If cancer spreads to the lungs, it may cause fluid to collect in the space surrounding the lung (pleural effusion). There are treatments that can help control this.
Doctors often use chemotherapy to treat lung cancer. It’s a combination of medicines that destroy cancer cells. It may also be combined with radiotherapy or immunotherapy.
Lung cancer is a serious disease that causes many deaths each year. It usually affects those who smoke tobacco (cigarettes, cigars or pipes), although non-smokers can get it as well. Exposure to secondhand smoke, workplace hazards (such as asbestos or radon), and hereditary cancer syndromes can also increase a person’s risk for lung cancer.
Symptoms of lung cancer can include coughing up blood or having difficulty breathing, chest pain, wheezing or hoarseness. Some types of cancer can cause these symptoms by affecting the way the lungs work or interfering with the immune system. Other symptoms can occur when the cancer spreads to other parts of the body, which is called metastasis.
If you have these symptoms, talk to your doctor. He or she will ask you questions about your health history and do a physical exam. The doctor may listen to your lungs with a stethoscope and ask about any other symptoms you have.
The type of cancer you have and how far it has spread (the stage) will determine what treatment you receive. Whether you need surgery, radiation or chemotherapy depends on what kind of cancer you have and how big it is.
When lung cancer is small and in the early stages, it does not usually cause symptoms. However, as the tumor grows, it may interfere with the lungs’ normal function and cause problems such as coughing up blood (hemorrhage), shortness of breath or chest pain. It can also damage the lymphatic system, which carries clear fluid that contains immune cells throughout the body in tubes called lymph vessels. Lymph nodes are small, bean-shaped organs that link the lymph vessels. Lung cancer often spreads to the lymph nodes in the area of the chest that is between the lungs.
Some types of lung cancer can spread to the bones, causing pain and swelling. It can also spread to other parts of the body, causing symptoms in the nervous system (paraneoplastic neurologic syndrome) or the endocrine system (paraneoplastic endocrine syndrome). Some people develop these symptoms as a result of another illness or condition before they are diagnosed with lung cancer.
Cancers start in the cells that line our organs, including the lungs. When these cells change and begin growing and dividing when they shouldn’t, they can form masses of tissue, called tumours, which interfere with the normal function of our organs and cause us to feel unwell. The most common type of lung cancer starts in the lining of our airways (lungs) or small air sacs (alveoli). This is known as non-small cell lung cancer (NSCLC). It accounts for about 85% of all cases of lung cancer. Less commonly, cancer can start in other parts of the body and spread to the lungs. This is known as secondary lung cancer.
The main way that doctors diagnose lung cancer is by taking a small sample of the tumour or lymph node and examining it under a microscope. They may also take blood to check for certain types of cancer cells or to see how the tumour is affecting your body’s overall health.
A CT scan is often the first test that a healthcare professional will do if they think you have lung cancer. This is a painless test that makes detailed, cross-sectional images of your body. It can reveal the location and size of a tumour. Other imaging tests include MRI and positron emission tomography, which is often combined with CT to create PET/CT scans.
Doctors can also use a technique called liquid biopsy, which involves drawing some of the fluid from around the tumour and checking it under a microscope for cancer cells. This is becoming more common, particularly in younger people.
If they suspect that you have lung cancer, your healthcare team will ask you questions about your past medical history and do a physical exam. They will also listen to your lungs with a stethoscope and examine your chest for signs of disease.
The next step in diagnosing lung cancer is staging it, which helps the team decide what treatment you might need. Staging is based on the type and size of the tumour, where it is in your lungs, and whether it has spread to other parts of your body.
Your doctor may recommend surgery, radiation therapy or other treatment for lung cancer depending on what type it is and how far it has spread. You will be cared for by a team of health professionals, including specialists in lung cancer, such as medical oncologists and radiation oncologists, and support staff, such as specialist nurses, physiotherapists, social workers and palliative care workers.
Non-small cell lung cancer (NSCLC) begins in the epithelial cells that line your lungs and airways. NSCLC accounts for about 85% of all lung cancer cases. It is often caused by smoking. It is usually divided into several different types, based on where the cancer starts and what the cells look like under a microscope. These include adenocarcinoma, squamous cell carcinoma, large cell carcinoma and mixed small/large cell carcinoma. Some NSCLCs can have a molecular subtype that influences how fast the cancer grows or how well it responds to treatment, such as PD-L1 expression or EGFR mutation status.
