Overview

Cancer of the lung
Cancer of the lung

Lung cancer is one of the most common and serious types of cancer. Around 47,000 people are diagnosed with the condition every year in the UK.

There are usually no signs or symptoms in the early stages of lung cancer, but many people with the condition eventually develop symptoms including:

  • a persistent cough
  • coughing up blood
  • persistent breathlessness
  • unexplained tiredness and weight loss
  • an ache or pain when breathing or coughing

You should see a GP if you have these symptoms.

Types of lung cancer

Cancer that begins in the lungs is called primary lung cancer. Cancer that spreads to the lungs from another place in the body is known as secondary lung cancer. This page is about primary lung cancer.

There are two main forms of primary lung cancer. These are classified by the type of cells in which the cancer starts growing. They are:

  • non-small-cell lung cancer – the most common form, accounting for more than 87% of cases. It can be one of three types: squamous cell carcinoma, adenocarcinoma or large-cell carcinoma.
  • small-cell lung cancer – a less common form that usually spreads faster than non-small-cell lung cancer.

The type of lung cancer you have determines which treatments are recommended.

Who's affected

Lung cancer mainly affects older people. It's rare in people younger than 40. More than 4 out of 10 people diagnosed with lung cancer in the UK are aged 75 and older.

Although people who have never smoked can develop lung cancer, smoking is the most common cause (accounting for about 72% of cases). This is because smoking involves regularly inhaling a number of different toxic substances.

Treating lung cancer

Treatment depends on the type of mutation the cancer has, how far it's spread and how good your general health is.

If the condition is diagnosed early and the cancerous cells are confined to a small area, surgery to remove the affected area of lung may be recommended.

If surgery is unsuitable due to your general health, radiotherapy to destroy the cancerous cells may be recommended instead.

If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy is usually used.

There are also a number of medicines known as targeted therapies. They target a specific change in or around the cancer cells that is helping them to grow. Targeted therapies cannot cure lung cancer but they can slow its spread.

Outlook

Lung cancer does not usually cause noticeable symptoms until it's spread through the lungs or into other parts of the body. This means the outlook for the condition is not as good as many other types of cancer.

About 1 in 3 people with the condition live for at least 1 year after they're diagnosed and about 1 in 20 people live at least 10 years.

However, survival rates vary widely, depending on how far the cancer has spread at the time of diagnosis. Early diagnosis can make a big difference.

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Symptoms

There are usually no signs or symptoms in the early stages. Symptoms of lung cancer develop as the condition progresses.

The main symptoms of lung cancer include:

  • a cough that doesn’t go away after 2 or 3 weeks
  • a long-standing cough that gets worse
  • chest infections that keep coming back
  • coughing up blood
  • an ache or pain when breathing or coughing
  • persistent breathlessness
  • persistent tiredness or lack of energy
  • loss of appetite or unexplained weight loss

If you have any of these, you should see a GP.

Less common symptoms of lung cancer include:

  • changes in the appearance of your fingers, such as becoming more curved or their ends becoming larger (this is known as finger clubbing)
  • difficulty swallowing (dysphagia) or pain when swallowing
  • wheezing
  • a hoarse voice 
  • swelling of your face or neck
  • persistent chest or shoulder pain

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Who can get it

Most cases of lung cancer are caused by smoking, although people who have never smoked can also develop the condition.

Smoking

Smoking cigarettes is the single biggest risk factor for lung cancer. It's responsible for more than 70% of cases.

Tobacco smoke contains more than 60 different toxic substances, which are known to be carcinogenic (cancer-producing).

If you smoke more than 25 cigarettes a day, you are 25 times more likely to get lung cancer than a non-smoker.

While smoking cigarettes is the biggest risk factor, using other types of tobacco products can also increase your risk of developing lung cancer and other types of cancer, such as oesophageal cancer and mouth cancer. These products include:

  • cigars
  • pipe tobacco
  • snuff (a powdered form of tobacco)
  • chewing tobacco

Smoking cannabis has also been linked to an increased risk of lung cancer. Most cannabis smokers mix cannabis with tobacco. While they tend to smoke less tobacco than people who smoke regular cigarettes, they usually inhale more deeply and hold the smoke in their lungs for longer.

It's been estimated that smoking 4 joints (homemade cigarettes containing a mix of tobacco and cannabis) may be as damaging to the lungs as smoking 20 cigarettes.

