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Lung cancer

Published by Bupa's health information team, May 2009.

This factsheet is for people who have lung cancer, or for people who would like information about it.

Lung cancer is the most common cancer in the world with around 1.3 million new people diagnosed every year. In the UK, lung cancer is responsible for the most deaths due to cancer in both men and women. According to Cancer Research UK, in 2005 this totalled over 33,000 people.

How cancer develops

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About lung cancer

The lungs

Your lungs surround your heart in your chest cavity (the thorax) and consist of spongy tissue with a rich blood supply. Air passes from your nose and mouth into the trachea (windpipe) and into each lung, through two airways called the bronchi. These divide into smaller airways, called bronchioles, which divide again and end in alveoli. These are air sacs with walls just one cell thick. It's here that oxygen filters into and carbon dioxide filters out of the blood.

Illustration showing the different parts of the lung
The different parts of the lung

What is lung cancer?

Lung cancer develops if the cells of your lungs grow out of control. This creates a lump (tumour) which can either be malignant (cancerous) or benign (not cancerous). You can get cancer in the lining of your bronchi or in the lung tissue itself.

Cancers that start in other organs can spread through the bloodstream or the lymphatic system (part of your immune system) to your lungs where they may grow and form 'secondary' tumours. This is called metastasis. It's important to know where the cancer started as this affects the choice of your treatment.

There are two main types of lung cancer - non-small-cell (NSCLC) and small-cell (SCLC), which develop and are treated in different ways.

Non-small-cell lung cancer

About 80 percent of lung cancers diagnosed are NSCLC. There are three types of NSCLC:

  • squamous cell carcinoma - which occurs mainly in the bronchi
  • adenocarcinoma - which is found mainly in the outer part of the lungs and is the most common lung cancer in non-smokers
  • large cell carcinoma - which can be found anywhere in the lungs

Occasionally it's not possible to work out which 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

SCLC usually starts in the cells lining your trachea or bronchi. This type of lung cancer can spread quickly - often before it's diagnosed.

Symptoms of lung cancer

Lung cancer often has no symptoms in the early stages of the disease and may be picked up by chance on a chest X-ray.

The first symptom you might notice is a cough. If you smoke and have chronic bronchitis, you may already have a continual cough, and your first alarm signal may be a change in the type of cough (for example, from dry to chesty) or a change in the colour of your phlegm (sputum). If you develop blood-stained phlegm, see your doctor.

You may also have other symptoms including:

  • aching chest
  • shortness of breath
  • weight loss
  • finger clubbing (broadening or thickening of the tips of the fingers)
  • hoarse voice
  • swollen glands (lymph nodes)
  • chest / shoulder pain

Causes of lung cancer

Many of the causes of lung cancer are unknown but there are certain factors that make lung cancer more likely, which are listed below.

  • Smoking - around 85 to 90 percent of lung cancers are smoking-related. If you're a smoker, you're more likely to get lung cancer. Passive smoking has also been linked to lung cancer. If you stop smoking, you will be less likely to develop lung cancer with each year that passes.
  • Environmental causes - radon gas is a naturally occurring radioactive gas that has been linked to the development of lung cancer in people who have been exposed to high levels, for example miners. Levels are higher in certain parts of the UK than others.
  • Chemicals - exposure to chemicals such as asbestos increases your risk of developing lung cancer.
  • Diet - some studies have shown a diet low in fruit and vegetables may contribute to an increased risk of developing lung cancer.

Diagnosis of lung cancer

Your GP will ask you about your symptoms and will examine you. He or she may also ask you about your medical history and may do some of the following tests or refer you to a chest physician for them.

  • A chest X-ray can often be helpful.
  • A CT scan uses X-rays to make a three-dimensional image of your body. It can be useful for detecting cancer and can help your doctor see how far it's spread (if at all).
  • A bronchoscopy is a hospital test in which a narrow tube with a light and lens on the end will be passed down your windpipe (trachea) and into your lung. This acts like a telescope and will allow your doctor to see your lung tissue. Your doctor may also use the instrument to take samples of tissue (biopsy) for examination under a microscope.