Staging is used to find out how far a tumour has grown, if it has spread and what symptoms you have. A surgical operation may be an option if the tumour is at an early stage, but it is only possible in a minority of patients with NSCLC. This is because NSCLC tends to grow quickly and can be hard to remove completely from the lungs.
During surgery, doctors will also remove nearby lymph nodes to see if the cancer has spread to them. Lymph nodes are bean-shaped organs that link up with your lymphatic system and help fight infection. Cancer that has spread to lymph nodes is called metastatic lung cancer.
If you have a metastatic NSCLC, your treatment may be combined with chemotherapy and/or immunotherapy. These are drugs that boost your body’s own immune system to kill any cancer cells it finds in the lungs and other parts of your body. Immunotherapy drugs work by blocking the proteins that stop your immune system from detecting and fighting cancer cells.
If your tumour has not responded to standard treatment, we can use a newer type of medicine called targeted therapy or personalised medicine. This involves giving you a drug that targets the specific genes or proteins that are involved in your cancer, to prevent it from growing.
The prognosis for lung cancer depends on the type of cancer, where it started, and how far it has spread. Almost 20% of all cancers are small-cell lung carcinoma (SCLC). The other 85% are non-small cell carcinoma, which includes squamous cell carcinoma, adenocarcinomas, and large cell carcinomas.
Lung cancer starts when normal cells start to grow and make more copies of themselves when they shouldn’t. They gain changes to their DNA that remove the off switch that keeps cells from growing and causes them to die at a certain time (senescence). When this process goes wrong, cancer cells grow out of control and form tumors. These tumors may grow in the lungs or they may move through lymph vessels that connect to the lungs. They may also get into the blood and then move to other parts of the body, forming metastases.
If a tumor is found at an early stage, it may be possible to cure the disease with surgery and/or radiation therapy. If a tumor has already spread, a combination of chemotherapy drugs can kill cancer cells and slow the growth of new ones.
When a person has lung cancer, it is important to have regular screenings. They can help find a tumor before it is large enough to cause symptoms, such as coughing up blood or shortness of breath.
People with lung cancer have a higher risk of getting infections in the lungs, including pneumonia or bronchitis. They are also at risk of having heart problems, such as arrhythmias or heart attacks, because of the way cancer can affect how your lungs work. They also have a higher chance of having high levels of calcium in their blood, which is called hypercalcemia.
The five-year survival rate for people with advanced lung cancer is 15% or less. It is lower for women than for men. It is also lower if the cancer has spread to other organs when it is diagnosed. The prognosis is better if the cancer is discovered at an earlier stage and when it is diagnosed in people who have not smoked for a long time.
Lung cancer can cause symptoms such as a cough that won’t go away, chest pain and shortness of breath. Sometimes, it can also cause other problems. These include a build up of fluid around the lungs (pleural effusion), changes in finger nails and clubbing, and too much calcium in the blood (hypercalcemia).
Symptoms can also occur when cancer spreads to the lungs from another part of the body. This is called metastasis.
Cancers that begin in the lungs are called non-small cell lung cancer (NSCLC). They can also start in other places and move to the lungs, which is called metastatic cancer. The cancer can then spread to other parts of the body, including the brain, bone and lymph nodes. Metastatic cancer can be harder to treat than cancer that stays in the lungs.
Unexplained chest pain is one symptom of lung cancer that can be difficult to diagnose. This pain may feel like heartburn or a bad cold. But if it doesn’t clear up with medication or gets worse over time, you should talk to your doctor about it.
Other symptoms include coughing up blood, wheezing and weight loss. A persistent cough that doesn’t go away or worsens over time is a red flag. This could indicate a serious condition, such as pneumonia or bronchitis. If you have chronic bronchitis or pneumonia that doesn’t go away, your doctor should evaluate you for lung cancer.
You may have other symptoms, such as a swollen lymph node, that aren’t related to cancer. These symptoms can be caused by many other conditions, including arthritis and viral infections.