Even smoking cannabis without mixing it with tobacco is potentially dangerous. This is because cannabis also contains substances that can cause cancer.

Passive smoking

If you do not smoke, frequent exposure to other people’s tobacco smoke (passive smoking) can increase your risk of developing lung cancer.

Radon

Radon is a natural radioactive gas that comes from tiny amounts of uranium present in all rocks and soils. It can sometimes be found in buildings.

If radon is breathed in, it can damage your lungs, particularly if you're a smoker. Radon gas causes a small number of lung cancer deaths in the UK.

Occupational exposure and pollution

Exposure to certain chemicals and substances which are used in several occupations and industries may increase your risk of developing lung cancer. These chemicals and substances include:

  • arsenic
  • asbestos
  • beryllium
  • cadmium
  • coal and coke fumes
  • silica
  • nickel

Research also suggests that being exposed to diesel fumes over many years increases your risk of developing lung cancer. One study has shown your risk of developing lung cancer increases by around 33% if you live in an area with high levels of nitrogen oxide gases (mostly produced by cars and other vehicles).

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Diagnosis

See a GP if you have symptoms of lung cancer, such as breathlessness or a persistent cough.

The GP will ask about your general health and your symptoms. They may examine you and ask you to breathe into a device called a spirometer, which measures how much air you breathe in and out.

You may be asked to have a blood test to rule out some of the possible causes of your symptoms, such as a chest infection.

Chest X-ray

A chest X-ray is usually the 1st test used to diagnose lung cancer. Most lung tumours appear on X-rays as a white-grey mass.

However, chest X-rays cannot give a definitive diagnosis because they often cannot distinguish between cancer and other conditions, such as a lung abscess (a collection of pus that forms in the lungs).

If a chest X-ray suggests you may have lung cancer, you should be referred to a specialist in chest conditions.

A specialist can arrange more tests to investigate whether you have lung cancer and, if you do, what type it is and how much it's spread.

CT scan

A CT scan is usually the next test you'll have after a chest X-ray. A CT scan uses X-rays and a computer to create detailed images of the inside of your body.

Before having a CT scan, you'll be given an injection containing a special dye called a contrast medium, which helps to improve the quality of the images.

The scan is painless and takes 10 to 30 minutes.

PET-CT scan

A PET-CT scan may be done if the results of a CT scan show you have cancer at an early stage.

The PET-CT scan (which stands for positron emission tomography-computerised tomography) can show where there are active cancer cells. This can help with diagnosis and choosing the best treatment.

Before having a PET-CT scan, you'll be injected with a slightly radioactive material. You'll be asked to lie down on a table, which slides into the PET scanner.

The scan is painless and takes 30 to 60 minutes.

Bronchoscopy and biopsy

If a CT scan shows there might be cancer in the central part of your chest, you may be offered a bronchoscopy.

A bronchoscopy is a procedure that allows a doctor to see the inside of your airways and remove a small sample of cells (biopsy).

During a bronchoscopy, a thin tube with a camera at the end, called a bronchoscope, is passed through your mouth or nose, down your throat and into your airways.

The procedure may be uncomfortable, so you'll be offered a sedative before it starts, to help you relax, and a local anaesthetic to make your throat numb. The procedure takes around 30 to 40 minutes.

A newer procedure is called an endobronchial ultrasound scan (EBUS), which combines a bronchoscopy with an ultrasound scan.

Like a bronchoscopy, an EBUS allows a doctor to see the inside of your airways. However, the ultrasound probe on the end of the camera also allows the doctor to locate the lymph nodes in the centre of the chest so they can take a biopsy from them.

The procedure takes around 90 minutes.

Lymph nodes are part of a network of vessels and glands that spread throughout the body and work as part of your immune system.

A biopsy from a lymph node can show if cancerous cells are growing there and what type they are.

Other types of biopsy

You may be offered a different type of biopsy. This may be a type of surgical biopsy, such as a thoracoscopy, a mediastinoscopy, or a biopsy done using a needle inserted through your skin (percutaneous).

Thoracoscopy

A thoracoscopy is a procedure that allows a doctor to examine a particular area of your chest and take tissue and fluid samples.

You're likely to need a general anaesthetic before having a thoracoscopy.

Two or three small cuts will be made in your chest to pass a tube (similar to a bronchoscope) into your chest.

A doctor uses the tube to look inside your chest and take tissue samples. The samples are then sent to a laboratory for testing.

