Lung cancer diagnosis and coronavirus

The coronavirus (COVID-19) pandemic is causing great concern to people around the world because it poses a potentially significant risk to their health. It is also putting healthcare systems under huge pressure.

Healthcare professionals and others are working tirelessly to provide the best possible care to people affected by the virus in addition to all those with existing conditions and others who become unwell.

While there are guidelines in place, they cannot cover all possible medical situations. Local doctors and other healthcare professionals will make decisions about your care and treatment based on what is most appropriate for you within the constraints of the current situation.

If you are concerned about lung cancer because you have symptoms, it is important that you contact you doctor’s surgery. They will speak to you on the phone or ask you to attend an appointment at the surgery as necessary.

ask about other, including:

  • if you smoke or have smoked and for how long
  • If there is any history of cancer in your family
  • if you have worked with diesel, certain chemicals and/or asbestos

When you are talking to your doctor, it can help if you have a written down the symptoms you have experienced, how long you have been having them and how they are impacting on your daily activities. Tell them that you are worried about lung cancer.

Please see our booklet Lung Health and You to find out more about symptoms and ways of reducing your risk. It also contains a symptom diary so you can write them down and take it with you to your doctor’s appointment.

Your doctor may arrange for you to have a nose or throat swab test to check if your symptoms are related to COVID-19. If the test is negative, and they think that your ongoing symptoms need to be investigated, they may refer you for further tests. The first step may be going for an X-ray or a CT scan.

If your symptoms do not suggest a possible COVID-19 infection, and your doctor has concerns that need to be followed up, they will refer you for further tests.

Wherever possible, any investigations for lung cancer and subsequent treatment and care will follow current national guidelines. Increasingly, the NHS should be offering a near-normal cancer services except that there will be extensive measures in place to make sure people are not exposed to the virus when they come to the hospital.

The national guidelines will help your GP assess whether you need to be referred for further tests. If they refer you because they think you may have cancer, or at least need to rule it out, normally be seen at the hospital within two weeks. or, speak to about it.

As the pandemic becomes more manageable, cancer services are, where possible, returning to normal in many areas. Many health authorities are managing their services by having “COVID-19 free” sites or areas for treatment and care services to enable those services to be provided and to reduce risk of infection.

Safety will always remain a high priority, and decisions about the timing and location of tests, assessments and treatment will be made while weighing up possible risk from COVID-19.

Guidelines are changing all the time in response to new evidence about what is the best approach. Here are some answers to questions we have been asked on our Ask the nurse service (call free on 0800 358 7200, or email lungcancerhelp@roycastle.org), and our online lung cancer forum (www.healthunlocked.com/lungcancer)

I need to go for an X-ray or a CT scan – should I be worried about COVID-19?

If you have been referred for an X-ray or a CT scan, it is because your doctor believes it is essential to follow up on symptoms you have told them about. It is good to have these tests as soon as possible as they can either rule out lung cancer or diagnose it earlier when more can be done.

Hospitals and other medical facilities are arranging reception and waiting areas to maximise people’s safety with social distancing measures in place. Your attendance for an X-ray or scan and any associated risks will have been considered against potential risks to your health of not having the procedures.

Travelling to and from your appointment you should use your own transport, or use public transport following current distancing guidelines. You may also choose to travel by taxi. If your hospital provides the service, you may be able to use hospital transport.

While you are in hospital, you will notice staff using protective equipment such as face masks, gown and eye protectors.  You may be asked to wear a mask at times during your treatment. This is all for your safety and that of the staff caring for you.

People with lung cancer are in a group “at risk” of being seriously unwell if infected by coronavirus (COVID-19). The NHS has to manage testing for and diagnosing possible lung cancer alongside a risk of infection from the virus.

I have had a CT scan – what can I expect?

If you have had a scan before, you may notice a difference in the service you will receive. The same steps in the process of following up a scan should take place but perhaps in a different way.

