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Lung cancer

Lung cancer is the second most common cancer in the UK. About 41,000 people are diagnosed with lung cancer each year.

Animation – How cancer develops

About lung cancer

You have two lungs in your chest, inside your ribcage. Your lungs bring oxygen into your body, 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.

Illustration showing the different parts of the lung

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. Cancer is named depending on where it originally comes from. For example if someone has breast cancer that spreads to the lungs it is still called breast 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 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.

Symptoms of lung cancer

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
  • 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 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.

Causes of lung cancer

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

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, 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

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.

Non-surgical treatments

  • 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

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.

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

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.

 

Produced by Dylan Merkett, Bupa Health Information Team, March 2013 

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

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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