Lung Cancer

What is lung cancer?

Lung cancer is among the leading causes of cancer death worldwide, largely because it usually presents late. Smoking is the dominant risk factor, though a meaningful proportion of cases occur in people who have never smoked. Screening with low dose CT in high risk groups detects disease earlier, when treatment is far more likely to succeed.

Causes

• Tobacco smoking, responsible for the large majority of cases
• Second hand smoke exposure
• Radon gas exposure
• Asbestos and occupational carcinogens
• Air pollution
• Genetic driver mutations, particularly in never smokers

Symptoms

• Persistent cough or change in a long standing cough
• Coughing up blood
• Breathlessness
• Chest pain that may worsen with breathing
• Unexplained weight loss and fatigue
• Recurrent chest infections
• Hoarseness
• Bone pain or headaches if spread has occurred

Risk factors

• Current or former smoking
• Age over 50
• Family history of lung cancer
• Occupational exposure to asbestos, silica or diesel fumes
• Previous chest radiotherapy
• Existing COPD or pulmonary fibrosis

Diagnosis

• Chest X-ray as an initial test, though it can miss tumours
• CT scan of the chest
• PET CT for staging
• Bronchoscopy or CT guided biopsy for tissue diagnosis
• Molecular and PD L1 testing to guide treatment
• Brain imaging where indicated

Treatment

• Surgical resection for early stage disease
• Radiotherapy including stereotactic techniques
• Chemotherapy
• Targeted therapy against specific driver mutations
• Immunotherapy with checkpoint inhibitors
• Smoking cessation, which improves outcomes even after diagnosis
• Early palliative care alongside active treatment

Self care

• Stop smoking, which improves treatment response even after diagnosis
• Stay as active as you can between treatments
• Maintain nutrition and weight with dietitian input
• Attend all treatment appointments and report side effects early
• Use breathlessness techniques taught by physiotherapy
• Accept early palliative care support alongside active treatment

When to see a doctor

Book an appointment if:

• Cough lasting more than three weeks
• A change in a long standing smoker's cough
• Breathlessness or chest pain
• Recurrent chest infections
• Unexplained weight loss or fatigue
• Hoarseness lasting more than three weeks

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Never smoke, and stop at any age
• Avoid second hand smoke
• Test the home for radon in affected areas
• Follow occupational protection for asbestos and diesel fumes
• Attend low dose CT screening if eligible
• Reduce exposure to indoor and outdoor air pollution

Outlook

Outlook depends heavily on stage at diagnosis. Early stage disease treated with surgery has good five year survival, whereas advanced disease has historically had poor outcomes. Targeted therapies and immunotherapy have significantly extended survival for many with advanced disease, particularly where a driver mutation is present, and CT screening is shifting more diagnoses to earlier curable stages.

Related conditions

Common questions