Misdiagnosis of lung mass is taken as TB

Dr Naresh Jakhotia, oncologist and additional consultant Bhagwan Mahaveer Cancer Hospital and Research Center Jaipur explains about the misdiagnois of lung cancer and TB.

Pulmonary tuberculosis and lung cancer have common symptoms, A misdiagnosis of lung mass may lead to cancer mortality Patients with lung cancer are often misdiagnosed as pulmonary tuberculosis leading to delay in the correct management as well as exposure to inappropriate medication. Several factors are responsible for this situation including lack of awareness, inadequate infrastructure and socio-economic factors.

Pulmonary tuberculosis and lung cancer have common symptoms like cough, expectoration, fever, hemoptysis, weight loss, and breathlessness. However, careful history and examination can help clinician to suspect lung cancer. The common symptom of lung cancer at presentation are chronic cough (a cough that does not go away), breathlessness, chest pain (aggravated by deep breathing), unexplained weight loss and loss of appetite, hoarseness of voice, hemoptysis, non-resolving pneumonia and superior vena cava syndrome (localized edema of face and upper extremities, facial plethora, distended neck and chest veins) and right shoulder pain radiating to right upper arm.

Cough is by far the most common symptom at presentation in lung cancer, and any “new” cough that persists longer than 2 weeks in patients over the age of 40 years who are tobacco smokers should be regarded with suspicion of lung cancer. An estimated 1.61 million people across the world are diagnosed with lung cancer annually. Lung cancer is the most common cause of death from cancer in men all over the world. According to National institute of cancer prevention and research Smoking accounts for 1 in 5 deaths among men and 1 in 20 deaths among women, accounting for an estimated 9,30,000 deaths in 2010 In India, In India, lung cancer was considered to be rare in the beginning of the century but has now reached almost epidemic proportions.

Risk Factors

“Tuberculosis is caused by infection of lung with small aerobic non- motile bacillus Mycobacterium tuberculosis (MTB). It spreads through the air when people who have an active MTB infection cough, sneeze, or otherwise transmit their saliva through the air. Lung cancer is an etiologically complex disease in which multiple genes are involved in the pathogenesis via different pathways. When these genes interact with the epidemiological factors, individual may develop lung cancer.

Tobacco smoking is the common risk factor for both pulmonary tuberculosis and lung cancer Other risk factors for lung cancer are

Passive smoking

Exposure to certain metals (chromium, cadmium, arsenic), some organic chemicals, radiation, air pollution.

Atmospheric and occupational agents known as carcinogens like Radon (well-established lung carcinogen), asbestos, arsenic, bischloromethyl ether, chromium, nickel, polycyclic aromatic compounds.

Some viruses like HPV and CMV.

Old healed tuberculosis

Personal traits (such as having a family history of lung cancer).

A missed or wrong diagnosis of lung cancer by clinician or general practitioner can lead to delays in treatment, wrong treatments, or no treatments at all. In developing countries like India, the main delay is accounted by patient’s ignorance in reporting to general practitioners.

And empirically treating cough/ breathlessness as tuberculosis, So if after staring anti tuberculosis therapy patent doesn’t have resolution of respiratory symptoms after 2 week, He/she should be properly evaluated.

For Appointments : Dr Naresh Jakhotia, oncologist and additional consultant Bhagwan Mahaveer Cancer Hospital and Research Center Jaipur