Postgrad Med J: first published as 10.1136/pgmj.48.555.33 on 1 January 1972. Downloaded from

Postgraduate Medical Journal (January 1972) 48, 33-45.

CURRENT SURVEY

The early diagnosis of cancer T. J. DEELEY M.B., Ch.B., F.F.R., D.M.R.T. Director of The South Wales and Monmouthshire Radiotherapy Service and Lecturer, Welsh National School of Medicine, Cardiff Summary those who already have metastatic disease in the Earlier diagnosis of malignant disease in the lung brain (Deeley & Rice Edwards, 1968) and at other may bring about improvements in the treatment. This sites where the tumour may be solitary (Deeley & article discusses the effects of early diagnosis on the Line, 1969). prognosis. Cancer of the lung may be associated with Control of cancer of the bronchus may be brought other lung pathology, thus increasing the problems of about in three ways-by prevention of the disease, diagnosis. Diagnosis depends on radiological examina- by earlier diagnosis and by improved methods of tion, cytology of the sputum, radio-isotope lung treatment. Prevention demands abolition of smoking scanning and mediastinoscopy: an account is given of -which so far has proved impossible. Existing Protected by copyright. how these may be used to diagnose the condition treatment methods are inadequate but perhaps, if the whilst it is still at an early stage and suitable for disease could be diagnosed at an earlier stage these radical treatment. results may be improved. The purpose ofthis paper is to review methods of bringing about an earlier diag- 'Alas regardless of their doom, nosis in established cases of carcinoma. In several The little victims play. fields work is in progress but future progress will No sense have they of ills to come, depend upon closer co-operation between the family Nor cares beyond today.' doctor, the chest physician, the radiologist, the cytologist and the patient himself. THESE words, taken from a poem by Thomas Gray, The consideration of the diagnosis of the disease aptly describe the insidious progress of carcinoma of can be divided into two parts, in the patient with the bronchus; by the time that symptoms develop the symptoms (early cancer diagnosis) and in the asymp- disease has often reached the stage when operation, tomatic patient (cancer detection). There are no if feasible, is seldom curative. Thompson (1967) in a specific symptoms of cancer of the lung. Le Roux http://pmj.bmj.com/ series of 1070 patients admitted to hospital with a (1968) found that only 68% of his patients presented bronchogenic carcinoma, found that 50% were un- with chest disease, 13% complained of symptoms suitable for surgery on clinical grounds, 20% were caused by metastases, 12% of non-specific symptoms inoperable at bronchoscopy and a further 10% were such as loss of weight or anorexia without respira- found to be inoperable at thoracotomy. Thus, in 80% tory symptoms, 2% of such symptoms as neuro- of these patients all that can be offered is a small logical or endocrinological changes and 5%° were chance of a cure by radiotherapy-a 5-year survival asymptomatic. When chest symptoms do occur

they on September 23, 2021 by guest. of 6°/ in inoperable cases was reported by Deeley & are those of many other chest diseases. Thus, in all Singh (1967)-or else the possible relief of distressing cases of chest disease with symptoms it is important symptoms. Too often, 'it is too late, if only he had to exclude the possibility of cancer, either as the come earlier'; an earlier presentation may have causative disease or as a concomitant of some other meant that the disease was operable, or, even if chest disease. The difficulty of diagnosing carcinoma locally extensive, it may not have been disseminated of the bronchus from the clinical symptoms was and there may have been the chance of radical radio- evident to William Stokes in 1882. In his book, therapy treatment and possible cure. 'A Treatise on the Diagnosis and Treatment of A considerable part of a radiotherapist's ti