After a thoracoscopy, you may need to stay in hospital overnight while any fluid in your lungs is drained.

Mediastinoscopy

A mediastinoscopy allows a doctor to examine the area between your lungs at the centre of your chest (mediastinum).

For this test, you'll need to have a general anaesthetic and stay in hospital for a couple of days.

The doctor will make a small cut at the bottom of your neck so they can pass a thin tube into your chest.

The tube has a camera at the end, which enables a doctor to see inside your chest.

They'll also be able to take samples of cells from your lymph nodes during the procedure.

The lymph nodes are tested because they're usually the first place that lung cancer spreads to.

Percutaneous needle biopsy

A local anaesthetic is used to numb the skin. A doctor then uses a CT scanner to guide a needle through your skin into your lung to the site of a suspected tumour.

The needle is used to remove a small amount of tissue from a suspected tumour so it can be tested at a laboratory.

Risks of biopsies

Like all medical procedures, a lung biopsy does carry a small risk of complications, such as a pneumothorax. This is when air leaks out of the lung and into the space between your lungs and the chest wall.

This can put pressure on the lung, causing it to collapse.

The clinician doing the biopsy will be aware of the potential risks involved. They should explain all the risks in detail before you agree to have the procedure. They will monitor you to check for symptoms of a pneumothorax, such as sudden shortness of breath.

If a pneumothorax does happen, it can be treated using a needle or tube to remove the excess air, allowing the lung to expand normally again.

Staging

Once tests have been completed, it should be possible for doctors to know what stage your cancer is, what this means for your treatment and whether it's possible to completely cure the cancer.

Non-small-cell lung cancer staging

Clinicians use a staging system for lung cancer called TNM, where:

  • T describes the size of the tumour (cancerous tissue)
  • N describes the spread of the cancer into lymph nodes
  • M describes whether the cancer has spread to another area of the body such as the liver (metastasis)

T

There are 4 main stages for T:

T1 lung cancer means that the cancer is still inside the lung.
T1 is broken down into 3 sub-stages:

  • T1a – the tumour is no wider than 1cm
  • T1b – the tumour is between 1cm and 2cm wide
  • T1c – the tumour between 2cm and 3cm wide

T2 is used to describe 3 possibilities:

  • the tumour is between 3cm and 5cm wide, or
  • the tumour has spread into the main airway or the inner lining of the chest wall, or
  • the lung has collapsed or is blocked due to inflammation

T3 is used to describe 3 possibilities:

  • the tumour is between 5cm and 7cm wide, or
  • there is more than 1 tumour in the lung, or
  • the tumour has spread into the chest wall, the phrenic nerve (a nerve close to the lungs), or the outer layer of the heart (pericardium)

T4 is used to describe a range of possibilities including:

  • the tumour is wider than 7cm, or
  • the tumour has spread into both sections of the lung (each lung is made up of 2 sections, known as lobes), or
  • the tumour has spread into an area of the body near to the lung, such as the heart, the windpipe, the food pipe (oesophagus) or a major blood vessel

N

There are 3 main stages for N:

N1 is used to describe cancerous cells in the lymph nodes located inside the lung or in the area where the lungs connect to the airway (the hilum).

N2 is used to describe 2 possibilities:

  • there are cancerous cells in the lymph nodes located in the centre of the chest on the same side as the affected lung, or
  • there are cancerous cells in the lymph nodes underneath the windpipe

N3 is used to describe 3 possibilities:

  • there are cancerous cells in the lymph nodes located on the chest wall on the other side of the affected lung, or
  • there are cancerous cells in the lymph nodes above the collar bone, or
  • there are cancerous cells in the lymph nodes at the top of the lung

M

There are 2 main stages for M:

  • M0 – the cancer has not spread outside the lung to another part of the body
  • M1 – the cancer has spread outside the lung to another part of the body

Small-cell lung cancer

Small-cell lung cancer is less common than non-small-cell lung cancer. The cancerous cells are smaller in size than the cells that cause non-small-cell lung cancer.

Small-cell lung cancer only has 2 possible stages:

  • limited disease – the cancer has not spread beyond the lung
  • extensive disease – the cancer has spread beyond the lung

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Lung cancer screening

There's currently no national screening programme for lung cancer in the UK. However, trials and studies are assessing the effectiveness of lung cancer screening, so this may change in the future.

