The aim of this page is to explain what lung cancer is, how it is diagnosed and how it is treated.
What is lung cancer?
Who is at risk?
What are the symptoms?
How is lung cancer diagnosed?
Getting your results
What treatment might be offered?
Taking care of your feelings
Benefits
Glossary
Further sources of help information
Lung cancer develops when cells become abnormal and grow out of control. Over time they form a clump - also known as a tumour. Lung cancer develops in the tubes that carry air in and out of the lungs (your airways). It can grow within the lung, and it can spread outside the lung.
Lung cancer often develops slowly. It is thought that cells first become abnormal at least five years before the cancer can be detected. The reasons for this delay include:
- most tumours grow slowly
- the lungs are large
- the lungs do not feel pain (pain is not common in lung cancer)
- some of the symptoms are similar to those of COPD, which many smokers also have.
The result of this is that by the time lung cancer is diagnosed, it has often spread outside the lung. If this happens, the cancer is not curable.
There are two main types of lung cancer, called
- small cell cancer
- non small cell cancer; this includes ‘squamous’ cell cancers and ‘adenocarcinoma’.[TOP]
Anyone can develop lung cancer, but people who smoke (or used to smoke) are most at risk. The risk increases with the total number of cigarettes you smoke. If you stop smoking, the risk gets less over time.
Passive smoking over a long period of time may occasionally cause lung cancer.
Non smokers may also develop one particular type of lung cancer ("adeno"). This can happen in a part of the lung where there is scarring because of something else.
Researchers are trying to find out if there is a genetic reason why only some smokers get lung cancer. There is no clear answer yet.
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Common symptoms are:
- a cough that won't go away. This is caused by irritation of the tubes that carry air in and out of your lungs (the airways)
- breathlessness - if the tumour is either large or blocks off an airway
- wheezing from that side of the chest - this may make it difficult to sleep on one side
- blood in your sputum (phlegm)
- pain - usually only if the tumour reaches the edge of the lung
- weight loss - because cancers use up energy to grow.
If you have these symptoms, you should see your doctor. But these symptoms are also very common in people who do not have lung cancer. People with long-term lung disease may have many of these symptoms in any case. A clue to possible lung cancer is if usual symptoms change or become worse. Your doctor will arrange for tests to know whether or not you have lung cancer.
In a few cases where the tumour has spread outside the lungs, the first symptom may not come from the chest at all, for example:
- liver jaundice (when the colour of your skin or eyes becomes yellow)
- bone pain or fracture
- skin lump
- nerve or brain damage affecting walking, talking, behaviour or memory.[TOP]
By the time symptoms appear, the tumour can nearly always be seen on a chest X-ray. This test is easy for family doctors to arrange and it is safe. If lung cancer seems likely then you will be seen by a hospital chest specialist within two weeks.
The specialist may need to take a sample of tissue (called a "biopsy"). There are different ways of taking a biopsy:
- if your tumour is near the middle of your lung, the chest specialist will use a bronchoscope. This is a very small telescope, and the test is done under sedation, so you won't feel anything
- if your tumour is near the edge of your lung, an X-ray specialist ("radiologist") will pass a needle into your chest, using a local anaesthetic to numb the area
- occasionally it is necessary to perform a minor operation under general anaesthetic to be sure of getting a good specimen.
You may also be advised to have a scan called a CT scan. This provides information about:
- the lung tumour in more detail
- exactly where and how big it is
- whether the cancer has spread outside your chest
- which sort of biopsy would be most helpful.
A CT scan involves lying on a cushioned table which moves through a large metal hoop. Some people worry that it will feel claustrophobic, but the staff will explain the procedure and talk to you during the test. You will be given an injection in your hand, and the machine will take pictures of your chest and stomach area. The whole procedure only takes a few minutes.
NB: it may take a few days for your test results to come through. Make sure you have a follow-up appointment.
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Once the specialist has your biopsy and CT scan results, she/he will discuss them with a group of lung cancer specialists who will work out what type of lung cancer you have and what treatment option is best for you. They will take into account:
- the type of lung cancer
- how developed it is (called the "stage" it is at)
- your general health and symptoms
Although you will be offered the particular approach that seems best for you as an individual, you may wish to make up your mind after talking to your close relatives or family doctor. Of course, at all stages the doctors and nurses will respect the views that you have about your treatment.
You will probably have all kinds of questions you want to ask, such as:
- will I be cured?
- what are the side-effects of treatment?
- should I stop working?
- can I still go on holiday?
- am I going to die?
No-one will have all the answers, but the specialist will answer your questions as honestly as possible. You will be introduced to your specialist lung cancer nurse, who will give you a contact telephone number so that you can call to ask questions as they come up. You should find him/her very approachable and willing to give advice on the disease, your treatment and any symptoms or problems that the illness might be causing you.
Unfortunately most people with lung cancer cannot be cured, and the illness may eventually lead to death. Energy and appetite get less, and normal activities become an effort. When these happen, life expectancy may only be a few weeks.
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Surgery
A small number of people with lung cancer can be offered an operation. If the team think that this is the best option for you, you will be referred to a chest surgeon. Before a final decision is made, the surgeon will need to be sure that your general health is good, and you will also have another scan (called a "PET scan"). This is a further check on the status of the cancer.
Removing lung cancer is a major operation, and it will take you a number of weeks to recover fully.
Sometimes surgery is more successful if you have chemotherapy (see below) either before or after your operation. The team looking after you will discuss this with you once all your results are available.
