosed at stage four. Yet in the UK, 75 per cent of lung cancers are diagnosed at an advanced stage. With 35,000 deaths annually, it outstrips the mortality figures for breast and bowel cancer combined. The UK Lung Cancer Coalition estimates at least 1,300 extra lung cancer deaths in the next five years in the wake of the pandemic.

This is not only due to late presentation and diagnosis, but also certain treatments including chemotherapy, surgery as well as the provision of intensive care beds after a major operation being interrupted due to coronavirus.

Sad news for a condition that has seen massive improvements in the last 15 to 20 years, including advances in treatment, significant expenditure in raising public awareness, and perhaps most importantly banning smoking in public places.

A cough is not the only symptom of lung cancer. Several other red flags include persistent chest pain, coughing up blood, shortness of breath and weight loss.

Recurrent chest investigations that don’t resolve despite antibiotics need looking into further.

Symptoms which you might not necessarily associate with lung cancer include a hoarse voice, due to the cancer affecting the nerve involved in talking, and swelling of the face and neck as a result of the mass obstructing the flow of blood back from these parts to the heart.

Both clinicians and patients may have put Covid above cancer as their initial assumption

Both clinicians and patients may have put Covid above cancer as their initial assumption

Finger clubbing, which alters the profile of your nails is another sign, yet it is not specific to lung cancer.

Sometimes just not feeling yourself, a reduced appetite, lack of energy, or a sensation of “something not quite right” are symptoms of a serious underlying condition, and despite being seemingly vague, should not be ignored.

It may also help to remember that while smoking is the primary risk factor for lung cancer, with passive smoking also raising the chances, it does occur in those who have never smoked.

Better news is that there is no link between Covid and lung cancer at the present time, and that those with solid organ tumours, which include lung cancer, are as able to fight Covid as those without cancer, even those with advanced cancer and/ or having cancer treatment.

No article on lung cancer would be complete without a plea about smoking cessation. Smoking raises the risk of lung cancer by up to a staggering 200 per cent, but also effects every single organ in the body, increasing the incidence of both cancer and non-cancer illnesses. Yet stopping smoking can yield benefits within 30 minutes, and if maintained, can over time reduce the risk of several conditions back to those of a non-smoker.

NHS smoking cessation services remain open during the pandemic, and although the stress and uncertainty of the current situation may put many people off trying, there is no better time than the present.