Some people with lung cancer develop a group of symptoms, known as syndromes, that are specific to certain types of cancer. For example, a tumor in the upper part of the lungs (sometimes called Pancoast tumors) can cause a set of symptoms that affect the nerves around the eyes and face, called Horner syndrome. Other syndromes include a high level of calcium in the blood, which is called hypercalcemia and causes you to need to urinate often or have excess thirst.
Coughing up blood is a symptom of some cancers that start in the lungs. It may also occur when cancer cells spread, or metastasize, to the lungs from another part of the body. This symptom is called hemoptysis. The amount of blood in the cough varies, but even a few teaspoons of blood can be dangerous. Blood in the cough may look bright red and frothy, or it may be mixed with mucus.
The cancers that can cause hemoptysis include squamous cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Both types of cancer may grow to the point where they block or irritate nearby blood vessels, causing them to bleed. This happens because of the location of these tumors in the lungs, or because of the effect of some cancer treatments.
Hemoptysis can also be a symptom of certain infections, such as viral or bacterial bronchitis. If coughing up blood lasts more than a week, it’s important to see your doctor.
It’s important to know that the symptoms of lung cancer can vary a lot. Some people who have lung cancer don’t have any of these symptoms.
If you have lung cancer, your GP will arrange tests to check for the disease and to find out what type of lung cancer you have. This might include a chest x-ray or other scans and blood tests. If the GP finds something unusual, they will refer you to a specialist and might suggest further tests. Depending on what type of cancer you have, you might need to see other health professionals, including a thoracic surgeon and medical oncologist. They may talk about treatment options with you at a meeting called a multidisciplinary team or MDT meeting.
Hoarseness is a common symptom of cancer in the throat and larynx, but it’s rarely the first symptom people notice. Hoarseness means your voice sounds rough or raspy and it can affect how loudly you speak or the pitch (how high or low you sound). It may also cause you to cough more than usual.
It’s rare for lung cancer to show symptoms in the early stages, so many people don’t think they have cancer until the disease spreads. This can lead to a delay in diagnosis and treatment.
Lung cancer can cause your throat to hurt if the tumor presses on the vocal cords. Your voice can become hoarse, especially if you speak or sing for long periods of time. It can also make it harder to swallow.
The most common cause of hoarseness is temporary swelling of the throat (laryngitis). Other causes include a sore throat, sneezing or coughing up phlegm. If you have a persistent hoarse throat that doesn’t go away, talk to your doctor.
Your doctor can tell if the problem isn’t caused by cancer or another illness by performing a physical exam of your throat and larynx. They may use an endoscope, a flexible, lighted tube designed to look inside your throat.
If the doctor finds a lump, they can perform a biopsy to determine if it’s cancerous. If it is, the doctor may refer you to an ear, nose and throat specialist for further tests.
Shortness of breath, or dyspnea, is a common lung cancer symptom that may feel like you can’t get enough air into your lungs. This can happen when a tumor grows to block an airway passage or as the cancer spreads and causes fluid to build up around the lungs and chest wall. It can also occur if the cancer starts bleeding into the lungs, causing pain.
The first step in identifying this lung cancer symptom is to make an appointment with your doctor. Bring your symptom tracker with you to give them the full picture and to avoid any confusion over what might be going on.
It’s important to remember that most symptoms of lung cancer involve the heart and lungs, and many of them can be caused by other conditions. That’s why it’s so important to pay attention to any seemingly harmless symptoms that last longer than they should or that come along with other troubling signs, such as a cough that doesn’t go away or rust-colored phlegm that isn’t clearing up.
Other factors that can cause breathlessness include COPD (chronic obstructive pulmonary disease) or a lung infection such as pneumonia or bronchitis. Other possible causes include a blood clot in the lungs or Horner syndrome, which is a collection of symptoms that affects your eyes, nose and mouth, including a red appearance of the skin, and can sometimes cause a loss of coordination.
To help with breathlessness, it’s recommended to quit smoking and stay at a healthy weight. It’s also a good idea to avoid secondhand smoke, as well as exposure to irritants such as chemicals and air pollution. You can check ozone alerts on the weather forecast and monitor your symptoms to know when it’s best to stay indoors.