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Treatment

Treatment for lung cancer is managed by a team of specialists from different departments who work together to provide the best possible treatment.

This team includes the health professionals required to make a diagnosis, to stage your cancer and to plan the best treatment. If you want to know more, ask your doctor or nurse about this.

The type of treatment you receive for lung cancer depends on several factors, including:

  • the type of lung cancer you have (non-small-cell or small-cell mutations on the cancer)
  • the size and position of the cancer
  • how advanced your cancer is (the stage)
  • your overall health

Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

The most common treatment options include surgery, radiotherapy, chemotherapy and immunotherapy. Depending on the type of cancer and the stage, you may receive a combination of these treatments.

Your treatment plan

Your suggested treatment plan depends on whether you have non-small-cell lung cancer or small-cell lung cancer.

Non-small-cell lung cancer

If you have non-small-cell lung cancer that's in only 1 of your lungs and you're in good general health, you'll probably have surgery to remove the cancerous cells. This may be followed by a course of chemotherapy to destroy any cancer cells that may have remained in your body.

If the cancer has not spread far but surgery is not possible (for example, because your general health means you have an increased risk of complications), you may be offered radiotherapy to destroy the cancerous cells. In some cases, this may be combined with chemotherapy (known as chemoradiotherapy).

If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy and / or immunotherapy is usually recommended. If the cancer starts to grow again after you have had chemotherapy treatment, another course of treatment may be recommended.

In some cases, if the cancer has a specific mutation, biological or targeted therapy may be recommended instead of chemotherapy, or after chemotherapy. Biological therapies are medicines that control or stop the growth of cancer cells.

Small-cell lung cancer

Small-cell lung cancer is usually treated with chemotherapy, either on its own or in combination with radiotherapy. This can help to prolong life and relieve symptoms.

Surgery isn't usually used to treat this type of lung cancer. This is because the cancer has often already spread to other areas of the body by the time it's diagnosed. However, if the cancer is found very early, surgery may be used. In these cases, chemotherapy or radiotherapy may be given after surgery to help reduce the risk of the cancer returning.

Surgery

There are 3 types of lung cancer surgery:

  • lobectomy – where one or more large parts of the lung (called lobes) are removed. Your doctors will suggest this operation if the cancer is just in 1 section of 1 lung.
  • pneumonectomy – where the entire lung is removed. This is used when the cancer is located in the middle of the lung or has spread throughout the lung.
  • wedge resection or segmentectomy – where a small piece of the lung is removed. This procedure is only suitable for a small number of patients. It is only used if your doctors think your cancer is small and limited to one area of the lung. This is usually very early-stage non-small-cell lung cancer.

People may be concerned about being able to breathe if some or all of a lung is removed, but it's possible to breathe normally with 1 lung. However, if you have breathing problems before the operation, it's likely these symptoms will continue after surgery.

Tests before surgery

Before surgery, you'll need to have some tests to check your general state of health and your lung function. These may include:

  • an electrocardiogram (ECG) – electrodes are used to monitor the electrical activity of your heart
  • a lung function test called spirometry – you'll breathe into a machine which measures how much air your lungs can breathe in and out
  • an exercise test

How it's performed

Surgery is usually done by making a cut (incision) in your chest or side and removing a section or all of the affected lung. Nearby lymph nodes may also be removed if it's thought that the cancer may have spread to them.

In some cases, an alternative to this approach, called video-assisted thoracoscopic surgery (VATS), may be suitable. VATS is a type of keyhole surgery, where small incisions are made in the chest. A small camera is inserted into one of the incisions, so the surgeon can see the inside of your chest on a monitor as they remove the section of affected lung.

After the operation

You'll probably be able to go home 5 to 10 days after your operation. However, it can take many weeks to recover fully from a lung operation.

After your operation, you'll be encouraged to start moving as soon as possible. Even if you have to stay in bed, you'll need to keep doing regular leg movements to help your circulation and prevent blood clots from forming. A physiotherapist will show you breathing exercises to help prevent complications.

When you go home, you'll need to exercise gently to build up your strength and fitness. Walking and swimming are good forms of exercise that are suitable for most people after treatment for lung cancer. Talk to your care team about which types of exercise are suitable for you.

Complications

As with all surgery, lung surgery carries a risk of complications. It is estimated that around 1 in 5 lung cancer surgeries will lead to complications. These complications can usually be treated using medicine or more surgery, which may mean you need to stay in hospital for longer.

