There are two main types of cancer that start in the lung (primary lung cancer). These are called non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). These names come from how the cancer cells look under a microscope.
Non-small-cell lung cancer
Nearly nine in 10 primary lung cancers are diagnosed as NSCLC. There are three main types of NSCLC.
- Adenocarcinoma mainly affects the outer part of your lungs. This is the most common type of lung cancer. Although it’s usually related to smoking, it’s also the type of lung cancer you’re most likely to get if you’re a non-smoker.
- Squamous cell carcinoma affects your main airways, usually near the centre of your lungs. Around three in 10 people with lung cancer will have this type.
- Large cell carcinoma can affect any part of your lungs and affects about one in 10 people with lung cancer.
Although these three types of lung cancer are different, doctors tend to put them all into one group because they are treated in a similar way.
Small-cell lung cancer
Just over one in 10 people who have lung cancer has small-cell lung cancer. This sometimes used to be called oat-cell lung cancer. It can develop quickly and spread to other parts of your body early on, often before it’s been diagnosed. For this reason, SCLC can be particularly difficult to treat. It’s almost always due to smoking.
Many people with lung cancer have no symptoms to begin with at all. The most common symptom though is a cough, especially one that doesn’t go away or gets worse. You may also:
- cough up blood
- feel short of breath
- have pain in your chest or shoulder
- lose weight unexpectedly
- feel tired
Less common symptoms include:
- swelling of your face or neck
- a hoarse voice
- broadening or thickening of the tips of your fingers (called clubbing)
Many of the symptoms of lung cancer, such as a cough, can also be symptoms of many other much less serious conditions. But if you’ve had any of these symptoms for longer than three weeks, contact your GP surgery for advice.
The symptoms of lung cancer, such as a persistent cough, can be very similar to those of much less serious conditions. Your GP will ask you about your symptoms, and will also want to know about your medical history and whether or not you smoke. After assessing you, your GP may ask you to wait and see if your symptoms improve on their own. They may also suggest seeing if treatment such as antibiotics or an inhaler helps.
If you have certain symptoms such as coughing up blood, your GP is likely to refer you for a chest X-ray straight away. Your GP may also refer you for a chest X-ray if you’ve had symptoms for more than three weeks with no obvious cause.
If your chest X-ray shows signs of lung cancer, your GP will refer you to a doctor who specialises in chest disease. If your GP is particularly concerned about your symptoms, they may refer you even if your X-ray seems normal, or before you have X-rays taken.
The specialist will ask you to have various tests to confirm whether you have lung cancer or not. Many people who are referred to a specialist are found not to have cancer. If you are found to have cancer, tests will be able to show what type of cancer you have. They will also show how advanced your cancer is and whether it has spread (this is called cancer staging). The tests may include the following.
- A CT scan of your chest and abdomen (tummy). This uses X-rays to make three-dimensional images of part of your body. You may also be offered a special form of CT scan called a PET-CT (positron emission tomography) scan. This can help show whether an abnormal area on your chest X-ray might be cancer. It can also help show if your cancer has spread.
- A 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.
- A needle biopsy through the skin of your chest wall (called a percutaneous transthoracic needle biopsy). If your cancer is in the outer part of your lung, the best way to reach it may be through your chest wall. Your doctor will numb your skin then insert a fine needle through your skin into the cancer beneath. He or she may use a CT scanner to guide the needle into the right place. Your doctor will take a biopsy and send this to the laboratory for testing.
Treatment of lung cancer depends on the type of cancer you have, how far it has spread and your general health.
Small-cell lung cancer (SCLC) is usually treated with chemotherapy rather than surgery because it has often spread by the time it’s diagnosed. Chemotherapy for SCLC is sometimes combined with radiotherapy. Or, if the cancer is more advanced, you may be offered chemotherapy first and radiotherapy later.
Non small-cell lung cancer (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. He or she will also advise you to stop smoking as this will help you reduce the side-effects of your treatment. Stopping smoking may also mean your cancer is less likely to come back after treatment.
- Radiotherapy uses radiation to destroy cancer cells. Your doctor will target a beam of radiation onto the area of your lung where the cancer is to shrink the tumour. You may have radiotherapy if you have NSCLC but you aren’t well enough for surgery. It’s sometimes given with chemotherapy, particularly if you have SCLC.
- Chemotherapy uses medicines to destroy cancer cells. It’s the treatment you’re mostly likely to be offered if you have SCLC but may also be used in NSCLC. You may have chemotherapy on its own, after surgery, or with radiotherapy. Chemotherapy is usually given as an injection or through a drip.
- Targeted therapies are medicines that can block messages in your cancer cells to stop them growing and dividing. They are also known as biological therapies. You may be offered a targeted therapy if you have a particular type of NSCLC.
All these treatments have potential benefits but can also cause side-effects. The doctors and nurses will give you information about the treatments to help you decide which treatment to have, and so you know what to expect. Everyone is different and the effects of treatment vary.
