Is Tuberculosis a Challenge in the Management of Lung Cancer?Deniz Köksal1, Derya Kızılgöz2, Ayşenaz Özcan2, Özge Şafak Koşan2, Nilgün Kalaç2, Mine Berkoğlu2
1Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
2Department of Chest Diseases, Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
Objective: The coincidence of tuberculosis (TB) and lung cancer (LC) at the initial diagnosis or the development of TB during the course of LC is a challenge in the management of both diseases. Herein we reviewed 10 LC patients who coincidentally had TB and evaluated the challenges in the management of both diseases. Keywords: Lung cancer, positron emission tomography, tuberculosis
Methods: The files of patients were retrieved from an archive, and available study forms were completed.
Results: The study included 10 LC and TB patients during a 4 year-period. The sites of TB were the lung (seven patients), mediastinal lymph nodes (LN) (one patient), cervical LN (one patient), and subcutaneous nodules (one patient). LC and TB were simultaneously diagnosed in four patients. The diagnosis of pulmonary TB was confirmed by sputum culture two months after LC diagnosis in four patients. TB was diagnosed later in the follow-up period in two patients. Only one patient with early-stage LC who had undergone surgical resection tolerated anti-TB therapy well. In one patient, TB caused the over-staging of LC. In one patient, LC had progressed during the course of anti-TB therapy. Hepatotoxicity was the leading adverse reaction due to anti-TB therapy.
Conclusion: These patients highlighted the importance of considering TB in the course of LC, especially in countries with a high TB prevalence. TB may cause the advanced staging of LC at the initial diagnosis; chemotherapy may worsen the TB course or cause reactivation TB. Reactivation TB may be considered as the progression of LC without tissue diagnosis or sputum analysis. The tolerability of anti-TB therapy is poor in these patients.
Deniz Köksal, Derya Kızılgöz, Ayşenaz Özcan, Özge Şafak Koşan, Nilgün Kalaç, Mine Berkoğlu. Is Tuberculosis a Challenge in the Management of Lung Cancer?. Eurasian J Pulmonol. 2017; 19(1): 46-50
Corresponding Author: Deniz Köksal, Türkiye