Complications of lung surgery can include:

  • inflammation or infection of the lung (pneumonia) 
  • excessive bleeding 
  • a blood clot in the leg (deep vein thrombosis), which could potentially travel up to the lung (pulmonary embolism)

Radiotherapy

Radiotherapy uses pulses of radiation to destroy cancer cells. There are a number of ways it can be used to treat lung cancer.

An intensive course of radiotherapy, known as radical radiotherapy, may be used to treat non-small-cell lung cancer if you are not healthy enough for surgery. For very small tumours, a special type of radiotherapy called stereotactic radiotherapy may be used instead of surgery.

Radiotherapy can also be used to control the symptoms, such as pain and coughing up blood, and to slow the spread of cancer when a cure is not possible (this is known as palliative radiotherapy).

A type of radiotherapy known as prophylactic cranial irradiation (PCI) is also sometimes used during the treatment of small-cell lung cancer. PCI involves treating the whole brain with a low dose of radiation. It's used as a preventative measure because there's a risk that small-cell lung cancer will spread to your brain.

The 3 main ways that radiotherapy can be given are:

  • conventional external beam radiotherapy – beams of radiation are directed at the affected parts of your body. 
  • stereotactic radiotherapy – a more accurate type of external beam radiotherapy where several high-energy beams deliver a higher dose of radiation to the tumour, while avoiding the surrounding healthy tissue as much as possible.
  • internal radiotherapy – a thin tube (catheter) is inserted into your lung. A small piece of radioactive material is passed along the catheter and placed against the tumour for a few minutes, then removed.

For lung cancer, external beam radiotherapy is used more often than internal radiotherapy, particularly if it's thought that a cure is possible. Stereotactic radiotherapy may be used to treat tumours that are very small, as it's more effective than standard radiotherapy alone in these circumstances.

Internal radiotherapy is usually used as a palliative treatment when the cancer is blocking or partly blocking your airway.

Courses of treatment

Radiotherapy treatment can be planned in several different ways.

People having conventional radical radiotherapy are likely to have 20 to 32 treatment sessions.

Radical radiotherapy is usually given 5 days a week, with a break at weekends. Each session of radiotherapy lasts 10 to 15 minutes and the course usually lasts 4 to 7 weeks.

Continuous hyperfractionated accelerated radiotherapy (CHART) is an alternative way of giving radical radiotherapy. CHART is given 3 times a day for 12 days in a row.

Stereotactic radiotherapy requires fewer treatment sessions because a higher dose of radiation is given during each treatment. People having stereotactic radiotherapy usually have 3 to 10 treatment sessions.

Palliative radiotherapy usually involves 1 to 5 sessions. 

Side effects

Side effects of radiotherapy to the chest include:

  • pain in the chest 
  • fatigue (tiredness)
  • persistent cough that may bring up blood-stained phlegm (this is normal and nothing to worry about) 
  • difficulties swallowing (dysphagia) 
  • redness and soreness of the skin, which looks and feels like sunburn 
  • hair loss on your chest 

Side effects should pass after the radiotherapy has been completed.

Chemotherapy

Chemotherapy uses powerful cancer-killing medicine to treat cancer. There are several ways that chemotherapy can be used to treat lung cancer. For example, it can be:

  • given before surgery to shrink a tumour, which can increase the chance of successful surgery (this is usually only done as part of a clinical trial).
  • given after surgery to prevent the cancer returning. 
  • used to relieve symptoms and slow the spread of cancer when a cure isn't possible.
  • combined with radiotherapy.

Chemotherapy treatments are usually given in cycles. A cycle involves taking chemotherapy medicine for several days, then having a break for a few weeks to let the therapy work and for your body to recover from the effects of the treatment.

The number of cycles you need will depend on the type and grade of lung cancer.

Most people need 4 to 6 cycles of treatment over 3 to 6 months. You will see your doctor after these cycles have finished. If the cancer has improved, you may not need any more treatment.

If the cancer has not improved after these cycles, your doctor will tell you if you need a different type of chemotherapy. Alternatively, you may need maintenance chemotherapy to keep the cancer under control.

Chemotherapy for lung cancer involves taking a combination of different medicines. The medicines are usually given through a drip into a vein (intravenously), or into a tube connected to one of the blood vessels in your chest. Some people may be given capsules or tablets to swallow instead.