Surgery may be an option to treat NSCLC if it hasn’t spread. Your surgeon may remove a small section, part of one lung or a whole lung, depending on the size, type and position of the cancer. Whether or not you are offered surgery also depends on how healthy your lungs are to start with. Some patients can be cured by surgery.
If you’re going to have surgery, stopping smoking beforehand will help you recover better afterwards. Before surgery, you may be given some advice on how to get yourself as fit as possible so you’re ready for the operation.
Advanced lung cancer
Lung cancer can be difficult to cure because often it has already spread by the time you’re diagnosed. If it isn’t possible to cure your cancer, your treatment will aim to extend your life and 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 and some others 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 losing your appetite. The doctors and nurses will help to support you through the treatment.
Smoking is the major cause of lung cancer, causing at least 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 can increase your risk of getting lung cancer include:
- exposure to asbestos
- exposure to high levels of radon gas – a naturally occurring radioactive gas
- previous lung disease, such as tuberculosis (TB)
- a weakened immune system, for example if you have HIV/AIDS
The most important thing you can do to reduce your risk of developing lung cancer is to stop smoking. The earlier you give up, the lower your risk of lung cancer. Try to avoid second-hand smoke - keep away from enclosed spaces where other people are smoking.
There’s some evidence that eating fruits and vegetables can help to reduce your risk of getting lung cancer. So try to eat a balanced diet with at least five portions of fruit and vegetables a day. Being physically active might also help you reduce your chance of getting lung cancer
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 will be available to you in hospices or at home. Your doctor will discuss this with you.
I’ve heard that there are new treatments available for lung cancer. How can I find out if they’re suitable for me and how can I benefit from them?
AnswerA lot of new treatments for lung cancer are currently being tested in clinical trials. Ask your doctor for more information.
ExplanationNew treatments for lung cancer are constantly being developed and tested in clinical trials. All new treatments need to go through clinical trials to test if they’re safe, have side-effects, are better than the current treatments available, or help you to feel better. Clinical trials may test changes to treatments already being used or may involve completely new treatments.
Some trials compare a standard treatment against a new one. Neither you nor your doctor will be able to choose which treatment you receive during this type of trial. You’ll be given information about both treatments and, if you agree to take part in the trial, you’ll be randomly allocated to your treatment. This means it will be pure chance which type of treatment you get.
Another type of clinical trial is a placebo-controlled trial where a new treatment is compared with a dummy pill (placebo). Again, you can’t choose which you receive. These trials are usually done if there isn’t a good standard treatment available for you. They are usually tried after you have already had some other standard treatments.
The researchers will be looking to see if either group of patients in the trial does better or has fewer side-effects. This helps them to see whether the new treatment is better or worse than the alternative.
The main advantage of entering a trial is that you will be helping others with the same condition by helping to identify the best treatments. In some cases you may be among the first to get a new treatment that works. Remember though, that new treatments aren’t necessarily better than existing ones – that’s why the trial is needed.
Each clinical trial has strict guidelines about who can take part. This might mean they are looking for people of a certain age, or at a particular stage in their illness. Ask your doctor if there are any clinical trials which might be suitable for you.
My doctor has mentioned hospice care. Can you tell me more about this?
AnswerIf you have cancer that can't be cured and you need support to control your symptoms, your doctor may recommend hospice care.
ExplanationIf you have cancer that can’t be cured, hospices can play an important role in offering you and your family support. Hospices tend to be comfortable and homely – smaller and quieter than a hospital. They aim to look after you as a whole person and also support those who care for you.
The doctors and nurses in a hospice can give you specialist care for the symptoms you may have with advanced cancer. These may include pain, sickness and breathing problems. 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. Your GP may be able to arrange a short stay in a hospice for you to give your carers a break.
Hospices may 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 practical advice, for instance, about money, equipment and services. They may also be able to offer you and your family help so you can cope better at home.
Your GP or specialist cancer nurse can tell you about hospices in your area.
I'm going to have surgery to remove part of one of my lungs. How active can I be afterwards?
AnswerAfter lung cancer surgery, it’s important to exercise gently so that you can get fit again. Ask your doctor or physiotherapist about which type of exercise is best for you.
ExplanationIt's important that you try to get yourself back to fitness as soon as possible after your lung cancer surgery.
A good form of exercise after lung surgery is walking. You’ll find that the nurses and physiotherapists in hospital will encourage you to be up and walking a little as soon as possible after your surgery. 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 do too much. Space out your activities during the day and listen to what your body is telling you. Rest when you need to.
As you start to recover from your surgery, you could try brisk walking or swimming. This will improve your muscle strength and fitness. Your doctor or physiotherapist may suggest you spend around half an hour a day walking.
Remember that each person is different – ask your doctor or physiotherapist about what exercise plan is best for you.
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