Lung Cancer

Symptoms

There are usually no signs or symptoms of lung cancer in the early stages. Symptoms develop as the condition progresses.

The main symptoms of lung cancer include:

• a cough that does not go away after 3 weeks
• a long-standing cough that gets worse
• chest infections that keep coming back
• coughing up blood
• an ache or pain when breathing or coughing
• persistent breathlessness
• persistent tiredness or lack of energy
• loss of appetite or unexplained weight loss

Less common symptoms of lung cancer include:

• changes in the appearance of your fingers, such as becoming more curved or their ends becoming larger (this is known as finger clubbing)
• difficulty swallowing (dysphagia) or pain when swallowing
• wheezing
• a hoarse voice
• swelling of your face or neck
• persistent chest or shoulder pain

See a GP if you have any of the main symptoms of lung cancer or any of the less common symptoms.

Causes

Most cases of lung cancer are caused by smoking, although people who have never smoked can also develop the condition.

Smoking

Smoking cigarettes is the single biggest risk factor for lung cancer. It's responsible for more than 7 out of 10 cases.

Tobacco smoke contains more than 60 different toxic substances, which are known to be carcinogenic (cancer-producing).

If you smoke more than 25 cigarettes a day, you are 25 times more likely to get lung cancer than someone who does not smoke.

Frequent exposure to other people’s tobacco smoke (passive smoking) can also increase your risk of developing lung cancer.

While smoking cigarettes is the biggest risk factor, using other types of tobacco products can also increase your risk of developing lung cancer and other types of cancer, such as oesophageal cancer and mouth cancer.

Occupational exposure and pollution

Exposure to certain chemicals and substances which are used in several occupations and industries may increase your risk of developing lung cancer. These chemicals and substances include:

• arsenic
• asbestos
• beryllium
• cadmium
• coal and coke fumes
• silica
• nickel

Research has also found that frequently being exposed to diesel fumes over many years increases your risk of developing lung cancer.

Diagnosis

See a GP if you have symptoms of lung cancer, such as breathlessness or a persistent cough.

The GP will ask about your general health and your symptoms. They may examine you and ask you to breathe into a device called a spirometer, which measures how much air you breathe in and out.

You may be asked to have a blood test to rule out some of the possible causes of your symptoms, such as a chest infection.

Chest X-ray

A chest X-ray is usually the first test used to diagnose lung cancer. Most lung tumours appear on X-rays as a white-grey mass.

However, chest X-rays cannot give a definitive diagnosis because they often cannot distinguish between cancer and other conditions, such as a lung abscess (a collection of pus that forms in the lungs).

If a chest X-ray suggests you may have lung cancer, you should be referred to a specialist in chest conditions.

A specialist can arrange more tests to investigate whether you have lung cancer and, if you do, what type it is and how much it's spread.

CT (computed tomography) Scan

A CT scan is usually the next test you'll have after a chest X-ray. A CT scan uses X-rays and a computer to create detailed images of the inside of your body.

PET-CT (Positron Emission Tomography-Computerised Tomography) Scan

You may have a PET-CT scan may be done if the results of a CT scan show you have cancer.

The PET-CT scan (which stands for positron emission tomography-computerised tomography) can show where there are active cancer cells. This can help with diagnosis and choosing the best treatment.

Bronchoscopy and biopsy

If a CT scan shows there might be cancer in the central part of your chest, you may be offered a bronchoscopy.

A bronchoscopy is a procedure that allows a doctor to see the inside of your airways and remove a small sample of cells (biopsy).

During a bronchoscopy, a thin tube with a camera at the end, called a bronchoscope, is passed through your mouth or nose, down your throat and into your airways.​

Other types of biopsy

You may be offered a different type of biopsy. This may be a type of surgical biopsy, such as a thoracoscopy, a mediastinoscopy, or a biopsy done using a needle inserted through your skin (percutaneous).

Risks of biopsies

Like all medical procedures, a lung biopsy carries a small risk of complications, such as a pneumothorax. This is when air leaks out of the lung and into the space between your lungs and the chest wall.

This can put pressure on the lung, causing it to collapse.

The clinician doing the biopsy will be aware of the potential risks involved. They should explain all the risks in detail before you agree to have the procedure. They will monitor you to check for symptoms of a pneumothorax, such as sudden shortness of breath.

If a pneumothorax does happen, it can be treated using a needle or tube to remove the excess air, allowing the lung to expand normally again.

Treatment Options

Treatment depends on the type of mutation the cancer has, how far it's spread and how good your general health is.

If the condition is diagnosed early and the cancerous cells are confined to a small area, surgery to remove the affected area of lung may be recommended.

If surgery is unsuitable due to your general health, radiotherapy to destroy the cancerous cells may be recommended instead.

If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy is usually used.

There are also a number of medicines known as targeted therapies. They target a specific change in or around the cancer cells that is helping them to grow. Targeted therapies cannot cure lung cancer but they can slow its spread.

Prevention Tips

Stop smoking

If you smoke, the best way to prevent lung cancer and other serious conditions is to stop smoking as soon as possible.

However long you have been smoking, it's always worth quitting. Every year you do not smoke decreases your risk of getting serious illnesses, such as lung cancer.

After 12 years of not smoking, your chance of developing lung cancer falls to more than half that of someone who smokes. After 15 years, your chances of getting lung cancer are almost the same as someone who has never smoked.

A GP or pharmacist can also give you advice about stopping smoking.

A balanced diet

Research suggests that eating a low-fat, high-fibre diet, including at least 5 portions a day of fresh fruit and vegetables and plenty of wholegrains, can reduce your risk of lung cancer, as well as other types of cancer and heart disease.

Exercise

There's some evidence to show that regular exercise may lower the risk of getting lung cancer, particularly in people who smoke or used to smoke.

If you have lung cancer, being physically active may help reduce symptoms like tiredness, anxiety and depression.

It's recommended that most adults do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity each week, plus strength-training exercises on at least 2 days each week.

When To See A Doctor

See a GP if you have any of the main symptoms of lung cancer or any of the less common symptoms.