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Lung cancer

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

Lung cancer is the most common cancer in the world. Around 1.3 million new cases are diagnosed every year globally. In the UK, lung cancer is responsible for the most deaths due to cancer; in 2004 this was a total of over 26,000 people. Most lung cancers are smoking-related.

Cancer - a general overview animation

The lungs

Your lungs are around your heart in your chest cavity (the thorax) and consist of spongy tissue with a rich blood supply.

Air goes from your nose and mouth, and passes 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 and carbon dioxide can filter into and out of the blood. In this process, known as gaseous exchange, molecules of oxygen and carbon dioxide bind to haemoglobin, one of the components of blood.

Illustration showing the lungs

What is lung cancer?

Lung cancer develops if the cells of the lung become abnormal and grow out of control. This creates a lump (tumour). Tumours can either be malignant (cancerous) or benign (non-cancerous). Cancer can occur in the lining of the bronchi or in the lung tissue itself.

Cancers that originate in other organs can spread through the bloodstream or the lymph system to the lung where they may grow and form "secondary" tumours. This is called metastasis.

There are two main types of lung cancer - small-cell and non-small-cell - abbreviated to SCLC and NSCLC. The different types of lung cancer both develop, and are treated, in different ways.

Non-small-cell lung cancer

About 80 out of every 100 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, unlike most lung cancers, is not linked as strongly to smoking
• large cell carcinoma, which can be found anywhere in the lungs

These types of NSCLC are grouped together because they behave in a similar way and respond to treatment differently to SCLC.

Occasionally it is not possible to work out which type of NSCLC you have and you may be diagnosed with undifferentiated non-small cell lung cancer. This will not make any difference to your treatment as all NSCLC is treated the same way.

Small-cell lung cancer

In SCLC, the cancer cells are small cells that are mostly filled with the nucleus (the control centre of cells). Sometimes it is called "oat cell" carcinoma because of the cells appearance under a microscope. The cancer usually starts in the cell lining of the trachea or bronchi. As this type of lung cancer can spread quickly, it is often found to have spread at the time it is diagnosed. This means it is not usually treatable with surgery.

Symptoms

Lung cancer often has no symptoms in the early stages of the disease.

A cough is usually the first symptom in most people. Smokers with chronic bronchitis may already have a continual cough, and their first alarm signal may be a change in the type of cough (eg from dry to productive) or a change in the colour of phlegm (sputum). If you develop blood-stained phlegm you should seek medical advice.

Other symptoms may include:

• aching chest
• shortness of breath
• weight loss
• finger clubbing (broadening or thickening of the tips of the fingers)
• hoarse voice
• swollen lymph nodes (lymph nodes are part of the body's immune system)

Causes

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 - most lung cancers are smoking-related. Smokers are at much greater risk of getting lung cancer and passive smoking has also been linked to lung cancer. Giving up smoking leads to a gradual reduction in the risk of developing lung cancer with each year that passes after stopping - returning to a normal level of risk 15 years after stopping.
• 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, such as the West Country and the Peak District. Smokers are also especially at risk.
• Chemicals - exposure to chemicals such as asbestos increases the risk of 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

Your doctor will ask you about your symptoms and will examine you. He or she may take a sputum sample to send to a laboratory to be tested for cancer cells - this is known as sputum cytology. Your doctor may also do some of the following tests or refer you to a hospital specialist for them.

• An X-ray will show any abnormalities in your lungs.
• A CT scan (computerised tomography) can be useful for detecting non-small-cell tumours and can help your doctor see how far the cancer has spread (if at all). For more information on CT scans, please see the separate BUPA factsheet, CT scan.
• A bronchoscopy is a hospital test in which a narrow tube with a light and lens on the end will be passed down the trachea and into your lungs. This acts like a telescope and will allow your doctor to view 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 has spread beyond where it started in the body. This will help to determine appropriate treatment. Ask your doctor for more information.

