What is lung cancer?

Lung cancer occurs when abnormal 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/metastatic cancer).

Lung cancer is the most common cause of cancer related death in Australia.

If is often diagnosed late, after it has already spread outside the lung, as early lung cancer may not cause significant symptoms. Lung cancer is more common in older people, and it is much more common in smokers, although non-smokers can get it too.

Primary lung cancer is divided into two main types:

• Non-small cell lung cancer (NSCLC) makes up about 85% of lung cancers. This includes adenocarcinoma, squamous cell carcinoma and large cell undifferentiated carcinoma.
• Small cell lung cancer (SCLC) 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 (lasting more than 3 weeks)
• a change in an existing cough
• breathlessness
• chest or shoulder pain
• a chest infection that does not go away (after 3 weeks) or keeps coming back
• coughing or spitting up blood

Other symptoms may include:

• fatigue
• unintentional weight loss
• abdominal pain
• joint pain
• difficulty swallowing
• hoarse voice or wheezing

Having these symptoms does not mean that you necessarily have lung cancer. Many of these symptoms can happen because of other medical problems or smoking. If you notice one or more of these symptoms for more than a few weeks, you should see your doctor.

What causes lung cancer?

Cancers are usually caused by genetic changes (mutations) in your body’s cells that happen during your life.

There are many factors that increase your risk of developing cancer, including the following:

• Older age — lung cancer is usually diagnosed in people over age 60 years.
• Smoking — smoking causes a large number of lung cancers in Australia. The risk increases with the number of years you have smoked in your lifetime and the number of cigarettes you smoked.
• Passive smoking — exposure to second-hand smoke also increases your risk of developing lung cancer.
• Family history — 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 and air pollution — 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).

There isn’t currently any evidence that vaping (using e-cigarettes) causes lung cancer. People who vape are 3 times as likely to start smoking cigarettes, which is the most significant cause of lung cancer in Australia.

When should I see my doctor?

You should see your doctor right away if you have new symptoms that concern you. This is particularly important if you have risk factors for lung cancer such smoking, a history of lung disease or a family history of lung cancer.

How is lung cancer diagnosed?

To diagnose lung cancer, your doctor will ask you questions about your health, medical and family history and carry out a physical examination.

If they are concerned you could have lung cancer, they will refer you for tests. These may include:

• blood tests
• imaging scans such as x-ray and computerised tomography (CT) scan
• lung function tests (spirometry) to assess your lung function and health

If your doctor is concerned about any findings, they may refer you to a specialist doctor for more tests to confirm if you have lung cancer. Your specialist may refer you for a positron emission tomography (PET) scan or a bronchoscopy with or without biopsy.

Biopsy

Your doctor may refer you for a biopsy. This is when your doctor takes a sample of cells from an area of concern and checks them for cancer under a microscope in a laboratory. The laboratory may also carry out special tests on your biopsy sample to check for specific gene changes or proteins in the cancer. This can help guide the recommendations for treatment.

Your doctor may take a biopsy sample using bronchoscopy or a minor surgical procedure such as CT-guided biopsy, depending on your individual circumstances.

Bronchoscopy

A bronchoscopy involves using a flexible tube with a camera at the end to look into your trachea (windpipe) and the large airways of your lungs for abnormalities. A specialist doctor will do your bronchoscopy, usually as a day procedure under sedation or a light general anaesthetic.

Your doctor maty take a biopsy during the bronchoscopy.

After a bronchoscopy you may have a sore throat and/or cough up some blood, but most people recover quickly. If you are concerned about this procedure, you can discuss this with your doctor.

CT-guided lung biopsy

If your doctor does not recommend a bronchoscopy, you may need to have a surgical procedure to obtain a biopsy, known as CT-guided lung biopsy. During this procedure, a CT scan helps a specialist doctor guide a thin needle through the chest wall to collect biopsy sample.

You may also be asked for a sample of sputum (phlegm) or have fluid drained from around your lungs (pleural tap). The cells in these fluids can also be checked for cancer.