These tests can help your doctor to 'stage' the cancer - this means describing its size, position and whether it's spread beyond where it started in your body. This will help to determine the best treatment for you. Ask your doctor for more information.

Treatment of lung cancer

Your treatment will depend on a number of factors such as the type of lung cancer, where it is in your body and whether and how far the cancer has spread. Sometimes a complete cure is possible through surgery, radiotherapy or chemotherapy or a combination of these. In other cases, where a cure isn't possible, your treatment will aim to give you as much quality of life as possible. This is known as palliative care.

There are a number of treatments which are described below. Some can have serious side-effects so it's important to discuss them in more detail with your doctor who will advise you which treatment is best for you.

Surgery

If the cancer hasn't spread outside of your lung a small area or a whole lung may be removed, depending on the size, type and site of the tumour. It also depends on how healthy your lungs are to start with as you will have less lung to use after the operation.

Surgery isn't usually used to treat SCLC because the cells from these tumours often spread quickly to other parts of the body before they have been found.

Radiotherapy and chemotherapy

Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour, or if it's small enough, kill it completely. Having the treatment is rather like having an X-ray, but it may have to be repeated over a few days. Side-effects can include tiredness and a sore throat. Radiotherapy is sometimes given along with chemotherapy, particularly in SCLC if it has been caught quite early.

Lung cancer can also spread to your brain and radiotherapy is sometimes used to treat this. In SCLC, radiotherapy may be used to reduce the chance of cancer developing in the brain - this is called prophylactic radiotherapy.

Chemotherapy

Chemotherapy uses powerful medicines to destroy cancer cells. It's the main treatment in SCLS but can also be used in NSCLC. Sometimes it's given after surgery to increase the chance of cure. It has side-effects, which include risk of infections, sickness, tiredness, and sometimes hair loss.

Newer medicines such as erlotinib (Tarceva) may help to stop your cancer growing so quickly. Erlotinib is sometimes used to treat people with NSCLC whose cancer has come back after initial treatment, or hasn't responded to at least one course of chemotherapy. It's a tablet and has some side-effects, which include a rash and diarrhoea.

Your surgeon, oncologist (a doctor specialising in cancer), and nurses who treat you will explain all the treatment options and give you more detailed information. Write down any questions you might have so you don't forget them.

Palliative care

Care for dealing with symptoms such as pain, breathing problems and weight loss is also available. You may be offered radiotherapy, chemotherapy and steroids to reduce pressure from the tumour on your airways, blood vessels, or cancer in your bones. Medicines are also available to help improve other symptoms such as pain, cough, nausea and vomiting and poor appetite.

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.

Related topics

Further information

Sources

  • Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. 2nd edition. Oxford, 2002:388-389
  • UK Lung Cancer incidence statistics. Cancer Research UK. http://info.cancerresearchuk.org, accessed 1 April 2008
  • UK Lung Cancer mortality statistics. Cancer Research UK. http://info.cancerresearchuk.org, accessed 1 April 2008
  • Types of lung cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 1 April 2008
  • Lung cancer. The diagnosis and treatment of lung cancer. National Institute for Health and Clinical Excellence (NICE). Clinical Guideline 24, 2005. www.nice.org.uk
  • The diagnosis and treatment of lung cancer, methods, evidence and guidance. National Collaborating Centre for Acute Care. 2005. www.rcseng.ac.uk
  • Miles JCH, Appleton JC, Rees DM et al. Indicative atlas of radon in England and Wales. Health Protection Agency. 2005. www.hpa.org.uk
  • Lung cancer - suspected. NHS Library for Health. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 13 May 2008
  • Treating lung cancer with cancer growth inhibitors. Macmillan Cancer Support. www.macmillan.org.uk, accessed 3 April 2008
  • British National Formulary (BNF). BMJ Publishing Group, 2007. 54:463

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2009

 

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