Lung cancer: Everything you need to know

There is a common misconception that lung cancer only affects older people or people who have smoked.

When Vivek’s wife was diagnosed with advanced lung cancer, she was just 29 years old and had never smoked. Thanks to advances in care, she was able to receive treatment personalised to her specific type of lung cancer, and she was given six more years of valuable time with her family, which may not have been possible a decade ago. “She gave me memories which keep me smiling today. She was able to see our son grow up and we had many beautiful moments”, says Vivek Tomar, patient advocate.

Increased understanding of lung cancer has led to significant advances in care over recent years, introducing new methods of diagnosing and treating lung cancer. However, it is still one of the most commonly diagnosed types of cancer and many patients face a risk of the cancer coming back, even after surgery.

Lung cancer affects people in different ways, depending on the subtype, stage and their treatment. Lung cancer is also often associated with stigma, meaning that some people may delay seeking medical advice due to fear and potential judgement from others.

The earlier lung cancer is diagnosed, the greater the chance that treatments will be effective. Given that there is often a lack of symptoms in early stages, lung cancer can be difficult to diagnose early.

Common signs and symptoms of lung cancer include:3,4

• Persistent cough that doesn’t go away after three weeks

• Getting out of breath doing things that didn’t affect you previously 

• Coughing up blood

• An ache or pain in the chest or shoulder

• Chest infections that keep returning or that don’t go away

• Loss of appetite

• Persistent tiredness or lack of energy

• Unexplained weight loss

Lung cancer is a complex disease, which can be broadly classified into main types: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). These types can be further classified into several different subtypes.1 Knowing the type and subtype of lung cancer can help inform treatment approaches.

The stage of lung cancer indicates its size and location, and whether it has spread, and helps doctors determine the most appropriate treatment approach. Diagnosing lung cancer in the early stages can significantly reduce the risk of it coming back and offer patients the opportunity to be free from cancer.14

NSCLC is commonly classified into four stages, typically numbered from Stage I to Stage IV.14

SCLC is most commonly categorised into two main stages:15,16

• Limited stage – The tumour is in one area on one side of the chest and can be treated with radiotherapy to this single area. This is the equivalent of Stages I-III.16

• Extensive stage – The cancer has spread to other parts of the body and can no longer be treated with radiotherapy to one area. This is the equivalent of Stage IV disease.16

A team of doctors and other healthcare professionals, called a multidisciplinary team (MDT), will work together to develop an appropriate lung cancer treatment plan for each patient.17 The treatment options will depend on the type of lung cancer and the stage of disease. 

In recent years, improved understanding of the biology behind the disease has led to the development of new personalised treatments that target specific types of lung cancer. 

The main treatments for lung cancer include:18 

• Surgery – Depending on the type, stage and position, it may be possible to remove the tumour through surgery

• Radiotherapy – Treatment where radiation is used to kill cancer cells

• Chemotherapy – An anti-cancer therapy that kills cancer cells

• Cancer immunotherapy – Therapies that work by helping the body’s immune system to fight cancer

• Targeted therapies – Therapies that work by targeting molecules that help cancer cells grow

Some patients may receive a combination of treatments, depending on their stage and type of disease. These treatments may include chemotherapy, cancer immunotherapy and targeted therapy.18

For people having surgery, additional treatments may be given before (neoadjuvant) and after (adjuvant) the operation to help reduce the risk of cancer returning. Patients may also receive additional treatment if their cancer comes back or progresses.18

Due to the fast-growing and aggressive nature of the disease, surgery is not common in SCLC.18 Before the introduction of cancer immunotherapy, there were no new treatment options available for these patients for several decades. While advances have made a difference for many patients, further research is needed to improve care for particularly hard-to-treat forms of lung cancer, like SCLC.