- 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 can spread to the lungs from a cancer somewhere else in the body (secondary cancer/metastasis).
Lung cancer is the fifth most common cancer in Australia. It is diagnosed more often in older people and it is much more common in smokers, although non-smokers can get lung cancer too.
Lung cancers are 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 other 15% of lung cancers, and usually start in the middle part of the lungs. They tend to spread more quickly than NSCLCs.
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
- chest or shoulder pain
- a chest infection which does not go away, or keeps coming back
- coughing or spitting up blood
Other symptoms may include:
Having some of these symptoms does not mean that you necessarily have lung cancer. Many of these symptoms can happen with other medical problems or as a result of 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.
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When should I see my doctor?
You should see your doctor immediately 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 current smoker.
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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:
Older age — Living longer means your body’s cells may have undergone more mutations and 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.
Exposures — 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).
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, medical history and your family history and perform a physical examination. They may then refer you for blood tests 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 also have tests to determine how well your lungs are functioning (spirometry).
If your doctor is concerned about any findings on these tests, they may refer you to a specialist doctor for more tests. These can include more sensitive scans such as positron emission tomography (PET) scans or procedures such as bronchoscopy. A bronchoscopy is performed by a specialist doctor, usually as a day procedure under sedation or a light general anaesthetic, and involves looking into your trachea (windpipe) and the large airways of your lungs for abnormalities.
A sample of lung cells (biopsy) can be taken during a bronchoscopy, so it can be checked for signs of cancer. If your doctor does not recommend a bronchoscopy, you may need to have a surgical procedure to obtain a biopsy. 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 all of 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.
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How is lung cancer treated?
Lung cancer can be treated with many different treatments. The type of treatment your medical team recommends will depend on many factors including the type of cancer, its stage, your general health and the goal of treatment. The treatment chosen will also depend on whether the cancer is started in the lung (primary) or spread from another part of your body (metastasis). In the case of a metastasis to the lung, the treatment usually be chosen based on the location of the primary cancer.
Types of cancer treatments can include:
Surgery to cut out the cancer. This includes lobectomy where one lobe of a lung is removed, 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 stop them dividing or spreading.
Chemotherapy, which uses strong medicines to kill cancer cells.
Targeted therapy, which uses medicine which attack specific features of a cancer, such as 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 individual 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.
You and your medical team may together create a cancer treatment plan that summarises the goals of your cancer treatment and details your planned treatments.
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, cough or chest pain because of how the cancer affects the lung’s function. As it advances, lung cancer may also cause other complications. These can include fluid build-up in the space around of your lung (pleural effusion). Your appetite may be affected and you may lose weight. You may feel very fatigued or have difficulty sleeping.
You may also experience these symptoms (and others) as a side effect of the treatments used to treat the cancer.
Your medical team has a lot of experience in treating these symptoms and complications 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 will succeed in spreading to another part of your body (metastasis). If this happens, you and your medical team may adjust your cancer treatment plan.
Other questions you might have
Does a bronchoscopy hurt?
Most patients are given sedation or a light general anaesthetic before having a bronchoscopy. This means you will be asleep during the procedure itself and you will not feel it. You may have a sore throat or cough up some blood after the procedure, but most people recover quickly.
Are biopsies accurate?
Few tests are 100% accurate. Biopsies are collected and analysed by experienced specialist technicians and doctors and are usually very accurate. If you are concerned, you may wish to discuss your concerns with your doctor or seek a second opinion from another specialist.
How quickly does lung cancer spread?
How quickly cancer spreads depends on a few factors. In general, lung cancer spreads quite quickly, and small cell lung cancers tend to spread more quickly than non-small cell lung cancers.
What's the prognosis?
Your prognosis will depend on how advanced your cancer was at diagnosis (staging), the effectiveness of your cancer treatment, and your general health. Your doctor can discuss realistic expectations for your prognosis in your situation.
Can I still get lung cancer if I have never smoked?
Yes, you can still get lung cancer if you have never smoked, although your risk of developing lung cancer is much lower than someone with a history of smoking.
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 for information about cancer and cancer treatment.
- Cancer Australia for information about cancer and cancer treatment.
- Lung Foundation for information and support.
- Peter MacCallum Cancer Centre for cancer information and support services.
- Carers Australia for information and support for carers.
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Last reviewed: July 2021