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What is lung cancer

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What is lung cancer – information and facts from our consultants

Lung cancer can be explained as uncontrolled cell growth in the lungs. It is the second most common cancer in the UK and over 41,000 people are diagnosed each year. Lung cancer is one of the most difficult cancers to treat and there are few symptoms of lung cancer in the early stages of the disease. Survival rates for the disease are poor when it is not detected early and, at present, there is no national screening programme for the disease in the UK.

Lung cancer symptoms

Lung cancer presents very few symptoms in the early stages of the illness. Symptoms that do develop can also be caused by other illnesses so having one or more of the lung cancer symptoms listed below doesn’t necessarily mean you have lung cancer. It is however essential to have symptoms checked by your GP or, if you are concerned, you can book a LungCheck where one of our specialists will carry out a risk assessment and a blood test.

Symptoms of lung cancer can include:

  • Persistent cough or a change in a long standing cough
  • A loss of appetite and associated weight loss
  • Shortness of breath
  • Pain when breathing or coughing
  • Coughing up phlegm with blood in it
  • Fatigue/tiredness and lethargy
  • Difficulty swallowing
  • A hoarse voice

Types of lung cancer

Lung cancer is normally categorised into two main groups:

Small cell lung cancer
Small cell lung cancer accounts for about 12% of lung cancers. It can also be known as oat cell cancer due to the size and shape of the cancer cells and is usually caused by smoking. People who have never smoked are unlikely to develop this type of lung cancer. Small cell lung cancer is the more aggressive of the lung cancer groups and it usually spreads faster than non small cell cancer

Non small cell lung cancer
Non small cell lung cancer accounts for around 88% of all lung cancers and can be further broken down into three common types:

  • Squamous cell carcinoma
  • Adenocarcinoma of the lung
  • Large cell carcinoma

Squamous cell carcinoma
This is the most common type of lung cancer. It is often caused by smoking and most commonly detected in the centre of the lung in one of the main airways. Cases of this type of lung cancer are decreasing in the UK due to the decline in smoking.

Adenocarcinoma of the lung
The number of people developing this type of lung cancer is increasing. Like squamous cell carcinoma, adenocarcinoma develops in the cells that line the airways but in a different type of cell that is responsible for the production of phlegm or mucus. It is most often detected in the outer area of the lung.

Large cell carcinoma
This is often found in the central part of the lung and is common in smokers. It is a very aggressive form of cancer and often spreads quickly to nearby lymph nodes and the chest wall as well as more distant organs.

Causes of lung cancer

Smoking
The biggest cause of lung cancer is smoking and is the cause of 80-90% of all cases. This doesn’t just include cigarette smoking, it applies equally to cigars, pipe tobacco, snuff, chewing tobacco and cannabis.

Passive smoking
Over recent years it has become apparent through research that passive smoking can also increase the risk of developing lung cancer and there is evidence that living with a smoker can increase the risk by up to 25%

Occupational exposure
There are some occupations that involve exposure to carcinogenic (cancer causing) materials that can increase the risk of lung cancer. These may include:

  • Asbestos
  • Nickel
  • Coke and coal fumes
  • Silicon
  • Arsenic
  • Beryllium
  • Uranium
  • Chromium

Radon
Radon is a naturally occurring radioactive gas found in some parts of the UK in high concentrations. The gas can pass through soil into the foundations of houses thus exposing occupants. It is estimated that radon gas is responsible for up to 9% of lung cancers in European countries.

Age
Oxidative stress and DNA damage that naturally occur in older age mean that cells are more likely to mutate into cancer cells. Lung cancer is more common in older people with most people being diagnosed over the age of 60 and it is uncommon to be diagnosed with the condition under the age of 40.

Genetic predisposition
There is a small risk if a close relative has had lung cancer and that risk is slightly greater if the relative was a non-smoker or developed the disease at an early age. There is also a greater risk if there is more than one relative with lung cancer on the same side of the family.

Lung cancer diagnosis

If you present with symptoms of lung cancer to your GP, the first stage of diagnosis after the GP has examined you and taken your history is usually to send you for an X-Ray. They may also give you a blood test and take samples of phlegm to examine for cancer cells.