A loss of appetite is a common lung cancer symptom. This is often due to the cancer itself, as well as its treatments. Chemotherapy can cause nausea, which makes people not want to eat. Radiation near the abdomen or head can also change the way foods taste, and cause pain when chewing or swallowing. Weight loss is a serious concern and should be discussed with your doctor.
Symptoms of lung cancer often start in the respiratory system, but cancer can spread to other parts of the body, too. When this happens, it is called metastatic disease.
The most common symptoms of metastatic lung cancer include chest pain and difficulty breathing. These symptoms can develop slowly, and it is important to see a doctor if you have them.
People who have lung cancer have a higher risk of getting infections. This is because the cancer may weaken the immune system. It is also important to get a flu shot every year.
Lung cancer can sometimes cause other health conditions, such as a blood clot in the lungs (pulmonary embolism) or a heart attack. This is because cancer can compress or obstruct the veins and arteries.
In rare cases, tumors can increase the amount of calcium in your blood, which is called hypercalcemia. This can cause nausea, vomiting, and excessive thirst. Some types of lung cancer, such as Pancoast tumors at the top of the lungs, can affect the nerves in your arms and legs, which causes pain or a droopy appearance (Horner’s syndrome).
Most people with lung cancer don’t have any symptoms until the cancer is advanced. If they do have symptoms, they are usually mistaken for a less serious condition.
Lung cancer treatment depends on the type and stage of your tumor. You might have surgery to remove the cancer or other treatments.
Some types of lung cancer can be cured, especially when it’s confined to the lungs and hasn’t spread. You may have surgery or radiation followed by medicine called chemotherapy.
If your cancer is in early stages and hasn’t spread, surgery may be an option. It can remove tumors that block your airways, helping you breathe easier. It can also remove tissue samples (biopsy) for testing, which can help your doctors decide on the best treatment.
Your healthcare team will discuss whether surgery is right for you. Your doctor will consider things like your lung function and quality of life after surgery. They will also look at results of other tests and your general health.
Before surgery, your doctor gives you medicine through a vein (IV) called general anesthesia. This puts you to sleep and keeps you from feeling pain during the operation.
During surgery, your surgeon removes the cancer and some healthy tissue around it. This improves the chances that all the cancer cells are removed. Your surgeon might also remove lymph nodes from your chest to check for cancer that has spread.
Each lung is made up of large sections called lobes. There are three lobes in your right lung and two in your left. Your doctor might remove just one of these lobes or the whole lung. This depends on your health and what type of cancer you have.
After surgery, you might need to stay in the hospital for a few days. You might be able to go home sooner, depending on the type of surgery and how quickly you recover. You might have tubes in your chest to drain fluid and blood.
You might have other procedures during your hospital stay, such as bronchoscopy or video-assisted thoracic surgery (VATS). These are less invasive ways for your doctor to see inside your chest. Your doctor might also use these techniques to remove fluid or tissue samples from your lungs.
Cancer cells divide uncontrollably and make too many copies of themselves, which build up to form masses (tumors) that keep the lungs from working normally. Lung cancer that starts in the lungs is called primary lung cancer, while cancer that starts elsewhere in the body and spreads to the lungs is called metastatic disease. Chemotherapy uses strong medicines to destroy cancer cells and stop them growing. You may have chemotherapy on its own or with other treatments such as radiotherapy or immunotherapy.
Chemotherapy is usually given as a combination of drugs that are injected directly into your bloodstream or, more often, put into a tube that connects to one of your veins in the chest (intravenously). Some types of chemotherapy are also available in capsules that you swallow. You can have these drugs as an outpatient or in hospital, and you will receive treatment over a number of weeks or months with breaks in between to let your body recover. Each set of chemotherapy treatments is called a cycle.
If the chemotherapy kills all the cancer cells, your doctor will say you have a complete response or no evidence of disease. You will then be able to have other treatments such as surgery or radiation without worrying that the cancer might return.
If the cancer is in an early stage, doctors can remove it using minimally invasive surgery. This uses several small incisions instead of a single large incision and special long surgical tools to perform the operation. This is often used for smaller, early stage tumors. Other procedures include lobectomy, which is the removal of 1 or more of the larger parts of the lung; wedge resection, which is the removal of a pie- or wedge-shaped piece of the lung around the tumor; and segmentectomy, where a section of a lobe is removed.
