Lung Cancer

Lung cancer occurs when cells in your lung change and start to grow uncontrollably to form a tumour.

Primary lung cancer begins in your lungs and secondary lung cancer starts in another part of your body and spreads to your lungs.

There are two main types of primary lung cancer:

• Non-small cell lung cancer (NSCLC) – accounts for the majority of cases. There are three types of NSCLC called squamous cell carcinoma, adenocarcinoma and large-cell carcinoma, but doctors tend to group them as they are treated similarly.
• Small cell lung cancer (SCLC) – is less common but usually spreads faster than non-small-cell lung cancer.

Anyone can develop lung cancer, but a large majority of cases occur in people who smoke or who used to smoke. Breathing in other people’s smoke over a long period can also increase your risk of lung cancer. Lung cancer is more common as you get older. Exposure to radon, a natural radioactive gas, or some other chemicals and substances through occupational exposure and pollution, such as asbestos, can also increase your risk.

In early lung cancer you may not have any symptoms.

The most common symptoms of lung cancer include:

• a lingering cough that may start to get worse
• shortness of breath
• recurrent chest infections
• loss of appetite or weight
• coughing up phlegm with blood in it
• an ache or pain when breathing or coughing
• fatigue or lack of energy

If you have lung cancer symptoms you should see your doctor. Lung cancer screening usually begins with a chest X-ray as the first assessment to check for lung cancer. If this shows signs of lung cancer you will be referred to a specialist in chest disease who can arrange more investigative tests to determine if you have lung cancer, what type it is, and how much it has spread.

Diagnostic tests for lung cancer include:

• CT scan - uses X-rays to make 3D images of the inside of your body. It detects smaller tumours and provides information about the tumour and lymph nodes.
• PET scan – shows if there are active cancer cells and can be used to stage lung cancer after diagnosis.
• Bronchoscopy and biopsy – a thin, flexible telescope, called a bronchoscope is used to see inside your airways and remove a small biopsy sample of tumour cells.
• Thoracoscopy - examines a particular area of your chest by taking tissue and fluid samples.
• Percutaneous transthoracic needle biopsy - a needle under CT scanner guidance is inserted through your skin and into your lung where the suspected tumour is. A small amount of tissue is removed and tested in the laboratory.

Once the diagnostic tests have been completed, your specialist should know the stage of your cancer, what treatment to recommend, and if it is possible to completely cure your cancer.

Your lung cancer treatment will depend on several factors, including the type of lung cancer you have, the size and position of your cancer, the stage of advancement of your cancer, and your general health.

Lung cancer treatments include:

• Surgery – an operation to remove a small section of your lung (wedge resection or segmentectomy), part of your lung (lobectomy), or your whole lung (pneumonectomy), based on the size, type, and position of your cancer, and the health of your lungs. Surgery may be performed using open surgery or keyhole techniques called video-assisted thoracoscopic surgery (VATS).
• Radiotherapy - radiation to destroy your cancer cells.
• Chemotherapy - medicines to destroy your cancer cells
• Targeted or biological therapies – medicines, often in tablet format, that block messages in your cancer cells to stop them growing and dividing.
• Immunotherapy – drugs help your immune system to attack cancer cells.
• Radiofrequency ablation - a CT scanner guides a needle to the site of your tumour that sends radio waves that generate heat to kill the cancer cells.
• Cryotherapy – freezing to kill your cancer cells.
• Photodynamic therapy (PDT) – cancer cells are destroyed using a laser light beam.

Non-small-cell lung cancer treatment

Surgery is normally performed to remove the cancerous cells if your NSCLC is only in one of your lungs and you are in good health. Chemotherapy may follow to destroy any remaining cancer cells.

Radiotherapy may be offered to destroy your cancer cells if cancer has not spread far but surgery is not possible, perhaps due to your health. Sometimes radiotherapy is combined with chemotherapy and is called chemoradiotherapy.

Chemotherapy and/or immunotherapy is usually recommended if your cancer has spread and surgery or radiotherapy would not be effective. If cancer restarts after chemotherapy treatment you may have another course of treatment.

Biological or targeted therapy may be recommended to control or to stop the growth of your cancer if it has a specific mutation.

Radiofrequency ablation may be used to treat non-small-cell lung cancer at an early stage.

Cryotherapy can be used if cancer starts to block your airways.

Photodynamic therapy may be used to treat early-stage lung cancer if surgery is not an option, or to remove a tumour that's blocking the airways.

Small-cell lung cancer treatment

Chemotherapy is the usual treatment for SCLC, either on its own or in combination with radiotherapy, to help prolong life and relieve symptoms.

Surgery may be an option if the SCLC is found early and might be followed by chemotherapy or radiotherapy to reduce the risk of the returning cancer. It is not usually used to treat SCLC as this cancer often spreads to other areas of the body before diagnosis.