Lung cancer

Lung cancer — symptoms and survival in the modern era

Lung cancer is the third most common cancer in the UK and leading cause of cancer death — ~48,000 cases yearly. Smoking causes most cases — but never-smokers develop lung cancer too — often different biology with targetable mutations.

Survival improving — immunotherapy and molecular targeted drugs transformed advanced NSCLC — early detection still best cure chance.

Symptoms — see GP

NICE referral criteria include:

• haemoptysis — any amount — urgent CXR
• chest X-ray for ≥3 week cough in smokers/ex-smokers
• persistent/recurrent chest infection
• weight loss, chest pain, hoarseness
• clubbing, supraclavicular lymph node

Advanced:

• bone pain
• brain metastases — headache, seizures
• SVCO — facial swelling, distended veins
• pleural effusion — breathlessness

Types

Non-small cell lung cancer (NSCLC) — ~85%

• adenocarcinoma — outer lung, never-smokers common
• squamous cell carcinoma — central, smoking-linked
• large cell

Small cell lung cancer (SCLC) — ~15%

• rapid growth, early spread
• chemoradiotherapy sensitive — limited vs extensive stage
• prophylactic cranial irradiation selected limited stage

Diagnosis pathway

1. Chest X-ray
2. CT thorax — staging scan
3. Biopsy — histology mandatory
4. Molecular profiling — EGFR, ALK, ROS1, BRAF, PD-L1, KRAS
5. PET-CT — metastasis search
6. MDT — treatment plan

Treatment overview

Early NSCLC:

• lobectomy — video-assisted thoracoscopic (VATS)
• stereotactic ablative radiotherapy (SABR) — inoperable early

Locally advanced:

• chemoradiotherapy
• immunotherapy consolidation — durvalumab post-chemorRT

Advanced/metastatic NSCLC:

• pembrolizumab monotherapy if PD-L1 high
• chemo-immunotherapy combinations
• osimertinib — EGFR mutation
• alectinib — ALK
• supportive care — breathlessness clinics

SCLC:

• platinum-etoposide — extensive stage + atezolizumab/durvalumab

Prevention

• stop smoking — risk falls but never to never-smoker level fully
• avoid asbestos — occupational
• radon — home testing high-risk areas

Lung cancer vs COPD

Both cause breathlessness and cough — new haemoptysis or weight loss — cancer until excluded — see COPD for chronic airflow limitation distinction.

3-week cough + smoking history — CXR same week — not repeat antibiotics alone.

Common questions

What are the early signs of lung cancer?

Persistent cough — new or changed — over 3 weeks, coughing blood, breathlessness, chest or shoulder pain, repeated chest infections, fatigue, weight loss, loss of appetite, hoarse voice, finger clubbing. Early stage may have no symptoms — reason screening pilots exist for high-risk groups.

Can non-smokers get lung cancer?

Yes — roughly 10 to 15% of cases — often adenocarcinoma in outer lung. Radon gas, occupational asbestos exposure, air pollution, and genetic factors contribute. Never assume immunity because you never smoked.

How is lung cancer diagnosed?

Chest X-ray first — CT chest with contrast if suspicious. PET-CT for staging. Biopsy — bronchoscopy, CT-guided needle, or EBUS for lymph nodes — confirms histology and molecular testing (EGFR, ALK, PD-L1). Staging determines treatment — I to IV.

Is lung cancer curable?

Stage I to II NSCLC — surgery or stereotactic radiotherapy can cure selected patients. Advanced stage — not usually curable but immunotherapy (pembrolizumab) and targeted drugs (osimertinib for EGFR) extend survival significantly compared to chemotherapy alone. Small cell — chemoradiotherapy sensitive but often relapses.

Should I get screened for lung cancer?

If invited to NHS Targeted Lung Health Check (current or ex-smokers 55–74 in pilot areas) — attend. No universal UK screening yet outside programmes. Discuss with GP if high risk — heavy smoking history, asbestos exposure.

Sources

• NHS — Lung cancer
• NICE — Lung cancer diagnosis and management
• Roy Castle Lung Cancer Foundation