Lung Cancer

Finding out you have lung cancer can be scary and overwhelming. We want you to know that you are not alone, and that there are resources to help you cope and learn about your disease.

Lung cancer is a type of cancer that starts in your lungs and can spread to other parts of your body.

What is lung cancer?
What are the causes of lung cancer?
What are the signs and symptoms of lung cancer?
What are the possible tests to diagnose lung cancer?
What are the possible treatments for lung cancer?
What is the future plan if you have lung cancer?

What is lung cancer?

Lung cancer is a type of cancer that starts in the lungs, in the bronchi (airways) or in the outer tissue of the lungs. There are two main types of lung cancer based on the appearance of the tumour cells under a microscope:

Non-small cell lung cancer (NSCLC) and
Small-cell lung cancer (SCLC).

Different types of lung cancer can grow and spread in different ways. Knowing the type of lung cancer is important for management and treatment.

Non-Small Cell Lung Cancer (NSCLC)

Around 85% of lung cancer cases are NSCLC. There three main types of NSCLC:

Adenocarcinoma – the most common type of NSCLC, making up almost half of cases, with many sub types
Squamous cell carcinoma – typically starts in the central airways (central bronchi) and makes up approximately 30% of lung cancer cases
Large-cell carcinomas (also known as undifferentiated carcinoma) – this is a sub type of NSCLC that cannot be easily categorised as either adenocarcinoma or squamous cell carcinoma.

Small Cell Lung Cancer (SCLC)

Approximately 10-15% of lung cancers are SCLC. These cancers are the most aggressive form of lung cancer and usually affect smokers. SCLC spreads rapidly, often before people notice symptoms. The cancer usually starts in the central airways of the lungs (bronchi).

Other types of cancer

Other types of cancer that occur in the lungs are much less common. Depending on the exact diagnosis, they may be much less aggressive than NSCLC or SCLC. These cancers may include:

Bronchial carcinoid tumours – not related to smoking, may be more common in younger people, and may have slow rates of growth and spread
Other rare cancers – involve smooth muscle, blood vessels, or cells involved in immunity and are uncommon.

What are the causes of lung cancer?

Smoking is the main cause of lung cancer. Smoking likely causes around 85% of all lung cancer cases. Second-hand smoke exposure is also a recognised cause of lung cancer.

In fact, one in three women and one in ten men who get lung cancer have never smoked. People who work with cancer-causing agents in their workplace (such as asbestos, arsenic, chromium, silica, radon or nickel) also have an increased risk of lung cancer, particularly if they have underlying lung damage.

Other factors which can increase your chance of developing lung cancer include:

Chronic obstructive pulmonary disease (COPD)
Family history of lung cancer
Previous chest-based radiation therapy to treat cancer
Previously diagnosed lung cancer, or cancer of the neck or head.

Tumours in the lung may also be due to cancer which has spread from another part of the body such as the breast, bowel or prostate. These are called secondary lung cancers or metastases.

If you or someone you know has lung cancer, you are not alone. Lung cancer is a common form of cancer. There are treatment options and resources to help you navigate every stage of your journey.

What are the signs and symptoms of lung cancer?

Early stages of lung cancer may show no symptoms. Common symptoms that do show can include:

A chronic cough that sounds hoarse, with the presence of blood-streaked mucus
Chest pain that doesn’t go away
Chronic respiratory infections (such as bronchitis or pneumonia)
Difficulty breathing and shortness of breath (that gets worse over time)
Difficulty swallowing
Fatigue or weakness
Pain and weakness in the shoulder, arm, or hand
Swelling of the neck and face
Temperatures and severe headaches
Weight loss, or loss of appetite
Wheezing.

However, these symptoms may have other causes so it’s important to see your doctor for a proper diagnosis.

What are the possible tests to diagnose lung cancer?

Understanding the many tests and treatments needed to diagnose lung cancer can be confusing and scary. Your doctor and medical team will explain what happens in each test and why you may need it. To diagnose or check for lung cancer, common tests include:

Biopsy – cells are removed from your lungs and checked for abnormalities under a microscope in one of several ways:
- Needle biopsy – this can be done through the skin, with local anaesthetic
- Via bronchoscopy – a tube is passed through the throat into the lungs under sedation
- Surgical biopsy – under general anaesthetic a surgeon removes tissue from your lungs via a small incision (cut) in your chest
Blood test – which will test levels of certain hormones or substances such as calcium
Chest X-ray – if symptoms are present, lung cancer tumours are usually visible on an X-ray
CT (computed tomography) – a powerful X-ray which may also be done for a more detailed exam of the chest and abdomen; it can also provide information on whether the tumour has spread to other organs
PET (positron emission tomography) – uses radiation to highlight cancer cells
Physical examination – and a complete medical history
Sputum cytology – a sample of your sputum (mucus) is tested for abnormal cells, but this is rarely done as it is often less accurate than other types of biopsies.

What are the possible treatments for lung cancer?

Depending on the type and stage of cancer, treatments can include:

Chemotherapy – is used after surgery, in combination with radiotherapy, or as a single treatment in the later stages of lung cancer
Quitting smoking – if you find it very difficult to stop smoking even after lung cancer has been diagnosed, it is very important that you receive help for this as it can improve your response to treatment and even survival; your medical team will help you with this
Radiation therapy – can be used as the main therapy or in combination with other therapies
Stereotactic radiosurgery/ radiofrequency ablation – a type of radiotherapy used to target early stage lung cancer in patients who may not be well enough for surgery
Supportive and palliative care (care that reduces pain and symptoms) – should be considered in patients with the later stages of disease as it can improve quality of live and even survival
Surgery – involves an operation to remove the tumour, surrounding lung tissue and often lymph nodes
Targeted therapy and immunotherapy – these are newer types of medications that may be used instead of, or after, chemotherapy.

What is the future plan if you have lung cancer?

When your doctor has diagnosed your lung cancer, you will be given the most suitable treatment plan for your stage. Your journey with lung cancer will be different to everyone else’s. It’s important to take the time to learn about your condition, treatments and future plan – so you can make the best possible decisions for your care.

Your medical team will be there to support you every step of the way, and talking about your lung cancer openly and honestly will help you to understand and plan for the future. Ensuring you have good support from your friends and family, as well as support groups can be very beneficial for your emotional wellbeing, as well as management and treatment outcomes.

Stigma

One of the difficulties faced by lung cancer patients, whether smokers or not, is stigma. Many people with lung cancer feel as if they are being blamed for their disease, even if this is not fair.

A recent report by Lung Foundation Australia 2018 found that many Australians, even lung cancer patients themselves, have a lack of sympathy for those with lung cancer because of the association with tobacco smoking.

At St Vincent’s Hospital, we work hard to overcome this stigma and to provide patients with the help and treatment they need – fairly, without judgement.