What is lung cancer?

Lung Cancer begins when abnormal cells grow and multiply in an uncontrolled way in one or both of the lungs. Cancer that starts in the lungs is known as primary lung cancer. It can spread to other parts of the body such as the lymph nodes, brain, adrenal glands, liver and bones. When cancer starts in another part of the body and spreads to the lungs, it is called secondary or metastatic cancer in the lung.

Types of lung cancer

There are two main types of primary lung cancer. These are classified according to the type of cells affected.

• Non-small cell lung cancer (NSCLC) – Makes up over 85% of lung cancers. It may be classified as squamous cells carcinoma, adenocarcinoma or large cell undifferentiated carcinoma.
• Small cell lung cancer (SCLC) – Makes up about 15% of lung cancers. It tends to start in the middle of the lungs and usually spreads more quickly than NSCLC.

Other types of cancer can also affect the lung area but are not considered lung cancer. These include tumours that start in the space between the lungs (mediastinum) or in the chest wall.

Pleural Mesothelioma is cancer that affects the covering of the lung (the pleura). It is different from lung cancer and is usually caused by exposure to asbestos. For more information on Mesothelioma please refer to our Understanding Mesothelioma booklet

How common is lung cancer?

About 2300 people (58% males, 42% females) are diagnosed with lung cancer in Queensland each year. The average age at diagnosis is 72. It is the fifth most common cancer in Australia accounting for 9% of all cancers diagnosed. More men than women develop lung cancer.

Risk factors

The causes of lung cancer are not fully understood, and some people develop lung cancer without having any knows risk factors. The factors listed below are known to increase the risk of developing the disease. Having these risk factors does not mean you will develop lung cancer, but if you are concerned about your risk, talk to your doctor.

• Tobacco smoking – In Australia, about 90% of lung cancer cases in males and 65% in females are estimated to be a result of tobacco smoking. The earlier the person starts smoking, the longer they smoke and the more cigarettes they smoke, the higher the risk of developing lung cancer. However, about one-fifth (21%) of people who are diagnosed with lung cancer have never been smokers.
• Second-hand smoking – Breathing in other people’s tobacco smoke (passive or second-hand smoke) can cause lung cancer. Living with a smoker increases a nonsmokers risk by up to 30%.
• Exposure to asbestos – People who are exposed to asbestos are more likely to develop lung cancer or pleural mesothelioma. Although the use of asbestos in building materials has been banned across Australia since 2004, there is still asbestos in some older buildings and fences.
• Exposure to other elements – People exposed to radioactive gases (radon) in the workplace, such as uranium miners, have an increased risk of lung cancer. Contact with the processing of arsenic, cadmium, steel and nickel, and exposure to diesel in the workplace may also be risk factors.
• Personal history – Having another lung disease (e.g. lung fibrosis, chronic bronchitis, pulmonary tuberculosis, emphysema) or human immunodeficiency virus (HIV) may increase the risk of lung tumours.
• Older age – Lung cancer is most commonly diagnosed over the age of 60 years, though it can occur in younger people.

Symptoms

The main symptoms of lung cancer are:

• a persistent new cough (lasting more than three weeks) or change in a cough you’ve had for a long time
• breathlessness
• pain in the chest or shoulder
• chest infection that lasts more than three weeks or that keeps coming back
• coughing or spitting up blood

A person diagnosed with lung cancer may also have experienced symptoms such as fatigue, weight loss, hoarse voice, wheezing, difficulty swallowing, abdominal or joint pain, and enlarged fingertips (finger clubbing). Having any one of these symptoms does not necessarily mean that you have lung cancer.

Some of these symptoms may be caused by other conditions or from side effects of smoking. However, if you have symptoms, see your doctor without delay. Sometimes there are no symptoms and the cancer is found during routine tests (often x-ray or CT scan) for other conditions.

Diagnosis

Your doctors will perform a number of tests to make a diagnosis and work out whether cancer has spread beyond the lung. The test results will help them recommend a treatment plan for you.

The tests to diagnose lung cancer may include:

• chest x-ray
• CT scan of the chest
• biopsy – a small sample of tissue is taken from the lung, the nearby lymph nodes, or both. There are various ways to take a biopsy such as CT-guided lung biopsy, Bronchoscopy, Endobronchial Ultrasound (EBUS), Mediastinoscopy, Thoracoscopy
• sputum cytology – lab tests on a sample of mucus from the lungs.
• pleural tap – lab tests on a sample of fluid drained from the lungs.

Further tests

Other tests may give more information about the cancer and help doctors work out whether it has spread to other parts of your body. These tests can guide treatment and may include;

• PET-CT scan – this scan combines a PET (positron emission tomography) scan with a CT scan in one machine. It can provide detailed information about the cancer.
• Other tests – you may also have a CT or MRI (magnetic resonance imaging) scan of the brain. If a PET-CT scan is not available or results are unclear, you may have a CT scan of the abdomen or a bone scan.

For more details, talk to your doctor or call Cancer Council 13 11 20.

Treatment

Treatment for lung cancer will depend on the type of lung cancer you have, the stage of the cancer, how well you can breathe (your lung function) and your general health. Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) are treated in different ways.

NSCLC in an early stage (I or II) is usually treated with surgery, if possible, to remove the cancer and the nearby lymph nodes. If surgery is not an option, radiation therapy is offered. Sometimes chemotherapy may be given after surgery or with radiation therapy.

Locally advanced (Stage III) NSCLC can be treated with surgery and chemotherapy or with radiation therapy and chemotherapy. Immunotherapy drugs may also be used. Treatment will depend on the number and location of the lymph nodes with cancer.

For advanced NSCLC (Stage IV) – Depending on the symptoms, palliative drug treatment (targeted therapy, immunotherapy or chemotherapy), palliative radiation therapy, or both, may be used.

Prognosis

The specialist will tell you the stage of the cancer, which describes how much cancer there is and whether it has spread.

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead your doctor can give you an idea about the general outlook for people with the same type and stage of cancer.

Support for Queenslanders

Whether you have been diagnosed with lung cancer, or have a family member or friend who is affected by cancer, there are times when you may need support. Our professional services and support programs are here to help you.

Find out more about:

• Phone support
• Email support
• Cancer counselling
• Practical and financial support
• Support groups
• Information sessions

You don’t have to face cancer alone – we’re here to help.

Resources

For more information about lung cancer and mesothelioma, please see these resources

If you are a patient, family or friend and would like to order a copy of either the Understanding Lung Cancer or Understanding Mesothelioma booklets, please call Cancer Council 13 11 20