Staging lung cancer

If your doctor diagnoses you with lung cancer, all the tests and scans done help your medical team determine the ‘stage’ of your cancer. Knowing how big the cancer is, what type of cancer it is, whether it has spread can help your doctors recommend a treatment plan.

Both NSCLC and SCLC use a staging system that considers the size of the tumour, if it has affected lymph nodes and if it has spread. This is called the tumour–nodes–metastasis (TNM) system. This information may be combined to give the lung cancer an overall stage of between 1 and 4.

• T (tumour) — Relates to the size of the tumour and how far the tumour has grown into the lung.
• N (nodes) — Shows if the tumour has spread to nearby lymph nodes.
• M (metastasis) — States if the tumour has spread to other parts of the body.

How is lung cancer treated?

The type of treatment your medical team recommends for you will depend on several factors including:

• the type of cancer
• its stage
• your general health
• the goal of treatment
• how well your lungs are working
• your preferences

Your doctor’s treatment goal may be to remove all signs of cancer — this is known as curative treatment. Sometimes, the goal may be to slow the cancer spread, relieve symptoms and maximise quality of life (palliative care) without curing the cancer.

Your treatment will also depend on where the cancer started: if lung cancer is your first (primary) cancer, or if it is in your lung after spreading from another part of your body (metastasis). In the case of a metastasis to the lung, the treatment your health team recommends is usually based on the location of the primary cancer.

Types of cancer treatments can include:

• Surgery to cut out the cancer, if the cancer is an early-stage NSCLC. Surgical options include:
  • lobectomy where one lobe of a lung is removed
  • segmentectomy or wedge resection where part of a lung is removed
  • pneumonectomy, where one whole lung is removed.
• Radiotherapy damages cancer cells and stops them dividing or spreading.
• Chemotherapy uses strong medicines to kill cancer cells.
• Targeted therapy uses medicine that attack cells because they have specific features that make them cancerous — for example, certain genetic mutations.
• Immunotherapy uses to medicines that help your immune system find cancer cells and kill them.

Your medical team may recommend one or a combination of these treatments, depending on your situation. Together, you and your team will decide on a cancer treatment plan.

Your medical team can also offer treatments to help you to manage your symptoms (palliative care), for example:

• exercise training and breathing techniques to help with your breathlessness
• insertion of a tube (stent) to open your airway, if cancer is blocking a large airway
• a pleural tap to drain fluid around your lungs
• nutrition advice from a dietitian to aid your recovery

Who provides lung cancer treatment?

Your medical team will include many different health professionals. It may include a GP, a radiologist, an medical and radiation oncologist, a cancer care nurse, a surgeon and allied health professionals such as counsellors and dietitians. Having a multi-disciplinary team means you receive the best care possible.

Sometimes, understanding the role of each health professional in your care team can be confusing. Ask your doctor if a cancer care coordinator is available. A cancer care coordinator is a health professional who coordinates your care, helps you communicate with all the health professionals involved in your treatment, and supports you and your family throughout your cancer experience.

Can lung cancer be prevented?

You can reduce your risk of developing lung cancer by reducing your risk factors, such as by quitting smoking and avoiding second hand smoke exposure.

You will not be able to influence other risk factors, such as your age and any family history of lung cancer.

Complications of lung cancer

Lung cancer can cause complications such as fluid build-up in the space around your lung (pleural effusion).

You may also experience side effects of treatments used to treat your lung cancer.

Learn more about different cancer treatments and their potential side effects.

Resources and support

Receiving a cancer diagnosis affects every area of your life and can feel overwhelming. There are many organisations that can help with information and support, including:

• Cancer Council, which has published the following resources:
  • a factsheet about lung cancer
  • All about cancer for Aboriginal and Torres Strait Islander people, including a PDF about lung cancer
• Free phone appointments with a lung cancer support nurse can be booked through the Lung Foundation. Call 1800 654 301 to book.

Other Languages

For people who speak a language other than English, Cancer Australia has published ‘Getting the best advice and care - a guide for those affected by lung cancer’ in several languages.