Lung Cancer

Lung cancer is one of the most common cancer in India. It can cause a persistent cough, breathlessness and unexplained weight loss. Most cases of lung cancer are caused by smoking.

What is lung cancer?

You may get lung cancer if cells in your lungs grow in an uncontrolled way. The cells usually form a lump (tumour).

Your lungs move oxygen from the air you breathe into your blood and remove carbon dioxide as you breathe out. They’re made up of lots of air tubes (called bronchioles) and air sacs (called alveoli).

You have different types of cell in the different parts of your lungs. This means you can get different types of lung cancer.

When a tumour starts in your lung, this is called primary lung cancer. Sometimes cancer spreads to your lungs through your bloodstream or immune system from another part of your body, such as your kidney, breast or prostate. This is called secondary lung cancer.

Types of lung cancer

The two main types of cancer that start in the lung are 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 every 10 primary lung cancers are NSCLC. The three main types of NSCLC are all different, but doctors tend to group them together because they’re treated in a similar way.

• Adenocarcinoma mainly affects the outer part of your lungs. Around four in every 10 people with NSCLC has adenocarcinoma. This can be related to smoking and exposure to asbestos.But it’s also the type of lung cancer you’re most likely to get if you don’t smoke.
• Squamous cell carcinoma affects your main airways (your bronchi), usually near the centre of your lungs. Around three in every 10 people with NSCLC will have this type of lung cancer.
• Large cell carcinoma can appear in any part of your lungs. It affects less than one in every 10 people with NSCLC.

Small cell lung cancer

Between one and two in 10 people with lung cancer has SCLC. SCLC can occur quickly and spread to other parts of your body early on, often before it’s been diagnosed. This makes SCLC particularly difficult to treat. SCLC is almost always caused by smoking.

Symptoms of lung cancer

Many people with lung cancer have no symptoms at first. Or sometimes the early symptoms can be very general, such as a cough or feeling a bit out of breath. You may think these symptoms are caused by smoking or a much less serious condition, such as asthma. Lung cancer is sometimes only discovered during a routine chest X-ray.

Lung cancer can cause:

• a cough that doesn’t go away or gets worse
• coughing up blood
• shortness of breath
• pain in your chest
• regular chest infections
• losing weight for no reason
• feeling very tired
• losing your appetite

If you’re coughing up blood, have a persistent cough or are short of breath, see your doctor as soon as possible, especially if you’re over 40. If you’ve had any of the other symptoms for longer than three weeks, contact your doctor surgery for advice.

Other symptoms of lung cancer include:

• losing your appetite
• swelling of your face or neck
• a hoarse voice
• broadening or thickening of the tips of your fingers (called clubbing)

If you have any of these symptoms, see your doctor as soon as possible.

Diagnosis of lung cancer

Seeing your doctor

Your doctor will ask you about your symptoms and medical history and whether or not you smoke. They may ask you to wait and see if your symptoms get better on their own, especially if you’re younger and have never smoked. This is most likely if your cough started when you had a cold or flu and you have no other symptoms.

Your doctor will refer you for a chest if they think your symptoms could be caused by lung cancer. You may have an urgent referral if you’re over 40 or if you smoke or have done in the past.

Referral to a specialist

If your chest X-ray shows signs of lung cancer, your doctor will refer you to a doctor who specialises in chest disease. If your doctor is particularly worried about your symptoms, they may refer you even if your X-ray seems normal or before you have any X-rays.

The specialist will ask you to have various tests to confirm whether or not you have lung cancer. If you do have cancer, the tests can show which type of cancer you have, how advanced it is and if it’s spread. This is called

These tests may include the following.

• A  of your chest and tummy. This uses X-rays to make three-dimensional (3D) images of part of your body. This is usually the first test you’ll have after a chest X-ray.
• A PET-CT (positron emission tomography) scan. You may be offered this special form of CT scan if you have early-stage cancer. It helps doctors to see where your cancer is and if the cancer has spread.
• A  . This test lets your doctor look inside your lungs and take a sample of tissue (a biopsy). A bronchoscope is a narrow, tube-like telescopic camera. You’ll be given an anaesthetic spray and some medicine to make you sleepy before the doctor passes the bronchoscope down your windpipe into your lungs.

A needle biopsy through the skin of your chest wall. This is called a percutaneous transthoracic needle biopsy. It may be the best way to reach your cancer to do a biopsy if your cancer is in the outer part of your lung. Your doctor will numb your skin then insert a fine needle through it. They may use an  or CT scan to guide the needle into the right place.

Treatment of lung cancer

How your lung cancer is treated depends on which type of cancer you have, how far it’s spread and your general health. Lung cancer can be difficult to cure because it may have already spread by the time you’re diagnosed.