Treatment

Your treatment for lung cancer will depend on a number of factors such as the type of lung cancer, its location and whether the cancer has spread and if so, how far. Sometimes a complete cure is possible through surgery, radiotherapy or chemotherapy, or a combination of these. In other cases, where a cure is not possible there are treatments which aim to maximise the length and quality of life. This is known as palliative care.

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

Treatment for non-small-cell lung cancer

The treatment options for NSCLC include the following.

• Surgery - if the cancer has not spread outside of the lung a small area or a whole lung may be removed, depending on the size, type and site of the tumour. Surgery is the only treatment to offer a complete cure.
• Chemotherapy and radiotherapy - sometimes it is not possible to remove all the cancer by surgery. In this case, chemotherapy and/or radiotherapy are given to shrink the tumour and to destroy any remnants of the cancer to prevent it spreading further. Chemotherapy and radiotherapy are also used to shrink the tumour prior to surgery. Lung cancer can spread to the brain. Sometimes radiotherapy may be given to the brain to help reduce the risk of this happening in the future. This is called prophylactic radiotherapy. For more information, please see the separate BUPA factsheets, Chemotherapy and Radiotherapy.
• Drug treatments such as erlotinib (Tarceva) may help to stop the cancer growing so quickly. Erlotinib is sometimes used to treat people whose cancer has come back after initial treatment, or has not responded to at least one course of chemotherapy.

Treatment for small-cell lung cancer

Surgery is not usually used to treat SCLC, except if the cancer is found very early. This is because this type of lung cancer often spreads quickly to other parts of the body before it has been diagnosed. The best treatment is usually chemotherapy. Chemotherapy may enable you to live for longer and your symptoms will be better controlled. If the cancer has not spread far, you may have chemotherapy and radiotherapy at the same time.

Palliative care

Care for dealing with the symptoms of lung cancer such as pain, breathing problems and weight-loss may also be available for people with lung cancer. Radiotherapy, chemotherapy and steroids may be used to reduce pressure from the tumour on the airways, blood vessels, or cancer in the bones. Drug treatments are also available to help improve other symptoms such as pain, coughing, nausea and vomiting, and poor appetite.

For more information about palliative care contact Macmillan nurses or Marie Curie.

Further information

• Cancerbackup
  0808 800 1234
  www.cancerbackup.org.uk
• British Lung Foundation
  020 7688 5555
  www.lunguk.org
• Macmillan nurses
  0808 808 2020
  www.macmillan.org.uk
• Marie Curie
  020 7599 7777
  www.mariecurie.org.uk

Sources

1. Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2002.
2. UK Lung Cancer incidence statistics. Cancer Research UK.
   www.cancerresearchuk.org
   accessed 25 July 2006
3. UK Lung Cancer mortality statistics. Cancer Research UK.
   www.cancerresearchuk.org
   accessed 25 July 2006
4. Types of lung cancer. Cancer Research UK.
   www.cancerhelp.org.uk
   accessed 25 July 2006
5. Lung cancer. The diagnosis and treatment of lung cancer.
   National Institutes of Clinical Excellence (NICE). Clinical Guideline 24, February 2005.
   www.nice.org.uk
6. The diagnosis and treatment of lung cancer, methods, evidence and guidance.
   National Collaborating Centre for Acute Care. February 2005.
   www.rcseng.ac.uk
7. European study of radon and lung cancer risks. Environmental Radon Newsletter, issue 42, Spring 2005.
   Health Protection Agency.
   www.hpa.org.uk
8. Lung cancer - suspected. UK Department of Health PRODIGY Guidance.
   www.prodigy.nhs.uk
   accessed 25 July 2006
9. Treating lung cancer with cancer growth inhibitors. Cancerbackup.
   www.cancerbackup.org.uk
   accessed 4 August 2006
10. BNF British National Formulary 51, March 2006.

Published by BUPA's health information team, healthinfo@bupa.com September 2006.

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