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All of the cells in our body grow and form new cells. This happens whilst the old cells die and get broken down. This cell turnover is a normal regeneration process and keeps us healthy.
In cancer, cells are damaged in a way that makes them form lots and lots of new cells more quickly than they should. This is done faster than the old cells die and leads to the formation of lumps (tumours).
The cells in cancer don’t do their regular job in the way they should. For example, in thyroid cancer, the tumour may produce hormones in large amounts, or not at all. This can lead to people having symptoms of hyperthyroidism or hypothyroidism. This is just one way in which cancerous cells can cause problems. Another way is where tumours become so large in size that they cause physical problems in the space that they are in. For example, in lung cancer, not leaving enough room for your lungs to work, causing breathlessness.
Cancerous cells can also travel through your body. This can be through the blood to other areas of the body, or through lymph nodes.
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If the cancer cells started in your lungs, this is known as primary lung cancer. If they start somewhere else, and travel to your lung, this is known as secondary lung cancer.
Primary Lung Cancer
As well as there being primary and secondary types of lung cancer, there are also different types of cancer within these categories. This depends on the type of cell which has started to get out of control. These are some of the types in primary lung cancer:
- Non-Small Cell Lung Cancer (NSCLC) – 80% of lung cancers will be of this type. NSCLC can also be split into different categories, depending on the type of cell, including squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
- Small Cell Lung Cancer (SCLC) – this makes up 15-20% of primary lung cancers. This type of cancer is generally more invasive. It grows more quickly and is more likely to have spread to other parts of the body when it is diagnosed.
- Mesothelioma – this is cancer affecting the cells that line the lung. It is most frequently caused by asbestos
Secondary Lung Cancer
This is where cancer has started somewhere else in the body and spread to the lungs. This means that whatever type of cancer it is, it is relatively advanced. As a result, this type of cancer is usually more challenging to treat. Some types of cancer spread to the lungs more often than others, these are:
- Breast cancer
- Bowel cancer
- Bladder cancer
- Certain types of kidney cancer
- Prostate cancer
Some people are much more likely than others to suffer from lung cancer. The vast majority of lung cancer is associated with smoking, though non-smokers can get it, too.
As smoking rates have fallen in the UK, so has the number of people being diagnosed with lung cancer. The number of men in the UK who smoke has decreased, but women have started to smoke more. As a result, the number of lung cancers diagnosed in women is actually increasing.
If you quit smoking, over ten years, your risk of lung cancer halves. If you are considering quitting smoking, you should talk to your GP. People are far more likely to successfully quit smoking with the help of their GPs, rather than when they try to do it alone. Support from your GP can involve cognitive behavioural therapy and multiple forms of medication.
Passive smoking is also a risk factor. This is where you breathe in smoke from someone else who has been smoking near you. The more you are exposed to this type of smoke, the greater the risk.
People under the age of forty very rarely get lung cancer. Almost 50% of lung cancers are diagnosed in people over the age of 75.
Does Air Pollution Cause Lung Cancer?
There are no studies which can conclusively say that air pollution causes lung cancer. If there is a link, it is a much weaker link than the one between smoking and lung cancer.
We know that air pollution can affect your lungs by worsening asthma attacks in people who have asthma and causing flare-ups of COPD. In children who are exposed to air pollution over a long time, their lungs are less developed than those who aren’t.
Can E-Cigarettes Cause Lung Cancer?
Vaping, or e-cigarettes, is relatively new. We won’t know of any damage/risks until people have been using e-cigarettes for extended periods. Still, the likelihood is that they are far less harmful than smoking.
There have been studies in mice which suggest that there may be a link between nicotine-containing e-cigarettes and lung and bladder cancer. It is important to remember, however, that this does not necessarily mean that there will be the same link in humans. It is not advisable to start using e-cigarettes if you have never smoked before.
Medications used by your GP to help with stopping smoking have been proven in research trials to be safe and effective. Currently, this is not true of e-cigarettes. If you are considering quitting smoking, you should speak to your GP before trying e-cigarettes.
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Symptoms in lung cancer can vary between person-to-person. If you have secondary lung cancer, symptoms may also be related to the initial cancer. Some of the most common signs that people initially see a doctor for are:
- Coughing – having a cough for more than 2 weeks. For someone who usually has a cough, having a change in your cough for more than 2 weeks also means you should be checked by a doctor.
- Recurrent chest infections – having multiple chest infections one after another, which don’t go away with antibiotic treatment.
