Lung cancer is the third most common cancer in the UK after breast cancer and prostate cancer[1]. Between 2017 and 2019, there were around 49,200 new lung cancer cases every year in the UK – more than 130 a day. Nearly half of diagnoses are in people aged 75 and over. Lung cancer accounts for 21% of all cancer deaths and is the most common cause of cancer death[2].
What is lung cancer?
Cell division – whereby cells make copies of themselves – is a normal part of healthy cell function. However, sometimes mutations occur which lead to uncontrolled cell division. Cells that divide uncontrollably can create masses of tissue (tumours) that can interfere with the function of organs in the body. There are different types of cancer that can affect the lungs. The two most common are non-small cell lung cancer (NSCLC) which includes squamous cell carcinoma and adenocarcinoma; and small cell lung cancer (SCLC) which includes small cell carcinoma and combined small cell carcinoma. NSCLC accounts for more than 80% of lung cancer cases. Other forms of cancer that affect the lungs and areas around the lungs are:
- Lymphomas which occur in the lymph nodes
- Sarcomas which occur in the bones or soft tissues
- And pleural mesothelioma which occurs in the lining of the lungs.
Lung cancer stages
There are different stages to lung cancer. These are based on the size of the tumour, how far it goes into the surrounding tissues and whether it has spread (metastasised) to the lymph nodes or other organs. All these factors are used when determining what stage the cancer is at. Stages range from 0 (where the cancer is in the top lining of the lung or bronchus and hasn’t spread anywhere else) to 4 (where cancer has spread to the fluid around the lung or heart, the other lung or other organs in the body). Lung cancer that has metastasised to other parts of the body is harder to treat than cancer in its original location.
What are the symptoms of lung cancer?
Early stage lung cancer may produce few symptoms and these can be confused with signs of less serious illnesses so may be overlooked. If you are experiencing the following symptoms, it’s important to get checked to rule out possible lung cancer:
- A persistent cough or a cough that is getting worse
- Wheezing or shortness of breath
- Chest pain
- Unexplained weight loss and/or loss of appetite
- Coughing up blood
- Unexplained fatigue
- Swelling in the upper chest, neck, arms or face
- Hoarseness
If you are at higher risk, it’s important to get screened for lung cancer. Lung cancer screening checks how well your lungs are functioning and aims to find lung cancer early when it is most treatable. Private lung cancer screening is available throughout the UK, while screening on the NHS is available in some areas for eligible patients.
What causes lung cancer?
Certain factors increase your likelihood of developing lung cancer. These include:
- Smoking – this is by far the biggest risk factor with around 80% of lung cancer deaths believed to be smoking-related. Being exposed to someone else’s tobacco smoke also puts you at risk. It is not yet known what the long-term impacts of vaping are, but experts believe it may cause lung damage.
- Exposure to harmful substances such as diesel exhaust fumes, airborne toxins, radon or asbestos.
- Being exposed to radiation treatment in the chest area (for example, treatment for breast cancer or lymphoma).
- A family history of lung cancer.
Diagnosing lung cancer
If you have suspected lung cancer symptoms, you will need to undergo diagnostic tests. Initial testing includes a chest X-ray and blood tests. These may be followed up with a CT scan and biopsy (taking a small sample of tissue or fluid which can be studied under a microscope). If lung cancer is diagnosed, a further PET/CT scan may be used to establish if the cancer has spread.
A cancer diagnosis can be frightening. You are likely to have many different questions and concerns and it may feel like your life has been turned upside down. Your clinical team will support you and your family every step of the way, from explaining your diagnosis to discussing your treatment options and what to expect.
Treatments for lung cancer
The treatment you are offered will depend on the type and stage of lung cancer and whether it has spread to other areas. Possible treatments include:
- Radiation therapy which uses high energy radiation to kill cancer cells. It may be used in conjunction with surgery.
- Chemotherapy which uses a combination of medication, usually administered via IV. It may be used before or after surgery or in combination with immunotherapy.
- Surgery to remove a tumour along with a small amount of healthy tissue around it. Sometimes part or all of the lung may be removed.
- Radiofrequency ablation which uses high energy radio waves to destroy cancer cells.
- Targeted drug therapy which aims to slow down or destroy cancer cells.
- Immunotherapy which helps the body’s own immune system fight the cancer cells.
- Palliative care which aims to relieve symptoms rather than destroying the cancer cells.
Some of these treatments can cause unpleasant symptoms, such as nausea, vomiting and hair loss. Your oncology team will be there to support you, including helping you to manage the side-effects of treatment. They will also talk to you about your prognosis and what to expect before, during and after your treatment. The good news is lung cancer survival rates have been increasing over the last 50 years in the UK.
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