Before you start chemotherapy, your doctor might prescribe you some vitamins and/or give you a vitamin injection. These help to reduce some the side effects.

Side effects

Side effects of chemotherapy can include:

  • fatigue 
  • feeling sick
  • being sick
  • mouth ulcers
  • hair loss

These side effects should gradually pass after treatment has finished, or you may be able to take other medicines to make you feel better during your chemotherapy.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Tell your care team or GP as soon as possible if you have signs of an infection, such as a high temperature, or you suddenly feel generally unwell.

Immunotherapy

Immunotherapy is a group of medicines that stimulate your immune system to target and kill cancer cells.

Immunotherapy can be used on its own or combined with chemotherapy.

A immunotherapy medicine called pembrolizumab is an option for non-small cell lung cancer. It is given through a drip into a vein in your arm or hand.

It takes around 30 minutes to receive a dose, and you will normally take a dose every 3 weeks. If the side effects are not too difficult to manage and the therapy is successful, immunotherapy can be taken for up to 2 years.

Side effects of pembrolizumab include:

  • feeling and being sick
  • joint pain and swelling
  • diarrhoea
  • fatigue
  • changes to your skin, such as your skin becoming dry or itchy

Targeted therapies

Targeted therapies (also known as biological therapies) are medicines designed to slow the spread of advanced non-small cell lung cancer.

Targeted therapies are only suitable for people who have certain proteins in their cancerous cells. Your doctor may request tests on cells removed from your lung (a biopsy) to see if these treatments are suitable for you.

Side-effects of targeted therapies include:

  • flu-like symptoms such as chills, high temperature and muscle pain
  • fatigue
  • diarrhoea
  • loss of appetite
  • mouth ulcers
  • feeling sick

Other treatments

As well as surgery, radiotherapy and chemotherapy, other treatments are sometimes used to treat lung cancer, such as:

Radiofrequency ablation

Radiofrequency ablation may be used to treat non-small-cell lung cancer at an early stage.

The doctor uses a CT scanner to guide a needle to the site of the tumour. The needle is pressed into the tumour and radio waves are sent through the needle. These waves generate heat, which kills the cancer cells.

The most common complication of radiofrequency ablation is a pocket of air may become trapped between the inner and outer layer of your lung (pneumothorax). This can be treated by placing a tube into the lungs to release the trapped air.

Cryotherapy

Cryotherapy can be used if the cancer starts to block your airways. This is known as endobronchial obstruction, and it can cause symptoms such as:

breathing problems
a cough
coughing up blood

Cryotherapy is done in a similar way to internal radiotherapy, but instead of using a radioactive source, a device known as a cryoprobe is placed against the tumour. The cryoprobe can generate very cold temperatures, which help to shrink the tumour.

Photodynamic therapy

Photodynamic therapy (PDT) can be used to treat early-stage lung cancer when a person is unable or unwilling to have surgery. It can also be used to remove a tumour that's blocking the airways.

Photodynamic therapy is done in 2 stages. First you'll be given an injection of a medicine that makes the cells in your body very sensitive to light.

The next stage is done 24 to 72 hours later. A thin tube is guided to the site of the tumour and a laser is beamed through it. The cancerous cells, which have become more sensitive to light, are destroyed by the laser beam.

Side effects of PDT can include inflammation of the airways and a build-up of fluid in the lungs. Both these side effects can cause breathlessness and lung and throat pain. However, these symptoms should gradually pass as your lungs recover from the effects of the treatment.

Will the NHS fund an unlicensed medicine if my doctor wants to prescribe it?

Your doctor can prescribe a medicine outside its licensed use if they're willing to take personal responsibility for this "off-licence" use of the medicine.

Your local clinical commissioning group (CCG) may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medication from NHS budgets.

Find out about access to new treatment.

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Living with

Lung cancer can affect your daily life in different ways, depending on what stage it's at and the treatment you're having.

Although not all these steps work for everybody, there are several ways you can find support to help you cope:

  • talk to your friends and family
  • talk to other people in the same situation
  • know about your condition
  • do not try to do too much
  • make time for yourself

Lung cancer specialist nurses

Your specialist team should have at least 1 lung cancer nurse specialist (CNS) working with them. Ask your doctor to arrange for you to see a specialist nurse, who can support you and provide information about other sources of advice and support. They will also have a contact number so you can call them later if you have any questions.