- Coughing up blood – also known as haemoptysis. If you have this symptom, you should always be seen by a doctor. If you have had a cough for a while, it may be that you have just burst a blood vessel at the back of your throat with the force caused by your cough. Haemoptysis can, however, be caused by serious underlying health conditions. If you have had this symptom, call NHS 111 for further advice.
- Shortness of breath – persistently feeling like you have to catch your breath doing things that would not usually make you feel this way. For example, having to stop whilst walking up the stairs when you would not normally need to. This can be due to several other health conditions as well, including anaemia, and having a chest infection.
- Weight loss – if you have not been trying to lose weight, and have noticed that you have lost a significant amount, you should see your GP. This is a symptom of many different types of cancer, including lung cancer. People who are depressed can also lose weight without trying, as well as those with an overactive thyroid and other medical conditions.
- Chest pain – is a very common symptom that people see a doctor with. Most of the time, chest pain is not caused by anything serious. If you are experiencing persistent, or severe chest pain, then you should call NHS 111 for advice, or in an emergency, dial 999. If your chest pain is intermittent, you should see your GP, or if you are worried, call NHS 111.
What Will Happen When I See My GP?
If you see your GP with any of the above symptoms, they will start by taking a thorough history and examination. They may begin by doing blood tests to look for other conditions which may be causing your symptoms, such as anaemia. Blood tests cannot be used to diagnose lung cancer, as there is no specific test to diagnose it.
Depending on your individual risk, they may send you for an urgent chest x-ray. This is usually the first test used to diagnose lung cancer.
The guidance in England is that anyone over forty, with two of the following symptoms (or one of the following symptoms if they are a smoker), should have an urgent chest x-ray within 2 weeks:
- Persistent cough
- Feeling tired all the time
- Weight loss
- Chest pain
- Shortness of breath
A biopsy may be taken of the cancer. This is where a small portion of the cancer is taken away and sent to a laboratory for testing. This is how the type of lung cancer you have is diagnosed. It can be useful to know what type of cancer someone has because it can affect specific treatments, and give an idea as to prognosis. A biopsy can be taken in several ways:
- Bronchoscopy – this is where a small tube is passed down your windpipe and into your lungs. A small camera is used to find the cancer and then take a small biopsy.
- Thoracoscopy – this is done whilst you are asleep. Cuts are made in your chest wall, and a camera is inserted to look at the lungs and take biopsies of any cancer seen.
- Mediastinoscopy – your mediastinum is the membrane layer that sits between your heart and lungs. Like in thoracoscopy, you will need to be asleep for this procedure. A small cut is made at the bottom of your neck, and a camera is inserted downwards into the mediastinum and can be used to take biopsies here.
- Percutaneous needle biopsy – a CT scanner is used to guide a needle to any tumours. The needle is inserted from outside of your chest into the tumour, and a small sample is taken as a biopsy.
An urgent chest x-ray can also be performed if your GP is concerned by other symptoms, such as recurrent chest infections, or finger clubbing.
An abnormal chest x-ray does not automatically mean that you have lung cancer. It can be difficult to interpret chest x-rays if there is an overlying infection, or if part of the lung has collapsed. If you have an abnormal chest x-ray, you may be sent for other investigations to look for lung cancer.
What Other Tests Are There For Lung Cancer?
There are lots of different scans and tests which may be used to diagnose lung cancer. Some are used to give a diagnosis, and others are used to see how advanced the disease is.
This is a scanner which uses radiation to take detailed pictures of the inside of your body. It is likely the first step following an abnormal chest x-ray. This type of scan may also be used on other parts of your body to check if the cancer has spread anywhere else.
Positron Emission Tomography (PET-CT) Scan
A PET-CT scan uses two different types of radiation to take pictures where the cancer is. These pictures are then put together to give an accurate image of the active cancer cells in your body, and the location of the tumours. It can be used to see how advanced the disease is when you are diagnosed, or it can be used to see how well treatment is working.
Biopsies are beneficial because they can be used to help make decisions about how to treat lung cancer. Your doctor will discuss the risks of having a biopsy with you when talking about the procedure. The most commonly occurring risk of having a biopsy is that air will leak out of your lung, causing it to collapse. This can cause chest pain and shortness of breath. The lung can be re-inflated if this happens by putting in a chest drain. This is a small tube which is put into your chest and drains into some sterile water. This allows the collapsed lung to re-inflate. If you have any concerns about the risks of undergoing a biopsy procedure, do discuss them with your doctor.
What Is Cancer Staging?
