There are two main types of lung cancer: non-small-cell (NSCLC) and small-cell (SCLC).
Non-small-cell lung cancer
About eight in 10 primary lung cancers are diagnosed as NSCLC. There are three types of NSCLC.
- Squamous cell carcinoma is usually due to smoking; it affects your main airways, usually near the centre of your lungs.
- Adenocarcinoma mainly affects the outer part of your lungs. It’s also usually related to smoking but is also the most common lung cancer in non-smokers.
- Large cell carcinoma can affect any part of your lungs and occurs in about one in 10 of all lung cancers.
It’s not always possible to identify the exact type of NSCLC you have and your doctor may diagnose you with ‘undifferentiated’ NSCLC.
Small-cell lung cancer
This type of lung cancer is made up of small cells when examined under the microscope. It can develop quickly and spread to other parts of the body early on, often before it’s been diagnosed. For this reason, SCLC can be particularly difficult to cure. It’s almost always due to smoking.
Many people with lung cancer have no early symptoms at all. However, you may have:
- a cough – this can come on gradually
- a change in a cough you have had for a long time – for example if you smoke, a constant dry cough may become chesty
- blood-stained phlegm (sputum)
- shortness of breath
- loss of appetite
- weight loss
Less common symptoms include:
- swelling of your face or neck
- a hoarse voice
- chest or shoulder pain
- broadening or thickening of the tips of your fingers (called clubbing)
These symptoms aren’t always caused by lung cancer but if you have had them for longer than three weeks, see your GP. The chance of curing lung cancer is higher if it is diagnosed early.
- a cough – this can come on gradually
Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP will usually refer you to a hospital for a chest X-ray.
If your chest X-ray shows signs of lung cancer, or your GP is particularly concerned about your symptoms, he or she will usually refer you to a doctor who specialises in chest disease.
You may have the following tests to confirm the diagnosis and find out the type of cancer you have and whether it has spread (this is called cancer staging).
- CT scan. This uses X-rays to make three-dimensional images of part of your body.
- Bronchoscopy. This test lets your doctor look inside your lungs. You are given some anaesthetic spray and medication to make you a little sleepy. He or she then passes a narrow, tube-like, telescopic camera down your windpipe into your lungs. Your doctor may remove a sample of tissue (a biopsy) and send it to a laboratory for testing to identify the type of lung cancer.
Treatment of lung cancer depends on the type of cancer, how far it has spread and your general health.
SCLC is usually treated with chemotherapy because it has often spread by the time it’s diagnosed; this is sometimes combined with radiotherapy. NSCLC may be treated with surgery, chemotherapy or other medications, radiotherapy, or a combination of these methods.
Your doctor will discuss your treatment options with you.
- Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancer cells, which shrinks the tumour. Radiotherapy is commonly given with chemotherapy, particularly in SCLC.
- Chemotherapy uses medicines to destroy cancer cells. It’s the main treatment in SCLC but can also be used in NSCLC. You may have it before or after surgery, or with radiotherapy.
- Targeted therapies are a newer kind of treatment. They are medicines that have been designed to aim their attack directly at the cancer cells.
- Radiofrequency ablation and laser therapy is less commonly used to target small tumours. They use heat or a high-energy beam of light to destroy cancer cells. They may be suitable if you have early-stage NSCLC or you don’t want or can’t have surgery.
- Photodynamic therapy is a more experimental form of treatment not commonly used. Light-sensitive medicines are injected into your body and absorbed by the cancer cells. A low-powered laser activates the medicines. This treatment may be suitable if you have small early-stage NSCLC or you don’t want or can’t have surgery.
Surgery may be an option to treat NSCLC if it hasn’t spread. Your surgeon may remove a small section, a lobe or a whole lung, depending on the size, type and position of the cancer. The use of surgery also depends on how healthy your lungs are to start with. Some patients can be cured by surgery.
Advanced lung cancer
Lung cancer can be difficult to cure because often it doesn’t cause symptoms until it has already spread. Where a cure isn’t possible, your treatment will aim to give you as good a quality of life as possible. This is known as palliative care.
Your doctor may offer you a combination of the treatments described here to help shrink the tumour and control your symptoms. Medicines are also available to help relieve other symptoms such as pain, coughing, feeling sick and vomiting and poor appetite.