Radiotherapy
This uses high-energy X-rays to destroy cancer cells. It is arranged by a specialist called a "clinical oncologist". You might be offered either:
- a long course of treatment ("radical radiotherapy"). This aims to cure the cancer if the cancer is small, but an operation is not possible. It means daily trips to the hospital for treatment over several weeks. This therapy can cause temporary side-effects like tiredness, dry throat or problems with swallowing. Your specialist nurse will give you advice about this and the cancer team will see you regularly to check how you are coping with treatment
- a short course of treatment ("palliative radiotherapy"). This aims to improve symptoms such as cough, bleeding, pain or breathlessness. This only involves between one and five visits to the hospital and generally causes few side-effects.
Chemotherapy
This means using drugs to treat cancer. It has the advantage that the drugs go straight into your blood stream where they can attack the cancer cells wherever they are, including outside the lung. But since chemotherapy also affects normal cells, temporary side-effects are common. The specialist (called a "medical oncologist") will always seek to minimise these side-effects.
Treatment involves having a drip and receiving drugs by injection and tablets, usually as an out-patient. You would usually have two courses ("cycles"), and then have another CT scan to see how you are responding. If chemotherapy is working you may be given four to six cycles in total, every three weeks.
Symptom control
If your cancer is found at an advanced stage or is making you feel unwell, you might decide with your doctors that none of the treatments described above is right for you.
You might benefit from a palliative approach. This focuses on the symptoms you are getting such as cough, breathlessness, poor appetite or weakness, and using medicines or other treatment to control these. The purpose is to improve the quality of your life so that you feel as well as possible.
Your specialist might recommend referring you to a palliative care team who can visit you and your family at home. Some of these teams are linked to a local hospice, and can provide lots of additional help and support to you during your illness.
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Being diagnosed with lung cancer is hard. And being treated for lung cancer can be difficult too.
You may feel shock, fear, disbelief, anger, loneliness or resentment. You may feel a combination of some or all of these emotions. You may feel like all you want is to be left alone. You may find it hard to accept that you have cancer at all. If you are or were a smoker, you may feel the cancer is your fault. Or you may feel angry and bitter that you have a disease just because of where you worked.
If you are a friend, relative or family member of someone who has been diagnosed with lung cancer, you may feel many of the same emotions.
It is better for everyone if you all talk about your feelings - when you are ready to.
You can also talk with your specialist cancer nurse. She or he can also help you find more specialist help with a counsellor or psychologist if you'd like that.
Some GP practices have a counsellor attached. And your GP can also tell you if there are community-based cancer nurse specialists in your area.
The British Lung Foundation has also produced a film for people who have just been diagnosed with lung cancer, which we can send to you for free. It may help you to discuss things with your family and friends. Please get in touch for a copy - our contact details are on the back page of this booklet.
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Having lung cancer might mean that you have to give up work or spend more money than usual on things like transport to appointments or extra prescriptions. This might make you worry about how you and your family are going to manage.
Most people with lung cancer are entitled to state benefits. For further information and advice, please speak with the benefits advisers on the British Lung Foundation helpline, 08458 50 50 20 (Mon - Fri, 10am - 6pm). You can also go to your local Citizens Advice, or speak with the Welfare Benefits office at your local council.
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Airways
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The tubes carrying air in and out of your lungs
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Biopsy
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Examination of a specimen of tissue, to confirm that it is cancer, and which type
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Bronchi
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Breathing tubes, airways; they carry air in and out of your lungs
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Bronchoscopy
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A test when a telescope in a flexible narrow tube is passed through your nose into your lungs; done with sedation
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Cancer
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A growth (tumour) that damages healthy tissue and spreads away from where it started; the same as malignant
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Chemotherapy
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A course of treatment with powerful drugs, aimed at attacking cancer cells
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Chest
physician
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A hospital doctor who specialises in lung .disease, including cancer; the person who .does a bronchoscopy
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COPD
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Chronic obstructive pulmonary disease (includes chronic bronchitis and emphysema)
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CT scan
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A sophisticated X-ray test which gives much more detail than a chest X-ray, it is used for staging cancer
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Hospice
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A centre which specialises in caring for people with advanced disease
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Malignant
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Another word for cancer
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Oncologist
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A cancer specialist who uses chemotherapy or radiotherapy
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Paliative care
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Ways of making symptoms less troublesome, and so make quality of life better; may involve care from lung cancer or hospice nurses
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Radical
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Treatment that is hoped will lead to cure
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Radiologist
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A specialist in X-rays, who is able to understand CT scan pictures and perform some types of lung biopsy
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Radiotherapy
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A high dose of X-rays from a machine .which kills cancer cells; it is usually done with the person lying down, and is painless
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Sedation
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An injection to make you sleepy, so that you won't find the test unpleasant or remember it; not a general anaesthetic
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Staging
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Includes information about where the tumour is, how big it is, and whether it has spread outside the lung
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British Lung Foundation helpline: 08458 50 50 20. Please go here for more information.
Cancerbackup - a cancer information charity offering advice and support to people with cancer, their families and friends.
Helpline: 0808 800 1234 Booklets: 020 7696 9003 w: www.cancerbackup.org.uk
NHS Choices
You can watch a lung cancer video and access further information on the NHS Choices website.
Department of work and pensions - for information on benefits and services available to you.
Helpline: 0800 88 22 00 w: www.dwp.gov.uk
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Page last medically reviewed: November '06
