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 is characterised by the uncontrolled growth of abnormal cells in the lung. There are two main forms of lung cancer, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), which are further categorised into several different subtypes.1
Every 13 seconds, someone receives a lung cancer diagnosis, with almost 2.5 million new cases of lung cancer diagnosed in 20222
Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for more deaths each year than breast, prostate and stomach cancers combined2
It is the most common cancer in men and the second most common in women2
The link between smoking and lung cancer is well known, with it being the most common driver of the disease. However, it is not the only cause. There are a number of lesser known lung cancer risk factors that people should also be aware of:5-8
Age – lung cancer is more common among older people
Radiation – people treated with radiotherapy have a moderately increased risk of lung cancer
Exposure to certain substances – workers in certain occupations may come into contact with high-risk cancer-promoting substances such as asbestos, radon gas, silica and arsenic
Urban air pollution – evidence suggests that lung cancer rates are higher in cities than in rural settings, mainly due to air pollution
Indoor air pollution – poor indoor air quality, caused by things such as open fires, certain building materials, cleaning products and cooling systems, have been linked to lung cancer
Other lung diseases – people with a history of lung diseases such as emphysema, tuberculosis, pneumonia or chronic obstructive pulmonary disorder are at an increased risk of lung cancer
Lowered immunity – those with a lowered immune system, for example due to HIV or AIDs, or taking immunosuppressant treatments following an organ transplant, have an increased risk
Signs and symptoms of lung cancer
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
Having any of these symptoms does not automatically indicate lung cancer, but it is worth seeking medical help as soon as possible to identify the cause behind it.3 If you or anyone you know are at high risk of lung cancer or experiencing known symptoms, speak to your healthcare provider about getting checked.
Types of lung cancer
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.
Around 80-85% of lung cancers are NSCLC, which can be classified into three main types, defined by the cell type:9,10
Adenocarcinoma, which is often found in the outer region of the lung
Squamous cell carcinoma, which is frequently linked to smoking
Large-cell lung cancer, which can begin anywhere in the lung, and often grows quickly
NSCLC can be further classified into different subtypes according to characteristics called biomarkers. Common biomarkers in lung cancer include: EGFR, KRAS, ALK, ROS1, BRAF, NTRK1/2/3, MET, RET, HER2, PD-L1.11
SCLC is the less common form of lung cancer, accounting for approximately 10-15% of cases. This type of lung cancer grows and progresses faster than NSCLC because the cells divide more rapidly and as a result, SCLC tumours spread more quickly. This type of lung cancer is named after the shape of the cells, which are small and oval-shaped in appearance.7,9,10
The majority of people with NSCLC have biomarkers that can be found through testing. The presence or absence of biomarkers can help doctors develop a personalised treatment plan.12,13
Stages of lung cancer
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
Treatments for lung cancer
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.
Redefining Lung Cancer Together
Scientists are unravelling the complexities of lung cancer, with care moving towards a more personalised approach for each patient. Yet lung cancer still has a significant impact on people with lung cancer, their loved ones, healthcare systems and society. Our ultimate goal at Roche is to provide people with the best chance to live a life free from cancer. Together with our partners, we are committed to addressing ongoing challenges for people with lung cancer at every stage of their journey.
At Roche, we remain committed to working closely with the lung cancer community, to identify new diagnostic tests and treatment options for lung cancer and to find innovative solutions that will redefine the journey and improve the outcomes and experiences for all those affected by this deadly disease.
References
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Accessed July 2024. World Cancer Research Fund International. What causes lung cancer? Available from:
Accessed July 2024. NHS. Lung cancer: Causes. Available from:
Accessed July 2024. European Lung Foundation. Indoor air pollution and the lungs. Available from:
Accessed July 2024. American Cancer Society. Lung Cancer Statistics. Available from:
Accessed July 2024. NFCR Lung Cancer. SCLC vs NSCLC: What’s the difference? Available from:
Accessed July 2024. Majeed U, et al. Targeted therapy in advanced non-small cell lung cancer: current advances and future trends. Journal of Hematology & Oncology. 2021;14(108)
Pakkala S. and Ramalingam S.S. Personalized therapy for lung cancer: striking a moving target. JCI insight. 2018;3(15).
National Cancer Institute. Biomarker Testing for Cancer Treatment. Available at:
Accessed July 2024. Cancer.net. Lung Cancer – Non-Small Cell: Stages. Available from:
Accessed July 2024. Macmillan Cancer Support. Staging of lung cancer. Available from:
Accessed July 2024. Cancer Research UK. Limited and extensive stage (small cell lung cancer). Available from:
Accessed July 2024. Cancer Research UK. Treatment options for small cell lung cancer (SCLC). Available from:
Accessed July 2024. NHS. Lung Cancer: Treatment. Available from:
Accessed July 2024.