Lung Cancer
There are over 38,000 new cases of lung cancer in the UK each year and over 35,000 people die from the condition, more than for breast and colorectal cancer combined. Lung cancer is now the leading cause of cancer death in women. About 90% of lung cancers are caused by smoking. The risk of developing it increases with the number of cigarettes smoked per day and the number of years of smoking. Quitting smoking greatly reduces the future risk of lung cancer but a small increased risk remains even after many years. Now that fewer men are smoking we have seen that lung cancer deaths in men have reduced by more than a quarter (27% reduction from 1971 to 2006). Unfortunately, the mortality rate amongst women has increased owing to the effect of increased tobacco consumption amongst women. The death rate from lung cancer is higher in Scotland. Only a minority of patients with lung cancer can be cured, although the cure rate is slowly rising with improvements in awareness of symptoms that can warn of cancer, improved diagnostic methods and treatment. Currently only 8% of patients can expect to be cured but improved treatments can benefit many patients.
What are the symptoms?
Lung cancer most often causes a cough that does not go away and/or progressive breathlessness. Other symptoms may be chest pain that is persistent, coughing up blood (haemoptysis), weight loss and loss of appetite, and sometimes a hoarse voice or pains elsewhere in the body due to spread of the cancer (metastases). Smokers and ex-smokers are particularly at risk and lung cancer is more common in older individuals (average age about 70 years). Most of these symptoms can be an early warning sign of a cancer which is still curable so it is important that medical advice is sought earlier rather than later. There are clear referral criteria recommended by the Department of Health and NICE (see web links).
How is the diagnosis made?
The first investigations include a chest X-ray and blood tests. A CT (computed tomography) scan is usually arranged by the hospital and is often done before being seen by the Respiratory Physician (lung specialist). This gives much more detailed information and allows the planning of the most appropriate next test. The further tests include bronchoscopy or trans-thoracic needle biopsy according to the site of the suspected cancer. This is performed to confirm that the diagnosis of suspected cancer is definitely correct and show which cell type is involved. There are three main types of lung cancer classified according to the type of cell involved. Squamous cell carcinoma and adenocarcinoma are collectively referred to as non-small cell carcinoma and the third type is small cell carcinoma. The treatments for non small cell and small cell cancer differ significantly (see below).
What can be done to improve cure rate and survival?
Most lung cancer is diagnosed too late for curative treatment to be possible. This is because either the cancer has spread too far or the patient is not fit enough for treatment. Early diagnosis is difficult because many of the common lung cancer symptoms are common in other conditions. It is difficult for both patients and doctors to decide when symptoms should be investigated. Chemotherapy is rarely curative for those with advanced cancer not suitable for surgery or radical (given to attempt cure) radiotherapy. There is clear guidance available about when symptoms should be investigated but many patients are unaware that they should report symptoms early. Bringing warning symptoms to a doctor’s attention early may mean that a patient may have cancer at an earlier stage and also that the patient may be fit enough to undergo treatment.
What are the treatments?
Non Small Cell lung cancer is best treated by surgery or radiotherapy that aims to cure (radical radiotherapy). However only 10-20% of patients will be suitable for surgery because the cancer will have either spread too far or the patient will not be fit enough for the major operation. Treatments with less powerful radiotherapy (palliative radiotherapy) or chemotherapy (see below) are other options. Sometimes it is thought best to give no specific treatment at the time of diagnosis, with the option to consider treatment later.
Small cell lung cancer is treated by chemotherapy or chemo-radiotherapy. This involves courses of a combination of cytotoxic drugs. These are drugs that try to kill or inhibit tumour cells but do have side effects. There are several different combinations in use. Chemotherapy is given by a specialist oncologist. It is given in courses that may involve a short hospital stay about every 3 weeks. The number of courses depends on how well the individual patient responds. Chemotherapy has side effects particularly nausea, vomiting malaise and hair loss (not all drugs. However there are very good drugs to control these side effects.
Many research trials are going on to try to improve results. Patients who are asked for their consent to take part in a trial should not be alarmed by this. It takes hundreds, and sometimes thousands, of patients to participate in a trial to detect small advantages of one treatment regime over another. Only with these efforts, however, will cancer chemotherapy continue to improve. Most patients going for chemotherapy are therefore likely to be asked to participate in a trial and most of these are being carried out on a national scale with many hospitals participating.
Needle Lung Biopsy
For more information about having a lung biopsy click here
Transbronchial Biopsy
For more information about having a transbronchial lung biopsy click here
Web Links
The following web links may provide more information on Cancer.
Please note that the Society does not endorse the content of any of these web links, but hopes that by providing the links below it is providing a useful service to the respiratory community.
Advance Decisions to Refuse Treatment
This team of healthcare professionals is hosted by Mid Trent Cancer Network (NHS) and works closely with the East Midlands office of the Care Services Improvement Partnership (Department of Health). The Team’s experience and skills represented here are used to promote, inform and train professionals about this new statutory right of people to make an ADRT.
http://www.adrtnhs.co.uk/
Cancer Research UK
The vision of Cancer Research UK is to conquer cancer through world-class research.
http://imperialcancer.co.uk/
CancerBACUP
http://www.cancerbacup.org.uk/
British Lung Foundation
The British Lung Foundation exists to provide a complete package of support for people living with lung disease and the people who look after them, in hospital and at home.
http://www.lunguk.org/
NICE
http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7178
Roy Castle Lung Cancer Foundation
The Roy Castle Lung Cancer Foundation is the only charity in the world wholly dedicated to defeating lung cancer, the biggest cancer killer in the UK.
http://www.roycastle.org/