If your scans show that you do not have lung cancer, or that there is a very low risk that you have, it is unlikely that you will be asked back to the hospital for the results. It is more likely that your consultant will speak to you on the telephone or on a video call. If the doctor feels, you may be asked to return at a later date, when covid-19 infections are reduced.

At the moment, your consultant may speak to you by telephone or on a video call about your results and further tests even if you might have lung cancer. Others might see you face to face first and then speak to you on the telephone or video calls for further appointments.

Doctors always prefer to talk about this face to face, but these are exceptional times. A lung cancer nurse specialist may also speak to you so you can ask more questions if you need to.

If I need further tests, what will happen?

Your doctor will speak to you about arranging any further investigations needed to plan your treatment. They will do their best to arrange these while asking you to visit the hospital the fewest number of times possible.

While you are at the hospital, the doctors may arrange for you to have more than one test during your visit. Although having lots of tests at one time may mean you have to spend longer at the hospital, it will mean you have fewer visits.

The doctors will try to gather all the information they need to determine whether you have lung cancer or what else may be causing your symptoms. They will assess the results of all your tests before arranging to talk to you about them.

Why might further tests or treatment be delayed?

Under normal circumstances, doctors may have identified further tests and treatments and go ahead and put dates in the diary. Now, the increased risk of other serious health problems because of infection to coronavirus (COVID-19) may have changed how doctors plan the next steps.

Factors about your health that affect decisions:

  • The risk to you of being infected by coronavirus and its associated complications make it safer to delay your treatment compared to the risks and benefits of going ahead, particularly if your lung cancer is growing slowly.
  • Your general health may place you at more risk of serious infection if you develop COVID, for example:
    • your age (70 or over)
    • if you are a smoker
    • the extent and type of your cancer, and
    • if you have other breathing or heart conditions (such as asthma, COPD or angina)
    • if you are overweight or have diabetes

Factors about the healthcare system that affect decisions:

  • Some treatments for lung cancer need higher levels of care and there is currently immense pressure on those services for people critically ill with coronavirus (COVID-19), including high dependency beds.
  • Fewer radiographers, oncologists, surgeons, anaesthetists, nurses and other medical staff may be available to carry out assessments and medical procedures.
  • Some staff are being redeployed to other medical areas (such as respiratory care, or perhaps one of the emergency coronavirus hospitals) where there is urgent need for more support.
  • Additional precautions against potential coronavirus (COVID-19) infections in operating theatres, chemotherapy wards and imaging centres may mean fewer procedures and treatments can take place.

Why might further tests and treatments NOT be delayed?

Until services in your area return to normal, many people’s treatment could be delayed. However, in some situations, risks to your health and longer-term care may mean treatment for your lung cancer is better sooner rather than later.

Doctors could recommend going ahead with tests and treatments if:

  • your cancer is likely to grow or spread quickly
  • you have symptoms that need to be treated, such as pain or breathlessness
  • a delay to your surgery may mean that your cancer becomes inoperable
  • the risks to your health from coronavirus are less significant than those from not going ahead
  • services in your area are recovering and these tests and treatments are possible

The tests and treatments are likely to be organised in a way that minimises your time in hospital.

Why might I not get a bronchoscopy?

A bronchoscopy is a where a flexible or rigid tube is passed down your windpipe into your lung. On the end of the bronchoscope, a small camera helps doctors look inside your lungs. They can also use the bronchoscope to take a biopsy (tissue sample) from areas they suspect may be cancer.

This procedure is commonly used to help diagnose lung cancer and to find out how much cancer there is.

Under current circumstances, this procedure will be used with caution and with strict infection control measures as there is a small chance that it may carry the virus to or from your lungs, putting you and others close by at risk. This may also mean that another technique is used to investigate your suspected lung cancer.

You may have a PET-CT scan to help doctors identify a different biopsy target that may be reached without using a bronchoscope. In these cases, they may use a needle biopsy where a thin needle is passed through your skin, between your ribs and into the suspected tumour to remove some sample tissue for testing.