Radiation therapy uses high-energy x-rays (photons), gamma rays, or atomic particles to attack cancer cells and reduce their ability to grow and reproduce. It can be used in combination with surgery and/or chemotherapy. Radiation can also be given as the primary treatment for people with early-stage lung cancer who are poor candidates for surgery, such as those with heart failure or on blood thinning medications that increase the risk of surgical bleeding. A newer approach, stereotactic body radiation therapy, or SBRT, delivers very precise doses of radiation in fewer treatments than traditional external beam radiation therapy. It targets tumors using multiple beams of radiation shaped to match the shape and location of your tumor. Your doctor may also use a technique called frameless stereotactic radiosurgery, which reduces the movement of your body during radiation treatments.
If the cancer has spread to other areas of the lungs, radiation can be used to shrink these tumors and relieve symptoms such as pain or blocking an airway. This is called palliative radiation therapy.
There are several types of radiation treatments available for non-small cell lung cancer, including intensity-modulated radiation therapy and volumetric modulated arc therapy. With these techniques, doctors can deliver very precise doses of radiation to the tumor and spare surrounding healthy tissue. Combined with chemotherapy, these treatments can offer cure rates comparable to those for surgery alone.
Immunotherapy uses medicines to help your own immune system fight cancer. It is an important treatment advancement that has impacted survival rates for some people with non-small cell lung cancer (NSCLC).
Our immune systems protect us by recognizing harmful cells and destroying them. Cancer cells, however, have ways to hide from your immune system, making it hard for the body to recognize them and destroy them. Immunotherapy takes the brakes off your immune system to help it recognize and destroy cancer cells.
The first immunotherapies to treat cancer were monoclonal antibodies that block checkpoint proteins, such as CTLA-4 and PD-1, which are on the surface of cells and act like “brakes” to your immune response. These drugs, which are given alone or in combination with chemotherapy, have been shown to significantly improve survival for some people with advanced melanoma and lung cancer, and are being studied as standard treatments for other solid tumors.
Another type of immunotherapy involves reprogramming your own immune cells to find and destroy cancer cells. These are called cellular therapy, and they can be given through a trial.
Researchers are also developing cancer vaccines. These aren’t used to prevent cancer, but to treat it by training the immune system to recognize and destroy abnormal cells that have specific markers, called antigens. Vaccines aren’t currently available for lung cancer, but you may be eligible to participate in a clinical trial to try them. Some types of immunotherapy can rev up your immune system, so you might feel sick and have fever, chills, headache, weight gain from extra fluids, diarrhea and other side effects. It’s important to tell your care team right away if you have any of these symptoms, so they can give you medicine to lower the effects or treat them.
Other treatments for lung cancer can include therapies to reduce pain, relieve symptoms and help keep the cancer from coming back. They also include procedures to remove fluid around the lungs or to help with breathing. There are also newer immunotherapies that use medicine to boost your own immune system so it can kill cancer cells. These are being tested in clinical trials for many different types of lung cancer.
Doctors use medical imaging to find out the stage of your lung cancer, which gives them a good idea of whether it can be treated with surgery or chemotherapy alone or in combination. You may need blood tests to see if you can tolerate the medicines used in your treatment plan. You will also need pulmonary function tests, which measure how well you can breathe.
Most early non-small cell lung cancer (NSCLC) and some SCLC can be removed by surgery. But you will usually need to have chemotherapy or radiation therapy first to make sure that any cancer cells left behind can be killed. This treatment is called adjuvant therapy.
If you have a small, early-stage tumor, doctors might be able to remove it using minimally invasive surgery, which has less side effects than traditional open surgery. This includes video-assisted thoracic surgery and thoracoscopy, which use smaller incisions to access your lungs.
Radiation therapy can be delivered by external beams or internally with brachytherapy or stereotactic body radiotherapy. For external beam radiation, you lie on a table while a machine directs radiation at precise points on your body. For internal radiotherapy, a thin tube (catheter) is inserted into your lung and a small piece of radioactive material is placed against the tumour for a few minutes.
