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Key facts
- Lung cancer affects the cells of the airways and lungs.
- Symptoms and signs might include breathlessness, persistent cough (with or without blood), chest pain and frequent chest infections.
- It is most common in older people and people who smoke.
- Lung cancer can be treated in several different ways including surgery, radiotherapy, chemotherapy and specialised medications.
- The expected outcome (prognosis) of lung cancer will depend on its type, its stage and how well it responds to treatment.
What is lung cancer?
Lung cancer occurs when cells in the lungs grow in an uncontrolled way. The cancer may start to grow in the lungs first (primary cancer) or may spread to the lungs from a cancer somewhere else in the body (secondary cancer/metastasis).
Lung cancer is the 5th most common cancer in Australia and, in general, it spreads quite quickly. This cancer is diagnosed more often in older people, and it is much more common in smokers — although non-smokers can get it too.
Lung cancer is generally divided into two main types:
- Non-small cell lung cancer (NSCLC) makes up about 85% of lung cancers.
- Small cell lung cancer makes up the remaining 15% of lung cancers. Small cell lung cancer usually starts in the middle part of the lungs and tends to spread more quickly than NSCLC.
What are the symptoms of lung cancer?
Common symptoms of lung cancer include:
- a persistent, new cough (lasts more than three weeks)
- a change in a cough you’ve had for a long time
- breathlessness
- chest or shoulder pain
- a chest infection that does not go away or keeps coming back
- coughing or spitting up blood
Other symptoms may include:
- fatigue
- unintentional weight loss
- difficulty swallowing
- hoarse voice
Having some of these symptoms does not mean that you necessarily have lung cancer. Many of these symptoms can happen because of other medical problems or smoking. However, if you notice one or more of these symptoms for more than a couple of weeks, you should see your doctor to discuss them.
What causes lung cancer?
Cancers are usually caused by genetic changes (mutations) in your body’s cells.
There are many factors that increase your risk of developing cancer, including the following:
- Older age — living longer means your body’s cells may have undergone more mutations, which means you may be more likely to develop cancer than younger people.
- Smoking— smoking damages the cells in your lungs and increases the chance of them undergoing mutations. Smoking is a major risk factor for developing lung cancer. Passive smoking (exposure to second-hand smoke in your environment) also increases your risk of developing lung cancer.
- Family history —some genetic mutations that may cause cancer can be passed from parent to child. If you have a family history of lung cancer, you may be at a higher risk of developing lung cancer yourself.
- Exposure to certain elements — significant exposure to substances such as asbestos, radon and some heavy metals may increase your risk of developing lung cancer.
- Lung diseases— you may have a higher chance of developing lung cancer if you already have a lung disease such as pulmonary fibrosis, pulmonary tuberculosis or chronic obstructive pulmonary disease (COPD).
When should I see my doctor?
You should see your doctor right away if you have new symptoms that concern you, especially those listed above. This is particularly important if you have risk factors for lung cancer such as a history of lung disease, a family history of lung cancer or you are a smoker.
How is lung cancer diagnosed?
Lung cancer is diagnosed with a range of tests and scans. When you visit your doctor, they may ask you questions about your general health and medical and family history. They may also perform a physical examination. They may then refer you for blood tests and/or scans.
You may have blood tests to find out your general state of health and how well your kidneys and liver are functioning. You may have scans, such as x-rays and computerised tomography (CT) scans, to look inside your body for signs of cancer. You may also have tests to determine how well your lungs are functioning (spirometry).
If your doctor is concerned about any findings that these tests show, they may refer you to a specialist doctor for more tests. These can include more scans, such as positron emission tomography (PET) scans, or procedures such as a bronchoscopy. A bronchoscopy involves looking into your trachea (windpipe) and the large airways of your lungs for abnormalities. It is performed by a specialist doctor, usually as a day procedure under sedation or a light general anaesthetic. This means you will be asleep during the procedure and you will not feel it. You may have a sore throat and/or cough up some blood after the procedure, but most people recover quickly.
During a bronchoscopy, a sample of lung cells (biopsy) can be taken to check it for signs of cancer. If your doctor does not recommend a bronchoscopy, you may need to have a surgical procedure to obtain a biopsy. Biopsies are collected and analysed by experienced specialist technicians and doctors and are usually very accurate. If you are concerned about this procedure, you may wish to discuss this with your doctor.
You may also be asked to provide a sample of sputum (phlegm) or have fluid drained from around your lungs to look for cancer cells.
If you are diagnosed with lung cancer, your tests and scans will give your medical team important information about your cancer and help them decide the best way to treat it. This usually involves a process called ‘staging’ where the cancer is categorised based how big it is and how far it has spread.
How is lung cancer treated?
Medical specialists can treat lung cancer in different ways. The type of treatment a medical team recommends for you will depend on several factors including the type of cancer, its stage, your general health and the goal of treatment. The most suitable treatment will also depend on whether the cancer started in your lung (primary) or spread from another part of your body (metastasis). In the case of a metastasis to the lung, the treatment is usually chosen based on the location of the primary cancer.
Types of cancer treatments can include:
- surgery, to cut out the cancer — this includes a lobectomy where one lobe of a lung is removed, a pneumonectomy, where one whole lung is removed, or a wedge resection where only part of a lung is removed
- radiotherapy, which damages cancer cells and stops them dividing or spreading
- chemotherapy, which uses strong medicines to kill cancer cells
- targeted therapy, which uses medicine that attacks specific features of a cancer — for example, certain genetic mutations
- immunotherapy, which helps your immune system see cancer cells and kill them
Your medical team may recommend one or a combination of these treatments, depending on your situation.
Cancer treatment may be given with the aim of removing all signs of cancer (curative). In other cases, the goal may be to relieve symptoms and maximise quality of life (palliative care) without necessarily curing the cancer completely.
The prognosis of lung cancer depends on how advanced it was at diagnosis (staging), the effectiveness of cancer treatment and a person’s general health. Your doctor can discuss realistic expectations for your own prognosis.
Together, you and your medical team can create a cancer treatment plan that contains the goals of your cancer treatment and the steps that these involve.
Can lung cancer be prevented?
You can reduce your risk of developing lung cancer by avoiding known risk factors, such as smoking and asbestos.
Other risk factors, such as age and a family history of lung cancer, cannot be changed.
What are the complications of lung cancer?
Some people with lung cancer will develop symptoms, such as shortness of breath, a cough and/or chest pain, because of how the cancer affects the lung’s function. As it advances, lung cancer may cause other complications. These can include fluid build-up in the space around your lung (pleural effusion). Lung cancer can also affect your appetite and you may lose weight. You may feel very fatigued and/or have difficulty sleeping.
You may also experience these symptoms and others as side effects of lung-cancer treatments.
Your medical team has a lot of experience in treating symptoms and complications of lung cancer and can give you advice and support to manage them.
Even if you are receiving cancer treatment, there is still a chance that your cancer can spread to another part of your body (metastasis). If this happens, you and your medical team may adjust your cancer treatment plan.