Cancer stages are used to give an idea of how advanced someone’s cancer is. Higher cancer stages are more advanced, and this affects your prognosis. The stages of lung cancer are:
STAGE 1 – the cancer is small, and only in the lung. It has not spread to other parts of the body.
STAGE 2 – the cancer is less than 7 cm (2.5 inches) and has not moved outside of the chest. Smaller tumours may have spread into the lymph nodes inside the chest, or the tumour might be moving into your ribs, or the muscles around them.
STAGE 3 – this is sometimes also known as locally advanced cancer. It is where the tumour is large, or has spread to other areas in your chest, like the border around your heart. It has not moved outside of the area of your chest.
STAGE 4 – this is where the cancer has spread outside of the lungs to other organs. It can sometimes be just inside the chest, but with fluid surrounding the heart and lungs, which contains cancer cells.
All of these stages can be further broken down into categories depending on many different factors. If you have lung cancer, you may also hear people referring to the TNM system. This is a different staging system which can be used to describe how advanced the cancer is. T (tumour) is from 0 to 4, depending on how big and where the tumour, or tumours are. N (nodes) ranges from 0 to 3 depending on if there are lymph nodes involved, and where they are. M (metastases) is graded as either 0 or 1; either you have tumours outside the lung, or you do not.
What Is The Prognosis of Lung Cancer?
There are multiple factors which affect your prognosis if you have lung cancer. This can depend on the type of cancer you have (NSCLC or SCLC), or the stage. It can also be affected by your underlying health and whether you are well enough to undergo certain treatments. The best idea you will get about your individual prognosis is by talking to your doctor, or oncologist.
Cancer Research UK has grouped together some statistics on survival, based on the stage of lung cancer. Some people find information like this helpful, and others do not. If you are unsure whether you want to know information like this, it can be helpful to talk to someone.
Macmillan nurses provide support and information for people who are dealing with cancer and those who care for them. They operate a dedicated helpline which you can call with any questions that you may have.
What Is The Treatment For Lung Cancer?
There are multiple different options for the treatment of lung cancer. What you will end up having is decided by a group of healthcare professionals called a multi-disciplinary team (MDT). This includes radiologists (doctors who specialize in looking at scans), oncologists (doctors who specialize in treating cancer), respiratory physicians (doctors who specialize in the lungs), and physiotherapists, amongst others.
There are many types of treatment that you may be offered to treat lung cancer. Some types of treatment are more commonly used than others. These are generally well known, as they are also used to treat other types of cancer.
If the cancer hasn’t spread much and can be safely taken away, you might be offered surgery. This type of surgery is very invasive, and will usually remove either part, or the whole of one lung. You have to be relatively fit to have this type of surgery.
This can be used instead of surgery for very small tumours, or can be used to help reduce the symptoms of lung cancer. It is where a beam of radiation is focused at the tumour inside the body, and this kills the cells inside the tumour. Side effects include pain around the area being treated, hair loss, a rash which looks like sunburn and fatigue.
This can be used with surgery to stop the cancer from returning. It can also be used to slow the spread of cancer if it can’t be completely removed. Powerful cancer-killing medications are taken, which cause the cells inside the tumours to die. Side effects include fatigue, feeling nauseous and being sick, hair loss, and ulcers inside of your mouth.
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The British Lung Foundation (BLF) is a UK based charity dedicated to people who suffer with a variety of lung conditions. They operate a helpline which you can use to ask any questions that you may have.
There are also dedicated cancer charities which provide help not only through helplines, but also financial and social support. If you are struggling to make it to treatments, or with finances, or in any way due to a diagnosis of cancer, you should contact Macmillan Cancer Support.
The Roy Castle Lung Cancer Foundation is the only UK charity dedicated specifically to lung cancer. Their website has a wealth of information on the condition, and they also operate a helpline run by nurses to provide information, advice, and support.
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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.
Biopsy – the process of taking away a small sample of something in the body so that it can be sent for further tests. This can be done in a variety of ways, but all methods of taking these samples will be called “biopsies”
Hyperthyroidism – also known as a hyperactive thyroid. This condition can lead to feeling hungry all the time, weight loss, diarrhoea, and palpitations
Hypothyroidism – also known as an underactive thyroid. This condition can lead to constantly feeling cold, feeling tired all the time, weight gain, and a large swelling around the neck known as a goitre
Tumour – an abnormal lump, or growth, that forms when abnormal cells divide too quickly and do not die
Vaping – the use of e-cigarettes to inhale vapour (a gas generated from the liquid in the cigarette)