Pulmonary Tuberculosis and Lung Cancer

Diagnosis of Primary Tumor  Sputum Cytology  Flexible Bronchoscopy and Biopsy  TTNA transthoracic needle aspiration  Cell Type Accuracy

 Central lesion, bronchoscopy is the most sensitive way to confirm a diagnosis of cancer.  Small (ie, < 2 cm) peripheral lesion, the sensitivity of bronchoscopy is low. TTNA has a much higher sensitivity than bronchoscopy

Difficult to differential diagnosis  The diagnosis of lung cancer superimposed on pulmonary tuberculosis is difficult especial the Acid fast stain is positive.  Thorac Med vol.17 no  Indian Journal of Chest Diseases & Allied Sciences. 39(4):251-4, 1997 Oct-Dec.

 In the endemic area of tuberculosis, there are many cases that present tuberculosis as a solitary pulmonary nodule (SPN) on chest radiographs.  hardly to D.D from lung cancer  Respiratory Medicine. 90(3):139-43, 1996 Mar.

 The possibility of coexisting tuberculosis should be kept in mind in patients with a malignancy, especially those with lung carcinoma in countries with a high prevalence of tuberculosis Tumori. 88(3):251-4, 2002 May-Jun Folia Histochemica et Cytobiologica. 39 Suppl 2:73-4, 2001

Incidence  The incidence of lung cancer in tuberculosis patients was about 2%.  Both lung cancer and pulmonary tuberculosis have a higher incidence of upper lober involvement. Thorac Med :

 The incidence of lung cancer is higher in patients with pulmonary tuberculosis (TB).  Japanese Journal of Clinical Oncology. 26(5):322-7, 1996 Oct  Thorac Med vol.17 no  Southern Medical Association Journal. 81(3):337-40, 1988 Mar.

The risk factors of lung cancer  Cigarette smoking,  Occupations,  Previous tuberculosis history found to independently correlate with an elevated risk of lung cancer for male patients. Cancer Causes & Control.12(4): , 2001 May)

TB scar v.s Lung Cancer  Significant association between tuberculous scars and carcinoma of the lung.  The possibility of malignancy has to be kept in mind when radiological scanning reveal the presence of lung scars.  European Journal of Radiology. 7(3):163-4, 1987 Aug.

The Marker - BAL neopterin  BAL neopterin levels are elevated in patients with lung cancer, especially the small-cell carcinoma type.  The levels of neopterin in BAL fluid may reflect the degree of disease activity in pulmonary tuberculous patients.

 Derived from guanosine triphosphate  Produced by stimulated macrophages under the influence of gamma-interferon of lymphocyte origin.  An excellent marker for the activation of the monocyte/macrophage.

Serum adenosine deaminase  The mean (+/- SD) of ADA activity was (4.47), 7.29 (1.08), (1.95) and 2.23 (1.00) units/litre in tuberculosis, malignancy, non-tubercular pulmonary diseases and healthy controls.

Serum C-reactive protein  Tuberculous patients with cavitation in chest X-ray had significantly higher levels of CRP than those without as well as healthy controls.  Normal CRP did not exclude tuberculosis  Infection. 17(1):13-4, 1989 Jan-Feb

Reactivation of tuberculosis  Deterioration of immunity due to local or systemic effects of the tumor itself and/or administered chemotherapeutics or radiotherapy may play roles  increasing the mortality in patients with various malignancies Tumori. 88(3):251-4, 2002 May-Jun

Evaluation methods  Direct microscopic evaluation  Sputum specimens  Materials obtained by fiberoptic bronchoscopy should be cultivated for tuberculosis.

Differential Diagnosis Tools MR imaging is a helpful adjunctive method in terms of differentiating a tuberculoma from a malignant tumor Journal of Magnetic Resonance Imaging. 11(6):629-37, 2000 Jun

Differential Diagnosis Tools  Diagnostic bronchoscopy under fluoroscopic guidance is a useful tool in evaluation of patients with a peripheral pulmonary nodule  Minimize unnecessary thoracotomy and give way for proper medication as early as possible.

Differential Diagnosis Tools  FDG-PET can identify malignant pulmonary lesions both in patients without and with a history of prior malignancy with a high sensitivity and negative predictive value for lesions greater than 1 cm.

Differential Diagnosis Tools  Differentiating tuberculosis or mycobacteriosis from bronchogenic carcinoma, metastasis, or pneumonia was difficult and biopsy was often necessary.

Differential Diagnosis Tools  Combined assays of CEA, CA 19-9, and ADA may be useful in distinguishing pleural effusions due to malignancies from those of tuberculous origin

Treatment  Three-four-drug anti-tuberculosis regimens should be given, especially in countries with high drug-resistance rates for eradicating tuberculosis.

Treatment  Surgery treatment of clinical patterns of pulmonary tubercolosis unresponsive to medical treatment  May be underlying lung cancer

 Survival is shorter in lung cancer patients who present initially with active TB than in those who do not have TB.  Japanese Journal of Clinical Oncology. 26(5):322-7, 1996 Oct.