GP KFPs / SAQs · respiratory-health
Lung cancer suspicion — KFP-style written assessment
KFP-style staged scenarios on lung cancer suspicion: the smoker with haemoptysis, the incidental nodule on CT for other reasons, NLST screening eligibility, and the Brock model for nodule assessment.
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Prompt
Lung cancer: the normal CXR is not reassurance — investigate the smoker, follow the nodule, screen the high-risk
KFP 1 (10 marks)
A 58-year-old man with a 40 pack-year smoking history has a persistent cough for 6 weeks, changing from his usual pattern. He has lost 4 kg unintentionally. His CXR is reported as normal. [1]
- Does the normal CXR exclude lung cancer? (3) [1]
- What is the next investigation? (3) [1]
- Name three other presentations in a smoker that would trigger the same urgency. (4) [1]
Model answers
- No. Up to 20-25% of lung cancers are missed by CXR. A normal CXR in a high-risk smoker with persistent symptoms provides false reassurance — clinical suspicion overrides the normal film. [1]
- CT chest — the next investigation when clinical suspicion is high regardless of CXR result. [1]
- Haemoptysis of any amount, finger clubbing, supraclavicular lymphadenopathy, hoarseness, or an incidental pulmonary nodule found on any scan. [1]
References3ShowHide
- [1]Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening N Engl J Med, 2011.PMID 21714641
- [2]de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial N Engl J Med, 2020.PMID 31995683
- [3]Winter A, Aberle DR, Hsu W External validation and recalibration of the Brock model to predict probability of cancer in pulmonary nodules using NLST data Thorax, 2019.PMID 30898897