Presentations
- Cough
- Dyspnoea
- Extrapulmonary complications of malignancy:
- acute neurological change
- acute spinal cord compression
- central airway obstruction
- oesophageal obstruction / tracheo-oesophageal fistula
- paraneoplastic phenomenon
- pathological fracture
- SVC obstruction
- venous thromboembolism
- Haemoptysis
- Incidental pulmonary nodule or mass
- Pleural effusion
- Weight loss
- Wheeze / Stridor
Conditions
- Epithelial tumours:
- adenocarcinomas
- adenomas
- adenosquamous carcinomas
- large cell carcinomas
- other epithelial tumours
- papillomas
- precursor glandular lesions
- salivary gland-type tumours
- sarcomatoid tumours
- squamous cell carcinomas
- squamous precursor lesions
- Haematolymphoid tumours, (e.g., diffuse large B cell lymphoma, Langerhans cell histiocytosis)
- Lung neuroendocrine neoplasms:
- neuroendocrine carcinomas
- neuroendocrine tumours
- precursor lesion
- Mediastinal tumours:
- chest wall tumours (e.g., neurofibromas)
- mediastinal germ cell tumours
- mesenchymal neoplasms
- thymic carcinomas, thymic neuroendocrine tumours, and thymomas
- Mesenchymal tumours specific to the lung
- Metastatic pulmonary tumours
- Pleural malignancy:
- mesothelioma
- metastatic disease
- primary lung malignancy
- Tumours of ectopic tissues (e.g., melanoma, meningioma)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Extrapulmonary complications of malignancy:
- acute cord compression
- acute neurological change
- oesophageal obstruction
- paraneoplastic phenomenon, including:
- hyponatraemia
- neurological change (e.g., Lambert–Eaton syndrome, seizure activity)
- pathological fracture
- SVC obstruction
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Cause and classification of lung tumours according to WHO criteria
- Compare and contrast investigations for staging of lung cancer, including the role of PET-CT and mediastinal lymph node sampling (EUS, EBUS and surgical techniques)
- Principles of screening for lung cancer, and assess suitable patients for low dose CT screen based on evidence-base and local funding:
- incorporate the role of smoking and vaping cessation counselling, management of concurrent respiratory disease, vaccinations, and pulmonary rehabilitation in management of patients identified for screening
- Role of diagnostic procedures including bronchoscopy, endobronchial ultrasound, pleural fluid cytology and thoracoscopy, surgical biopsy, as well as emerging modalities including liquid biopsy
- Staging and prognosis of lung cancer, including the role of genetic factors, according to IASLC criteria
Investigations
- Advanced testing for serological, cytological, and histological samples:
- basic staining, slide preparation and interpretation of cytological (e.g., EBUS) samples
- flow cytometry
- immunohistochemistry, fluorescent in situ hybridisation, PCR, and next generation sequencing techniques
- liquid biopsy
- Lung function tests for peri-operative assessment
- Radiological investigations:
- chest CT scan
- chest MRI
- chest x-ray
- fluoroscopy
- PET with / without integrated computer tomography
- ultrasonography
Procedures
- Bronchoscopy including endobronchial ultrasound (linear and radial modalities), flexible bronchoscopy (including single use), and rigid bronchoscopy:
- advanced therapeutic modalities, such as APC, cryotherapy, and Nd-YAG laser
- bronchoscopic drug delivery
- brushings
- cryobiopsy
- cytology and microbiology from washings / bronchoalveolar lavage fluid
- fine needle aspiration
- forceps bronchial and transbronchial biopsy
- large airway debulking or stent placement
- Pleural:
- Procedure techniques:
- ambulatory and underwater seal drainage
- anaesthesia (local, regional, and general approaches)
- closed pleural biopsy
- indwelling tunnelled pleural catheter
- large bore drain insertion
- needle thoracentesis
- small bore intercostal catheter insertion
- thoracoscopy
- therapeutic interventions:
- intrapleural fibrinolysis and irrigation
- pleural fluid drainage
- pleurodesis
- Define performance status, clinical frailty scores, operability, and respectability, and apply appropriately towards patient care
- Identify and engage community supports and services
- Role of multidisciplinary care, palliative care, and psychological support for holistic management of patients with thoracic malignancy
- Understand the function and have first-hand experience attending and presenting patients at lung cancer multidisciplinary team meetings
- Understand the indications, benefits, risks, and diagnostic yield of various diagnostic modalities, and utilise appropriately for investigation and management of peripheral pulmonary lesions