Other diagnostic methods that may be undertaken include:

Bronchoscopy
Where a narrow tube with a camera is passed into the airways to look for signs of abnormalities

CT Scan
This takes X-Rays through sections of the body using a dye to identify where the cancer may be

PET-CT Scan
This takes detailed pictures of the structure of the body and, by use of a radioactive drug that is given to the patient, it is possible to see where the cancer cells are.

Biopsy
A biopsy extracts cells from the lung so that they can be examined for cancer in the laboratory. There are two types of biopsy that can be done and the type undertaken will depend on how difficult it is to get to the area of the lung that is of interest.

A biopsy through the skin is where samples of cells from the suspected lung tumour are taken via a needle passed through the skin.

A surgical biopsy is carried out if the cells are difficult to get to and requires a general anaesthetic to give surgeons access to the lung.

Lung cancer treatment

Treatment of lung cancer will depend on many factors including:

  • The type of lung cancer
  • The stage of cancer (i.e. how far has it progressed – see our page on lung cancer stages)
  • Where the cancer is in the lung
  • The general health of the patient

Small cell lung cancer treatment
This type of lung cancer is most often treated with chemotherapy and radiotherapy. Radiotherapy may also be advised for the brain as this type of lung cancer commonly spreads to this organ. This is known as prophylactic cranial irradiation.

If small cell lung cancer is detected in the early stages and hasn’t spread to lymph nodes in the chest then it may be possible to have surgery to remove the tumour.

Non small cell lung cancer treatment

If this disease is caught in the very early stages then surgery may be possible to remove the tumour and, depending on the stage, follow up chemotherapy may be used to reduce the risk or recurrence. Radiotherapy can also be used after surgery if all of the tumour could not be removed completely.

At later stages of this type of lung cancer whole lung removal may be possible depending on where the cancer is or, as an alternative if surgery is not possible, radiotherapy may be advised.

If there are indications that the cancer has spread to the lymph nodes on the same side of the chest as the lung cancer then chemotherapy may be advised before or after surgery (depending on when the cancer in the lymph nodes was detected)

If cancer is found in the lymph nodes on the opposite side of the chest to the lung cancer then surgery is not an option and chemotherapy and radiotherapy may be used.

At very late stages of this disease treatment can only be given to reduce symptoms and improve survival times to help people live comfortably for as long as possible.

Lung cancer prevention

There are things everyone can do to try and reduce the risk of getting lung cancer including:

Give up smoking
The biggest cause of lung cancer is smoking so the best prevention is not to smoke or give up smoking if you do. People who give up smoking have a risk similar to non-smokers after about 15 years.

Avoid passive smoking
Whilst the risk is small of developing lung cancer from passive smoking, it is a risk and so passive smoking should be avoided. Recent legislation is making this easier.

Know about Radon
Radon poses a small risk but if you live in an area with high levels (you can find out at http://www.ukradon.org/ -please make this a no follow)contact your local Health Protection Agency who can measure levels in your house and advise you on reducing levels if they are high.

Prevent exposure at work
If you work in an environment where you are exposed to carcinogenic materials you should ensure you have all the legally required safety equipment e.g. respirators, protective clothing and that all legally required health and safety regulations are being adhered to. You may also want to undertake regular screening which may in some cases be provided by your employer.

If you work with asbestos, it is particularly important that you stop smoking as asbestos and tobacco increase the risk of lung cancer even further.

Lifestyle
Exercise is believed to reduce lung cancer risk along with a diet rich in fresh fruit and vegetables.

Concerned about lung cancer?

If you are concerned about lung cancer, think you may be at risk or have worrying symptoms, please contact your GP or contact us to arrange for a LungCheck where you will undergo a full lung cancer risk assessment based on age and smoking history as well as a blood test that is more accurate than a CT scan and seven times more likely to correctly identify lung cancer.

LungCheck
If you want fast, accurate screening for lung cancer
OneStop Clinic
If you require further tests due to your LungCheck results indicating you are at a high risk
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