Time to intervene

While simple treatment is preferable in patients with advanced, incurable malignancy, more aggressive measures are sometimes required

Tom was a 74-year-old, lifelong smoker, who complained of an itchy, purplish rash on his head and the backs of his hands.

The rash improved, but did not completely resolve, after his GP prescribed topical steroid creams. More than 12 months after the onset of this rash, Tom presented urgently after coughing up blood. He also described a progressive decline in weight and usual activities over the past three months.

Imaging showed an 8cm mass at the right hilum, with bilateral mediastinal lymphadenopathy. Bronchoscopic biopsy revealed non-small cell lung cancer (NSCLC) of squamous cell type.

Staging was consistent with bulky Stage IIIB disease, which is incurable; the five-year survival rate is 3-7%. 

Initial treatment
Randomised trials show radical radiotherapy with concurrent platinum-based chemotherapy yields best survival outcomes for Stage IIIB NSCLC,