Volume 3, Number 3

Michael D Peake, Editor

In this issue, Martin Walshaw reviews some of the changes in the management of lung cancer over the last few years. From a personal perspective, as someone working in the field for over 25 years, I would strongly affirm that there have been enormous improvements in virtually all aspects of the care of these patients.

Ian Watson MB ChB MRCGP GP, Oldham

Reducing deaths from cancer is a priority of government policy. Indeed, one of the working groups informing the forthcoming Cancer Reform Strategy is looking at ways of improving cancer awareness. There is evidence that for some cancers, patients in England are diagnosed at a more advanced stage compared with other European countries.

David Fishwick MBChB FRCP AFOM MD Reader in Respiratory Medicine and Honorary Consultant Respiratory Physician; Chris M Barber BMBS BMedSci MRCP AFOM MD Senior Lecturer in Respiratory Medicine and Honorary Consultant Respiratory Physician, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust

While workplace conditions in the UK continue to improve due to an ever increasing understanding of exposure risk, certain groups of workers still have the potential to be harmfully exposed. The UK Health and Safety Executive is charged with policing the appropriate legislation, to ensure that all who work are put at low risk of developing occupational-related ill health. The problem of complex workplace exposures relates to the fact that, over the last 100 years, exposures have undergone rapid change.

Rosemary Lord MRCP Specialist Registrar; James Spicer MRCP PhD Consultant Medical Oncologist; Peter Harper FRCP Consultant Medical Oncologist, Dept Medical Oncology, Guy’s Hospital, London

ung cancer causes 33,000 deaths annually in the UK. Worldwide it is the leading cause of cancer-related mortality in both men and women, accounting for almost 1.2 million deaths each year. Non-small cell lung cancer (NSCLC) accounts for around 80% of all cases and the majority present with stage IIIB or IV disease, for which one-year survival rates are less than 12%. Median survival overall is only about four months in untreated patients who present with metastatic disease.

Martin Walshaw MB ChB(Hons) MD FRCP Clinical Director, The Cardiothoracic Centre, Liverpool

Lung cancer is the commonest fatal malignancy in the West, with over 28,000 deaths in 2005 in England and Wales alone. It often presents late in its natural history, when it is too advanced for curative treatment, either because many of its symptoms mirror those of other common chest diseases, or it is silent until a late stage.

Derek Pounder MB ChB DA FRCA Consultant Anaesthetist and Specialist in Pain Medicine, Department of Pain Medicine, St Mary’s Hospital, Portsmouth

Malignant chest wall pain, especially due to mesothelioma, can often be very difficult to treat. This type of tumour invades the chest wall unilaterally and causes pain due to rib, nerve and soft-tissue destruction (costopleural syndrome). Large doses of strong opioid therapy are often employed, causing the usual side-effects of sedation, dysphoria, constipation and confusion. Despite considerable doses, patients still may not achieve adequate analgesia.