Lung cancer: diagnosis and treatment

Lung cancer is one of the most common types of cancer in the UK. There are two main types of lung cancer, small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC). 

How is lung cancer diagnosed?

For most patients, diagnosis begins when they visit their GP with a symptom of lung cancer eg breathlessness, chest pain, a lingering chest infection, repeated chest infections, a persistent cough or coughing up blood.

If your GP suspects that you could have lung cancer, they will carry out some examinations and tests. This may include being asked to breathe into a device called a spirometer. A spirometer measures how much air you breathe in and out, which determines your lung capacity. 

Your doctor may also carry out blood tests to rule out other conditions, such as a chest infection. 

How do I take a spirometry test?

If you need to have a spirometry test, you may need to take some steps to prepare eg if you take any medication for your lungs and your medicine is inhaled, you may need to stop using it before your spirometry test. 

During your spirometry test, a clip will be placed on your nose to stop air escaping. You will have a few practise attempts before your official reading is taken. The nurse will ask you to inhale fully, close your lips tightly around the mouthpiece of the spirometer and then exhale as quickly as you can, making sure you fully empty your lungs. 

What happens after a spirometry test?

You will most likely be referred for a chest X-ray. Most tumours can be detected on an X-ray and this is how most lung cancers are diagnosed. A chest X-ray can identify a mass or tumour in your chest but can’t provide a definitive answer on whether you have lung cancer — for this you will need a biopsy. A mass in your lungs may not always be cancer; other causes include tuberculosis and aspergillosis. 

After having your chest X-ray you may be referred for a CT scan, which provides detailed images of the inside of your body. Before your CT scan, a special dye is injected into a vein to improve the quality of the images collected. The scan is carried out in hospital and is a painless procedure that takes less than 30 minutes. 

If your scan results show that you have early-stage lung cancer, you may be referred for a PET-CT scan (positive emissions computerised tomography). A PET-CT scan can help determine what stage your cancer is at, which helps your oncologist (a doctor specialising in treating cancer) create the most appropriate treatment plan. 

What is a biopsy and will I need one?

A biopsy involves taking a small sample of your tissue to be examined under a microscope. In the case of lung cancer, a biopsy can determine which type of lung cancer you have, SCLC or NSCLC.

Depending on the results of your CT scan, you may be offered a bronchoscopy. This is a procedure that allows the doctor to see the inside of your airways using a small camera. During your bronchoscopy, they can also perform a biopsy. The procedure involves passing a bronchoscope — a long, thin tube with a camera at one end — through your mouth or nose, down into your throat and into your airways.

You will be offered a sedative to relax you before your bronchoscopy and a local anaesthetic will be applied to numb your throat. This is a day procedure that will take place in hospital and tends to take between 30 minutes and two hours. 

There are other methods for collecting a biopsy, including:

• Fine-needle biopsy — a thin needle is inserted through your skin into the chest to take a biopsy
• Thoracoscopy — this requires a general anaesthetic and allows your oncologist to take tissue and fluid samples from your chest; two or three small cuts will be made into your chest so that a thin tube with a camera on the end can be passed inside

Treatment for lung cancer

There are a number of different treatments for lung cancer. Your treatment will depend on the type of cancer you have, the size and position of your cancer, what stage it’s at and your general health.

Treatments may include: 

• Chemotherapy — drugs that destroy cancer cells; these drugs are given either as an injection into a vein or orally as a tablet
• Immunotherapy drugs or targeted therapy — immunotherapy helps your immune system identify and destroy cancer cells; targeted therapy uses drugs that take advantage of the differences between healthy cells and cancer cells, to better target the cancer cells
• Radiotherapy — high energy rays are used to destroy cancer cells in a targeted area
• Surgery — an operation where the cancerous tissue is cut out; there are three main types of surgery:
• Lobectomy, where part of the lung is cut out
• Pneumonectomy, where a whole lung is removed 
• Wedge resection, where a section of the lung is removed

A combination or series of treatments may be recommended to treat your cancer.

What type of treatment will I have?

Surgery, followed by chemotherapy, is usually recommended to treat very early-stage SCLC where the cancer hasn’t spread. However, in most cases, SCLC is only diagnosed after it has spread to some extent and in these cases, surgery is not usually appropriate. You will instead be offered chemotherapy and radiotherapy. 

If you have NSCLC and you are in good health, you will most likely be offered surgery to remove the cancer, followed by chemotherapy.

How is surgery performed?

The type of surgery you have will depend on the position and size of your cancer. In most cases, a cut will be made in the side or front of your chest so that the cancerous tissue can be removed. 

In some cases, you may be offered keyhole surgery called video-assisted thoracoscopic surgery (VATS). This uses smaller cuts and involves inserting a small camera inside your chest to help your surgeon see the tissue they are operating on. 

If you need to have all or part of your lung removed, then you may have open lung surgery called a thoracotomy. A cut will be made on the side of your chest, usually around 10-20cm long, to remove some of your lung tissue. 

Lung surgery is a serious operation and will only be offered if you are well enough to cope with it.