Smoking is the major cause of lung cancer, causing around eight in 10 lung cancers. Passive or second-hand smoking (breathing in other people’s smoke) is also linked to lung cancer.
Other factors that make lung cancer more likely include:
- exposure to asbestos
- exposure to high levels of radon gas – a naturally occurring radioactive gas
- not enough fruit and vegetables in your diet
- previous lung disease, such as tuberculosis (TB)
- a weakened immune system, for example if you have HIV/AIDS
You can reduce your risk of developing lung cancer by making certain lifestyle changes such as:
- stopping smoking
- not drinking excessive amounts of alcohol
- eating a balanced diet with at least five portions of fruit and vegetables a day
Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home.
I have heard that there are new treatments available for lung cancer. How can I find out if they are suitable for me and how can I benefit from them?
A lot of new treatments for lung cancer are currently being tested in clinical trials. Ask your doctor for more information.
New treatments for lung cancer are currently being tested in clinical trials. These are done to test if the new treatment is safe, has side-effects, is better than the current treatment available or helps you feel better.
Clinical trials may involve slight changes to treatments already being used or may involve completely new treatments. Some trials compare a standard treatment against a new one. You won’t be able to choose which treatment you receive – you will be given information about both and a computer will randomly allocate your treatment.
Another type of trial is a placebo-controlled trial. These are often done if there isn’t a good standard treatment available for you. Again, a computer will choose whether you receive a new experimental medicine or a dummy pill (placebo). The researchers will then see if either group of patients does better or has fewer side-effects. The advantage of entering a trial is that you may receive a new treatment or you may be helping patients in the future. All treatments used now have at sometime been tested in a clinical trial.
Ask your doctor if these treatments in clinical trials are suitable for you. He or she will consider the type and stage of your cancer, any treatment you have already had, your general health and other medical conditions you have.
I'm going to have surgery to remove part of one of my lungs. How will this affect my lifestyle – will I have to stop doing sports?
The impact that surgery for lung cancer will have on your ability to do sport and exercise will depend on how much of your lung is removed and how healthy your remaining lungs are.
The impact surgery will have on lifestyle and ability to do sports will vary from person to person. It will partly depend on how much of your lung is removed and how healthy the rest of your lungs were before the surgery. If you are or were a smoker, your lungs may have been damaged. Your surgeon will test your lungs before surgery to identify this. The surgeon will attempt to remove all the cancer, while leaving as much of the healthy lung as possible.
After surgery for lung cancer it's important that you try to get yourself back to fitness as soon as possible. Before you leave the hospital ask your doctor or physiotherapist how much exercise you should try to aim to do. At first it's important that you take it slowly and don't over exert yourself.
As you start to recover from your surgery you could try brisk walking or swimming. This will improve your muscle strength and fitness. You could also try other exercises including breathing and relaxation techniques. Try to maintain a healthy lifestyle by not smoking, eating healthily and drinking alcohol in moderation.
My doctor has mentioned hospice care. Can you tell me more about this?
If you have cancer that can't be cured and you need support to control your symptoms, your doctor may recommend hospice care.
If you have cancer that can’t be cured, hospices can play an important role in offering you and your family support. Hospice care can improve your symptoms and quality of life. Many hospices also offer care if you aren’t terminally ill but if you would benefit from palliative care to help with symptoms such as pain, breathing problems and weight loss. You may not need full-time hospice care – you may only need to visit a hospice once a week for support or advice, or for a few days to get your symptoms under control.
Hospices also offer you and your family and friends a range of additional support. This includes counselling on how to cope with your cancer as well as bereavement support. You can find hospice care not only in specialist centres and palliative care units, but also in hospitals and hospice day centres.
- Lung cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 5 November 2012
- Non-Small Cell Lung Cancer. eMedicine. www.emedicine.medscape.com, published October 2012
- Small Cell Lung Cancer. eMedicine. www.emedicine.medscape.com, published September 2012
- How do you find a trial? Cancer Research UK. www.cancerresearchuk.org, accessed 5 November 2012
- What is hospice care? Help the Hospices. www.helpthehospices.org.uk, accessed 5 November 2012
- After surgery for lung cancer. Cancer Research UK. www.cancerredearchuk.org, accessed 5 November 2012
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