Lung cancer Cancerbackup Lung cancer is the deadliest form of cancer in the UK with more than 38,000 new cases in the UK every year.

In this article

Symptoms Causes and risk factors

Treatment and recovery Further information

Lung cancer has always been more common in men, particularly those aged over 40. However, as fewer men smoke now rates have fallen. Meanwhile lung cancer rates increased among women until the 1980s as more took up smoking. Although rates among women have stabilised, the disease now claims more lives than breast cancer.

This article deals with primary lung cancer - when the cancer has started in the lung. It shouldn't be confused with secondary lung cancer, when cancer in another part of the body spreads to the lung.

If you have the following, or any other symptoms, you must have them checked by your doctor (but remember, all occur in many conditions other than cancer):

• A persistent cough or change in the nature of a longstanding cough
• Shortness of breath
• Coughing up blood-stained phlegm (sputum); blood is a warning sign that always needs urgent investigation
• Chest discomfort - a dull ache or sharp pain when you cough or take a deep breath
• Loss of appetite and weight

Cigarette smoking is the cause of nearly all lung cancers. The risk increases with the number and type of cigarettes smoked.

One in ten lung cancers occurs in non-smokers. But in a number of cases, exposure to passive smoke (inhalation of other people's cigarette smoke) may be a cause.

Pipe and cigar smokers have a lower risk than cigarette smokers, but it's still a far greater risk than that of non-smokers.

Some rare types of lung cancer are not related to smoking. Other causes include exposure to certain chemicals and substances, such as asbestos, uranium, chromium and nickel. These have all been linked to lung cancer but are very rare. Contact your local environmental health officer if you're concerned.

If a person stops smoking the risk of lung cancer is greatly reduced, so that after about 15 years the chances of developing the disease are similar to that of someone who has never smoked.

At present there's no effective screening test for lung cancer. If you suspect you have any of the symptoms mentioned, see a GP immediately. Initial tests will include a chest x-ray. You may also be asked to bring samples of phlegm for examination.

There are several tests that can be done to diagnose lung cancer and these include:

• CT or MRI scans – these sophisticated scans involve lying still inside a machine as it takes images of the internal organs. The pictures that result can give a very good idea of whether cancer might be present but are not absolutely definite as cell samples are needed to make a full diagnosis. Scans are often done in order to guide a biopsy to suspicious areas.
• Bronchoscopy - a thin flexible tube is passed gently through your nose or mouth and into the lung airways. Photographs and cell samples are then taken
• Mediastinoscopy - a small cut is made through the skin at the base of the neck under general anaesthetic. A tube is then passed into the chest, allowing the doctor to examine the area at the centre of the chest and local lymph nodes
• Lung biopsy - a needle is passed through the skin into the lung and a sample of cells is taken for examination.

Lung cancer patients may be referred to special clinics.

There are several different types of lung cancer, which are generally divided into two groups:

• One in five are rapidly spreading small-cell lung cancers (SCLC)
• The remainder are relatively slow-growing non-small-cell lung cancers (NSCLC)

A rarer type of lung cancer, which affects the covering of the lung (the pleura) is mesothelioma.

Treatment of lung cancer depends on the type of tumour, its location and how far it has spread, as well as the persons general health. A process known as staging is used in each case to asses these factors and recommend appropriate treatment, which may include surgery, chemotherapy and radiotherapy.

When the tumour is away from the centre of the chest and there's little or no spread (typically in NSCLC), surgery is often used. A small part of the lung may be removed (wedge resection), or a lobe of the lung (lobectomy) or an entire lung (pneumonectomy).

You can breathe normally with only one lung. However, if you had breathing difficulties before the operation you may be more breathless afterwards. Breathing tests will be carried out to help you and your doctor decide on the best course of action.

Chemotherapy and/or radiotherapy are usually more effective in treating SCLC because this type of cancer has usually spread to more than one place by the time it's diagnosed.

Particular treatments may be used in certain instances or to control specific symptoms. For example, lung cancer sometimes causes breathlessness by obstructing the wind pipe or one of the main airways. In such cases laser therapy can provide some relief.

New ways of treating lung cancer are being studied and starting to come into wider use. These include biological therapies which are drugs that block the signals that cancer cells need to grow. For example monoclonal antibody treatments (MAB) may help the immune system target diseased cells or prevent the formation of new blood vessels that a tumour needs in order to grow. In NSCLC, different ways of giving radiotherapy and chemotherapy are being investigated.

Sometimes new symptoms can develop during your illness. These may be caused by the spread of the cancer to other parts of the body, but could also come about because some lung cancer cells produce hormones that upset the body's chemical balance.

If you have any worrying or new symptoms, tell your GP straight away so you can be investigated promptly or reassured that there's nothing to worry about.

The Roy Castle Lung Cancer Foundation
Website: www.roycastle.org

Cancerbackup
Website: www.cancerbackup.org.uk

This article was last medically reviewed by Dr Trisha Macnair in April 2009.