If your doctors think there is a high probability that you have lung cancer based on assessing your scans and clinical history, they may opt to recommend going straight to treatment. They will make sure you understand their reasons for doing this.

In some cases, the decision may be to offer you lung surgery without having had a biopsy taken. If this does happen, there is the chance that when the suspected tumour is removed and then tested, it may be found not to be cancerous. Your doctors will make sure you know and understand this before going ahead with the operation.

I have been told I have lung nodules – what does this mean?

Lung nodules can be found incidentally on X-rays or CT scans you may have had for another condition, or if you have had a lung health check. They may also be identified following your referral for cancer investigations. This is a very common finding and is usually nothing to worry about. They do not affect the function of the lungs or interfere with breathing.

They represent small changes to lung tissue and are recognisable on the X-ray or scan. Lung nodules are often very small (too small to investigate further) and cause no symptoms.

Once discovered, it’s important to watch them over time and monitor any changes. This is done by repeating an X-ray or CT scan of your chest at certain intervals.

Most lung nodules stay exactly the same size, get smaller or even disappear over time. Rarely, a lung nodule may increase in size. If so, it’s important to determine the nature of the nodule and further investigation will be necessary.

The process of managing this will be done with a focus on infection control. This will include careful assessment of risk represented by the nodules and any additional risk of clinical investigations.

Your hospital team or GP will make sure you know what the nodules on your X-ray or scan mean and how they will be monitored or managed.

The risk of ignoring small lung nodules is that they may be an indication of a more serious condition developing. The benefit of lung nodule follow-up is to ensure early detection of possible lung cancer. The alternative to monitoring lung nodules is to ignore them and risk something more serious developing.

What can I do to help myself?

It is very important that you follow the guidelines about social distancing or self isolating and shielding as they apply to you. You still need to do everything you can to avoid being infected by coronavirus (COVID-19). If doctors decide that further investigations or treatment is necessary, this will not go ahead if you have any infection, including coronavirus (COVID-19).

If you have a date for further investigations or treatment, be particularly careful during the 14 days before your treatment starts to reduce your risk of being infected. This will minimise the chance of your having contracted the virus before your appointment but without showing symptoms.

Take the time before your appointment, or during any delay, to do some exercise. Looking after your health by exercising and eating healthily is good preparation to help you manage treatment and recovery. If you are a smoker, it is very important that you stop as soon as you can. Smoking is associated with increased risk with coronavirus (COVID-19).

Giving up smoking can be hard. Advice from your lung cancer team may be all you need, with or without, for example, nicotine replacement patches or chewing gum. Speaking to a specialist health advisor or counsellor may help you more, particularly if you have tried to stop in the past without success. Some medicines can also help with smoking cravings. Ask your doctor or nurse about what could be best for you.

You can also join our online forum where you can get support from others who have stopped smoking or are trying to stop: www.healthunlocked/quitsupport

People who do exercise to strengthen their breathing and improve their stamina respond to treatment better. They can also come through treatment better and recover quicker with fewer complications. Doing exercise like this before treatment is known as prehabilitation.

Contact your lung cancer team or physiotherapist for advice.

Remember to adapt the suggestions to follow the guidelines for self isolation or shielding, so do the exercises indoors or in your own garden if you have one.

Where can I seek advice?

Your medical team is your best source of information about nodule management and any treatment and recovery. Keep their phone numbers and emails addresses nearby so you can get in touch whenever you need to.

You can also call the Roy Castle Lung Cancer Foundation’s Ask the nurse service free on 0800 358 7200, or email them at lungcancerhelp@roycastle.org, for other advice about lung cancer. Using the same number, you can also be connected to our Keep in touch support service for one-off or regular telephone chats with our team, or email info@roycastle.org and ask for a call.

You can also find information about receiving a diagnosis of lung cancer in our booklet Managing your lung cancer diagnosis.