Lung cancer

Published by Bupa’s Health Information Team, January 2011.

This factsheet is for people who have lung cancer, or who would like information about it.
Lung cancer is the second most common cancer and the third most common cause of death in the UK. About 33,400 people are diagnosed with lung cancer each year.

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About lung cancer

You have two lungs and they are located in your chest inside your ribcage. Your lungs bring oxygen into your body and pass it into your blood and remove carbon dioxide. Air passes from your nose and mouth into your windpipe (trachea). Your windpipe divides into two airways called the right and left bronchus, and one goes into each lung. Each bronchus divides into smaller tubes called bronchioles. These lead to air sacs called alveoli. This is where oxygen filters into and carbon dioxide filters out of your blood.

Lung cancer is the uncontrolled growth of cells in the lungs. This creates a lump (tumour) that can be either malignant (cancerous) or benign (not cancerous).

Lung cancer can start in the lining of your bronchi or your lung tissue – this is known as primary lung cancer. Cancer that has spread to the lungs through your bloodstream or your immune system from another part of your body is known as secondary lung cancer.

Types of lung cancer

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 the most common type of lung cancer and affects the bronchi.
• Adenocarcinoma mainly affects the outer part of your lungs and is the most common lung cancer in women and non-smokers.
• Large cell carcinoma can affect any part of the 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 you may be diagnosed with ‘undifferentiated’ NSCLC. This won’t make any difference to your treatment as all NSCLC is treated the same way (see Treatment of lung cancer).

Small-cell lung cancer

This type of lung cancer starts in the smallest cells in your lungs – usually in the cells lining your bronchi. It can develop very fast and spread to other parts of the body very early – often before it’s been diagnosed. For this reason SCLC can be difficult to treat.

Symptoms of lung cancer

Most people with lung cancer have no early symptoms at all, but others may have:

• a cough – this can come on gradually
• a change in a cough you have had 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
• tiredness

Less common symptoms include:

• swelling of your face or neck
• a hoarse voice
• chest or shoulder pain
• broadening or thickening of the tips of the 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.

Causes of lung cancer

Smoking is the major cause of lung cancer, causing around nine 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 the following.

• 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.
• A weakened immune system, for example if you have HIV/AIDS.

Diagnosis of lung cancer

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, you will usually be referred to a doctor who specialises in chest disease.

You may have the following tests to confirm diagnosis, find out the type of cancer you have and if the cancer has spread (this is called cancer staging).

• CT scan. This uses X-rays to make three-dimensional images of part of the body.
• Bronchoscopy. This is a procedure used to look inside your lungs. A narrow, tube-like, telescopic camera is passed down your windpipe into your lungs. Your doctor may remove a sample of tissue (a biopsy). This will be sent to a laboratory for testing to determine the type of lung cancer.

Treatment 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. NSCLC may be treated with surgery, chemotherapy, radiotherapy, laser treatment, or a combination of these methods.

Your doctor will discuss your treatment options with you.

Non-surgical treatments

• Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous 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.
• Biological therapies are medicines that use substances occurring naturally in your body to kill cancer. The substances are manufactured so that they can be used in larger quantities to fight cancer. These include erlotinib (Tarceva), gefitinib (Iressa), cetuximab (Erbitux), and bevacizumab (Avastin).
• Radiofrequency ablation (or laser therapy) is when a high-energy beam of light is used to destroy cancer cells. It’s suitable if you have early stage NSCLC or you don’t want or can’t have surgery.
• Photodynamic therapy is when light-sensitive medicines are injected into your body and absorbed by the cancer cells. A low-powered laser is used to activate the medicines. This treatment is suitable if you have small early stage NSCLC, or when you don’t want or can’t have surgery.

Surgery

Surgery may be used to treat NSCLC if the cancer hasn’t spread. A small section, a lobe or a whole lung may be removed, depending on the size, type and position of the cancer. It also depends on how healthy your lungs are to start with.

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.

You may be offered 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, cough, feeling sick and vomiting and poor appetite.

Prevention of lung cancer

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

Getting enough vitamin D may reduce your risk of developing a number of cancers, including lung cancer – although more research needs to be done to be certain. Vitamin D is also well known to be important for bone health.

Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don't get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

Always read the patient information leaflet that comes with your supplements and if you are pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

Help and support

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.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.