Lung cancer

Primary lung cancer is when cells in your lungs or airways start to grow abnormally and in an uncontrolled way. It’s one of the most common cancers in the UK – around 44,500 people are diagnosed with lung cancer each year. It’s more common in people over 60.

There are two main types of lung cancer, depending on the kind of cell the cancer starts in:

• Small-cell lung cancer (SCLC) – about one in five cases of lung cancer are SCLC, which tends to spread more rapidly
• Non-small-cell lung cancer (NSCLC) – the most common type of NSCLC is squamous cell carcinoma which grows more slowly and doesn’t metastasise quickly (spread to other parts of the body)

There aren’t usually symptoms or signs in the early stages so people are often diagnosed after the cancer has already spread. In these cases it is harder to treat, but treatment can slow the progress of the cancer and ease symptoms.

Lung cancer symptoms vary and get worse as the cancer progresses. The most common symptoms are:

• Breathlessness
• Chest pain
• Coughing up blood
• Fatigue
• Persistent chest infections
• Persistent cough
• Unexplained weight loss

Your GP will discuss your symptoms and may ask you to breath into a spirometer – a device that measures how much air you can force out in one breath to measure your lung capacity.

They might recommend a blood test to rule out other conditions, such as a chest infection.

If this is inconclusive, they’ll refer you for an X-ray. If this shows abnormal shadowing or other changes, a specialist can conduct other tests to confirm if you have lung cancer and its stage. These tests include:

• CT scan
• PET-CT scan – a more detailed type of CT scan
• Bronchoscopy – a long, thin tube with a camera on the end is used to look into your airways and take a small sample of tissue (lung biopsy) for analysis in a laboratory
• Fine-needle biopsy – if the cancer is at the edge of the lung, a biopsy can be taken using a needle through the chest

Primary lung cancer is caused by smoking in 85% of cases.

Other factors include:

• Regular exposure to other people’s cigarette smoke (passive smoking)
• Working with certain substances, including asbestos, nickel, chromium and radioactive materials
• Background radiation from radon – levels vary throughout the UK
• Air pollution
• A family history – though most cases don’t run in families

If you smoke, it’s important to stop to help improve your treatment outcomes and avoid further complications.

Treatment depends on:

• The type of cancer you have – ie NSCLC or SCLC
• Where the cancer is and how big it is
• The stage of cancer – how much it’s progressed and if it’s metastasised (spread)
• Your general health

You may receive a combination of different treatments, depending on your circumstances. Common treatments are:

• Surgery – such as a lobectomy (part of the lung is removed) or pneumonectomy (a whole lung is removed)
• Radiotherapy – high energy radiation is aimed at cancerous tissues to destroy it or stop cells from multiplying
• Chemotherapy

Less common treatments include:

• Biological therapy – newer medications which can be used as alternatives to chemotherapy
• Radiofrequency ablation – radio waves are sent into the tumour through a needle which generates heat to destroy the cancer cells
• Cryotherapy – a probe is used to freeze and shrink the tumour if it starts to block your airways
• Photodynamic therapy (PDT) – a special kind of laser therapy to destroy the cancer cells

Even if it’s not possible to cure your tumour, a multi-disciplinary team can recommend further treatment to help control the growth and ease your symptoms.