• Non-small cell lung cancer (NSCLC) that’s at an early stage and hasn’t spread is usually treated with surgery first. This may cure some types of NSCLC. Surgery may be followed by chemotherapy.Sometimes radiotherapy combined with chemotherapy, or radiotherapy alone, may be given as an alternative to surgery to cure the cancer. If the cancer has already spread, you may be offered treatments such as chemotherapy or immunotherapy first.
• Small cell lung cancer (SCLC) is usually treated with chemotherapy rather than surgery. This is because the cancer has often spread by the time it’s diagnosed. Chemotherapy for SCLC is sometimes combined with radiotherapy.

Your doctor will discuss all of your treatment options with you. They’ll also advise you to stop smoking, as this will help to reduce the side-effects of your treatment. Stopping smoking may also mean your cancer is less likely to come back after treatment.

If it isn’t possible to cure your cancer, your treatment will aim to extend your life and improve your quality of life as much as possible. This is called palliative care.

Surgery

Your surgeon may remove a small section, part of a lung or a whole lung, depending on the size, type and position of your cancer. Whether or not you’re offered surgery also depends on how healthy your lungs are to start with.

If you’re going to have surgery, stopping smoking before your operation 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 your operation.

Non-surgical treatments

Radiotherapy uses radiation to destroy cancer cells. Your doctor will target a beam of radiation onto the area of your lung with the cancer to shrink the tumour. You may have radiotherapy if you have NSCLC but you aren’t well enough for surgery. You may also have radiotherapy with chemotherapy, especially if you have SCLC.

Chemotherapy uses medicines to destroy cancer cells. 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’re also called biological therapies and usually come in the form of tablets.You may be offered targeted therapy if you have a particular type of NSCLC.

Immunotherapy is a newer type of cancer treatment, which helps your immune system to attack cancer cells.A number of immunotherapy drugs are now available to treat advanced NSCLC.

All lung cancer treatments can help to manage your cancer, but they can also cause side-effects. Your doctors and nurses will give you information about the treatments. This will help you decide which treatment is right for you and what to expect. Everyone is different and the effects of the treatments vary from person to person.

Causes of lung cancer

Smoking is the biggest cause of lung cancer, causing around nine in every 10 cases.Your risk of lung cancer is related to how much you smoke, how long you’ve been smoking and when you started smoking. It also depends on which type of cigarettes you smoke. Smoking unfiltered cigarettes and high-nicotine cigarettes increases your chances of getting lung cancer. Passive or second-hand smoking (breathing in other people’s smoke) is also linked to the disease.

You may also be more likely to get lung cancer if you:

• are exposed to asbestos
• are exposed to high levels of radon gas – a naturally occurring radioactive gas
• have had lung disease, such as tuberculosis (TB) or chronic obstructive pulmonary disease(COPD), in the past

Prevention of lung cancer

The most important thing you can do to reduce your chances of getting lung cancer is to stop smoking. Speak to your doctor about the best ways to give up smoking. Using nicotine replacement therapy (such as gums or patches) or e-cigarettes may help you quit.

Try to avoid second-hand smoke – keep away from enclosed spaces where other people are smoking. Try to avoid exposing yourself to anything at work that could increase your risk of lung cancer, such as asbestos or radiation.

There’s some evidence that eating fruits and vegetables can help to lower your chances of getting lung cancer if you’ve never smoked. So try to eat a balanced diet with at least five portions of fruit and vegetables every day.Taking dietary supplements doesn’t seem to make you less likely to get lung cancer and may even be harmful.

Being more physically active may help to reduce your chance of getting several cancers.

Living with lung cancer

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is getting enough support to deal with the emotional aspects as well as the physical symptoms.

Your doctors and nurses will help to support you through your treatment. They can prescribe medicines and offer practical advice to deal with any symptoms you may have such as pain, exhaustion, breathlessness, coughing, anxiety and depression.

Your hospital should also offer a range of helpful services, including dietitians, counsellors, complementary therapists and benefits advisers. Lots of therapies can be useful, including art, music, drama and relaxation.Voluntary groups and patient organisations, such as Macmillan nurses and Marie Curie nursing and day centres, are also available.

It’s important to share your feelings and talk about any worries you have. Your specialist cancer doctors and nurses are experts in providing the support you need. You should have a key worker assigned to you as soon as you’ve been diagnosed.

If you can, take a friend or relative with you to your hospital appointments.Make sure you understand the pros and cons of every treatment and that you’re in charge of making your own decisions. Don’t rush into making a decision until you’re sure about it.

Encourage your family and close friends to get support and talk about their feelings too. Caring for someone with cancer can be very stressful.

If you have more advanced cancer, you can get support through hospices or at home. Your doctor will discuss this with you.