Breathing Clarity: Navigating the Depths of Lung Cancer vs. TB – A Comprehensive Conversation with Dr. Navneet Singh & Vivek Sharma on Unlocking Awareness
Vivek Sharma: Hello. My name is Vivek Sharma. I am an author and social worker, and I work in the field of mental health and cancer. I bring many innovative videos in the areas of mental health and cancer for you, featuring experts discussing how improvements can be made in cancer, how life can be transformed. Today, we have Dr. Navneet Singh, a professor at PGIMER Chandigarh, who has played a pivotal role in advancing lung cancer treatment. Thank you, Doctor, for sparing your valuable time to share insights on cancer with us.
Dr. Navneet Singh:I hold the position of a professor in the Pulmonary Medicine Department at PGIMER, Chandigarh, specializing in respiratory issues. Our department holds the distinction of being the first of its kind in the country to introduce the DM course, signifying super-specialization in lung-related matters during the 1980s and 90s. Subsequently, numerous courses in medical specialties and institutes were established. Nevertheless, our department remains the pioneering institute in the treatment of lung diseases, particularly focusing on lung cancer through groundbreaking research initiatives. Throughout the past few decades, my primary area of expertise and research has been centered around lung cancer.
Vivek Sharma: Fantastic. You mentioned about the importance of research, and from what I have seen, you have been the Principal Investigator in numerous studies. Please tell us, when it comes to lung cancer, many oncologists say that sometimes it’s not clear why people have started treatment for tuberculosis and why there is still a big confusion between lung cancer and tuberculosis detection. To what extent is this statement accurate and supported by factual evidence?
Dr. Navneet Singh: It’s crucial to recognize that there is an overlap in symptoms between lung cancer and tuberculosis. For instance, common symptoms like cough, chest pain, blood in phlegm, weight loss, and reduced appetite can manifest in both conditions. Frequently, the diagnostic findings for both diseases may appear similar, leading to considerable confusion. Hence, further confirmation becomes imperative. If tuberculosis is suspected, tests such as sputum examination or biopsy can be conducted to establish a definitive diagnosis. Similarly, for lung cancer, accurate identification is essential to tailor the appropriate treatment modalities. Without proper confirmation, the treatment may prove ineffective or potentially harmful.
Vivek Sharma: You explained it very well, sir. These has triggered me with one more thought. Occasionally, even doctors may find themselves in the position of patients when exposed to certain diseases. So, one aspect is, let’s say I am a patient consulting a doctor, and when the doctor prescribes multiple tests for me, there is often a concern about the necessity of these extensive tests. Undoubtedly, there are various valid reasons from a doctor’s point of view. However, if a patient is seeking tests from a general physician, how would they determine the appropriate tests based on their specific situation? Do you not think that, it is crucial to distinguish between lung cancer and tuberculosis?
Dr. Navneet Singh: In such cases, I will say that a general blood test, such as routine blood tests, may not yield specific values. However, a test that has proven to be highly valuable is the examination through a phlegm test. There are two methods for this: AFB smear and another is tuberculosis genetic testing, also known as CBNet or Gene expert. If an individual tests positive in these examinations, it indicates the person has tuberculosis. On the other hand, for diagnosing lung cancer, the most crucial test is a biopsy or FNAC with a cell block. If a tumor is detected through these, it signifies 100% cancer.
A standard blood test cannot confirm the existence of cancer. Testing for tuberculosis is accessible at all government dispensaries or public hospitals, and it is provided free of charge. Additionally, free tests for AFB and CBNet Sputum tests are also available. In instances where sputum is unavailable, an alternative sample is collected from the patient’s body, such as by obtaining pleural fluid or lymph fluid from outside the esophagus. This testing is offered at no cost in all government hospitals or dispensaries.
Vivek Sharma: So, What are the most common symptoms of TB ?
Dr. Navneet Singh: The common symptoms of TB are fever, cough, blood in phlegm, weight loss, reduced appetite.
Vivek Sharma: If you are encountering these symptoms and have consulted a doctor, consider asking about CBNet. In the initial stages, if there is an opportunity to roll it out, it can be advantageous. Early detection helps in the possibility of effective treatment, leading to improved treatment outcomes.
So, if these tests are done, what are the chances of detection in the early stages? What results can be achieved ?
Dr. Navneet Singh: Lung cancer can be detected in only two ways in the early stage. One is through missed case diagnosis due to TB testing, and another case is when a patient has no symptoms and has significant smoking exposure. However, the detection of lung cancer is commonly detected by low dose CT scan around the world. In India, we’ve tried low dose CT scans in patients, but the only problem that arises in these tests is old TB marks get detected causing complications in identifying tumors. In addition to that, CT scan is not just a single test that will determine the presence of cancer. Apart from that other tests such as biopsy and follow-up scan need to be done for accurate detection of cancer. And during this process if the tumor is found, then doctors will evaluate the need of treatments and therapies. So, it’s basically a chain of process.
Vivek Sharma: So, How much does it cost to get a low dose CT scan done?
Dr. Navneet Singh: CT scans are relatively affordable, ranging from Rs 1500 to Rs 2500. However, Vivekji, the issue lies not in the cost but in the identification of lung cancer. Regardless of where the diagnosis is obtained, expert evaluation is essential to detect cancer in its early stages. Additionally, not every patient requires a low-dose CT scan due to the associated risks of radiation exposure in the scan.
So, based on our data, if you have a heavy smoking exposure then doctors will recommend doing these low-dose CT scans.
Vivek Sharma: How will you define a heavy smoking exposure among patients?
Dr. Navneet Singh: It differs in countries. In western countries, they consider on the basis of pack years i.e. 25 to 30 pack yrs of heavy smoking exposure. In India, we don’t consider pack years, as many people in India use bidi for smoking and a single packet of bidi consists of 12,20 bidi or even more. We therefore follow the smoking index that determines how many cigarettes a person has smoked on the daily basis.
As a result, we consider a person as a heavy smoker if their smoking index exceeds beyond 300 scale. For example, if a person has smoked frequently 10 cigarette per day for around 30 yrs than the smoking index will be calculated as – 10*30 = 300. So, if it goes beyond these 300 scale numbers, the person has been involved in heavy smoking exposure.
Vivek Sharma: So, if the scale number is beyond 300 one should consider going for low dose CT scan?
Dr. Navneet Singh: Yes, absolutely they should. But, they need to understand that there are follow-up scans as well that need to be performed in the duration of 6 months, 1 year, and so on. Just getting one scan doesn’t end the story.
Vivek Sharma: Amazing, thank you so much, Sir. You were listening to Dr. Navneet Singh, who is a pulmonary specialist and an expert doctor in lung cancer. And, you’re listening to me, Vivek Sharma – a Social Entrepreneur. Stay tuned!
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