Lung cancer

Lung cancer is the third most common cancer in the UK. It can cause a persistent cough, breathlessness, and weight loss. Most cases of lung cancer are caused by smoking.

What is lung cancer?

You may get lung cancer if cells in your lungs grow in an uncontrolled way. The cells usually form a lump (tumour).

Your lungs move oxygen from the air you breathe into your blood and remove carbon dioxide as you breathe out. They’re made up of lots of air tubes (called bronchioles) and air sacs (called alveoli).

You have different types of cells in the different parts of your lungs. This means you can get different types of lung cancer.

You may have:

• primary lung cancer – when a tumour starts in your lung
• secondary lung cancer – when cancer cells have spread to your lungs through your bloodstream or immune system from cancer that started in another part of your body, such as your kidney, breast , or prostate

Over 49,000 people are diagnosed with lung cancer each year in the UK.

Types of lung cancer

The two main types of cancer that start in the lung are:

• non-small cell lung cancer (NSCLC)
• small cell lung cancer (SCLC)

These names come from how the cancer cells look under a microscope.

Non-small cell lung cancer

About 8 in every 10 primary lung cancers are NSCLC. There are three main types of NSCLC:

• adenocarcinoma
• squamous cell carcinoma
• large cell carcinoma

Adenocarcinoma mainly affects the outer part of your lungs. Around 4 in every 10 people with NSCLC have adenocarcinoma. This is related to smoking. But it’s also the type of lung cancer you’re most likely to get if you don’t smoke. It can be caused by air pollution or asbestos.

Squamous cell carcinoma affects your main airways (your bronchi). It’s usually near the centre of your lungs. Around 3 in every 10 people with NSCLC have this type of lung cancer.

Large cell carcinoma can appear in any part of your lungs, but most often in the centre of your lungs. It affects about 1 in every 10 people with NSCLC.

Small cell lung cancer

Two in 10 people with lung cancer have SCLC. SCLC can start quickly and spread to other parts of your body, often before it’s been diagnosed. SCLC is almost always caused by smoking.

Causes of lung cancer

Smoking (tobacco cigarettes) is the biggest cause of lung cancer. In the UK, it causes over 8 in every 10 lung cancers. Your risk of lung cancer is related to how much you smoke, how long you’ve been smoking and when you started smoking. Passive or second-hand smoking (breathing in other people’s smoke) is also linked to lung cancer.

You may also be more likely to get lung cancer if you:

• are exposed to asbestos
• are exposed to high levels of radon gas – a naturally occurring radioactive gas
• have had lung disease such as tuberculosis (TB) or chronic obstructive pulmonary disease (COPD) in the past

Diagnosis of lung cancer

NHS Lung Health Checks

NHS Lung Health Checks aim to diagnose lung cancer at an early stage when the cancer is easier to treat. The service is now changing to a targeted lung cancer screening service in England.

You may be invited to an NHS Lung Health Check if:

• you live in some parts of England and Wales – this service isn’t available everywhere yet
• you’re aged 55 to 74
• you are a current or former smoker

You’ll be asked about your breathing, lifestyle, family, and medical history. If you may be at a higher risk of lung cancer, you may be offered a low-dose computer tomography (CT) scan to create a detailed picture of your lung.

Seeing your GP

If you have any symptoms, a GP will ask you about your symptoms and medical history and whether or not you smoke. If you only have a cough, they may ask you to wait and see if it gets better on its own. This is most likely to happen if you’re younger, have never smoked, or your cough started when you had a cold or flu.

If your GP thinks your symptoms could be caused by lung cancer, they’ll refer you for a chest X-ray or a scan. You may have an urgent clinic referral if you’re over 40 and you smoke or have smoked in the past.

Referral to a specialist

If your chest X-ray shows signs of lung cancer, a GP will refer you to a doctor who specialises in chest disease. Sometimes, they may refer you even if your X-ray seems normal or before you have any X-rays.

The specialist will ask you to have some tests to confirm whether or not you have lung cancer. If you do have cancer, the tests can show which type of cancer you have, how advanced it is, and if it’s spread (metastasised). This is called cancer staging.

These tests may include the following.

• A CT scan of your chest and tummy. This uses X-rays to make three-dimensional (3D) images of part of your body. It’s usually the first test you’ll have after a chest X-ray.
• A PET-CT (positron emission tomography) scan. You may be offered this type of CT scan if you have early-stage cancer. It helps doctors to see where your cancer is and if the cancer has spread.
• A bronchoscopy. This test lets your doctor look inside your lungs and take a sample of tissue (a biopsy). A bronchoscope is a narrow, tube-like, flexible telescopic camera. You’ll be given an anaesthetic spray and some medicine to make you sleepy. Or you may have a general anaesthetic and be asleep during the test. The doctor passes the bronchoscope down your windpipe into your lungs.
• A needle biopsy through the skin of your chest. This is called a percutaneous lung biopsy. Your doctor will numb your skin with a local anaesthetic then insert a fine needle. They’ll use an ultrasound or CT scan to guide the needle into the right place.

Prevention of lung cancer

The most important thing you can do to reduce your risk of developing lung cancer is to stop smoking. Speak to your local pharmacist or GP about the best ways to give up smoking. Nicotine replacement therapy (such as gums or patches) can help you quit. Vaping may be an option for you to consider. But quitting completely is better for your health.

Try to avoid second-hand smoke – keep away from enclosed spaces where other people are smoking. Try to avoid exposing yourself to anything that could increase your risk of lung cancer – this includes asbestos and radiation.

There’s some evidence that eating fruit and vegetables can help to reduce your risk of getting lung cancer. So try to eat a balanced diet. Research suggests that taking vitamin supplements doesn’t seem to have any effect on the risk of lung cancer and may even be harmful.

Being more physically active may help to reduce your chance of getting several cancers.

Living with lung cancer

A lung cancer diagnosis can be distressing for you and your loved ones. An important part of cancer treatment is getting enough support to deal with the emotional aspects as well as the physical symptoms.

You should have a lung cancer clinical nurse specialist assigned to you as soon as you’ve been diagnosed. This person will coordinate your care. A range of doctors and nurses will help to support you through your treatment and help you to make decisions about the type of treatment you’d like. They can prescribe medicines and offer practical advice to deal with symptoms, such as pain, exhaustion, coughing, and depression.

Your hospital should also offer a range of helpful services, including dietitians, counsellors, complementary therapists, and benefits advisers. Voluntary groups and patient organisations, such as Macmillan nurses and Marie Curie nursing, and day centres are also available.

If you have more advanced cancer, you can get support through specialist palliative care teams – either at your local hospice or in your own home. Your doctor will discuss this with you.