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Breathlessness

Breathlessness is common in people who have lung cancer, whether it is a symptom of the condition or a side effect of treatment.

In many cases, breathlessness can be improved with some simple measures such as:

  • breathing in slowly through your nose and out through your mouth (after treatment for lung cancer, you may see a physiotherapist, who can teach you some simple breathing exercises).
  • making daily activities easier – for example, using a trolley when you go shopping or keeping things you often need downstairs, so you don't need to regularly walk up and down the stairs.
  • using a fan to direct cool air towards your face.
  • eating smaller and more frequent meals and taking smaller mouthfuls.

If measures like these aren't enough to control your breathlessness, you may need further treatment. There are medicines that can help to improve breathlessness. Home oxygen treatment may be an option in severe cases.

If breathlessness is caused by another condition, such as a chest infection or a build-up of fluid around the lungs (pleural effusion), treating this may help your breathing.

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Pain

Some people with lung cancer have pain, while others never have any.

Pain is not related to the severity of the cancer – it varies from person to person. What causes cancer pain isn’t thoroughly understood, but there are ways of treating it so the pain can be controlled.

People with advanced lung cancer may need treatment for pain as their cancer progresses. This can be part of palliative care, and is often provided by doctors, nurses and other members of a palliative care team. You can have palliative care at home, in hospital, in a hospice or other care centre.

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Emotional effects and relationships

Having cancer can lead to a range of emotions. These may include shock, anxiety, relief, sadness and depression.

People deal with serious problems in different ways. It's hard to predict how living with cancer will affect you.

Being open and honest about how you feel and what your family and friends can do to help you may put others at ease. But do not feel shy about telling people that you need some time to yourself, if that's what you need.

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Talk to others

Your CNS or GP may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist phone helpline. Your GP surgery will have information on these.

You may find it helpful to talk about your experience of lung cancer with others at a local support group. Patient organisations have local groups where you can meet other people who have been diagnosed with lung cancer and had treatment.

If you have feelings of depression, talk to a GP so they can provide you with advice and support.

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Money and financial support

If you have to reduce or stop work because of cancer, you may find it hard to cope financially. If you have cancer or you're caring for someone with cancer, you may be entitled to financial support.

  • If you have a job but can't work because of your illness, you are entitled to Statutory Sick Pay from your employer.
  • If you don't have a job and can't work because of your illness, you may be entitled to Employment and Support Allowance.
  • If you're caring for someone with cancer, you may be entitled to Carer's Allowance.
  • You may be eligible for other benefits if you have children living at home or you have a low household income.

It's a good idea to find out what help is available to you soon after your diagnosis. You could ask to speak to the social worker at your hospital, who can give you more information.

Free prescriptions

People being treated for cancer may apply for an exemption certificate which gives them free prescriptions for all medication, including treatment for unrelated conditions.

The certificate is valid for 5 years and you can apply for a certificate by speaking to a GP or cancer specialist.

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Palliative care

If lung cancer cannot be cured and you have a lot of troubling symptoms, your GP and specialist team can give you support and pain relief. This is called palliative care. Support is also available for your family and friends.

As the cancer progresses, your doctor should work with you to establish a clear management plan based on your (and your carer's) wishes. This includes whether you'd prefer to go to hospital, a hospice, or be looked after at home as you become more ill.

It will take account of what services are available to you locally, what's clinically advisable and your personal circumstances.

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Prevention

If you smoke, the best way to prevent lung cancer and other serious conditions is to stop smoking as soon as possible.

However long you have been smoking, it's always worth quitting. Every year you do not smoke decreases your risk of getting serious illnesses, such as lung cancer. After 10 years of not smoking, your chances of developing lung cancer falls to half that of someone who smokes.

Help Me Quit can offer advice and support to help you quit smoking. You can call 0808 278 6119, or visit the website.

A GP or pharmacist can also give you advice about stopping smoking.

A balanced diet

Research suggests that eating a low-fat, high-fibre diet, including at least 5 portions a day of fresh fruit and vegetables and plenty of wholegrains, can reduce your risk of lung cancer, as well as other types of cancer and heart disease.

Exercise

There's strong evidence to suggest that regular exercise can lower the risk of developing lung cancer and other types of cancer.

Most adults are recommended to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity each week, plus strength-training exercises on at least 2 days each week.

Find out more about health and fitness.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 20/10/2020 12:19:01