Diagnostic issues of lung cancer after SARSCOV- 2 pandemic in smoker patients: Case studies
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Târgu Mureș Emergency Clinical County Hospital, University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania
'Victor Babeş' University of Medicine and Pharmacy, Timișoara, Romania
Publication date: 2022-07-05
Tob. Prev. Cessation 2022;8(Supplement):A101
The SARS-COV-2 pandemic overwhelmed the healthcare systems over the world. Romanian healthcare system should face this pandemic, and this fact was followed by a delay in diagnosis and treatment of many pathologies, especially pulmonary neoplastic diseases. We present 3 cases of smoker male patients with non-small cell lung cancer, in metastatic phase. The diagnosis was delayed due to the first patient, smoker of 35 pack-years, admitted in hospital for cough, mucopurulent sputum, and pain at the right scapulohumeral joint. The thoracic CT scan performed revealed a left endobronchial expansive process and atelectasis, massive left pleural effusion, and metastatic bone tumors at T3-T12 level, right collarbone, right shoulder blade, ribs, sternum, and left humeral head. The second patient, smoker 85 pack-years, presented for chest pain in the left posterior hemithorax with paresthesia in the left upper limb, dry cough, dysphonia, and dyspnea. The CT scans revealed an expansive homogeneous, well delimited mass located at the upper left lobe level. The tumor was adherent to the aortic club, without a cleavage plan, and in contact with bone lysis of T1 and first costal arch. Third patient, smoker, 45 pack-years, admitted to hospital for rest dyspnea, asthenia, fatigue, paroxysmal nocturnal dyspnea, dry cough, and pain at the left coxo-femoral joint. The CT scans revealed an upper right lobe T2N2M1 bronchopulmonary carcinoma and metastatic bone tumors at D8, D9, and D12. Biopsy via fibro bronchoscopy was performed and confirmed squamous cell carcinoma for two cases and adenocarcinoma in the third case. The SARS-COV-2 pandemic impeded patients access to pneumologist, and the diagnosis of malignant tumors was delayed. The consequences were poor prognosis and shortened life expectancy. A peculiarity of COVID-19 pandemic was the lockdown which increased tobacco use.