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Your Questions Answered: Lung Cancer

Specialist Interview

Every year, around 47,000 are diagnosed with lung cancer – one of the most widespread and serious forms of cancer in the UK. With early detection and the right treatment, however, the prognosis can be very good for lung cancer patients.

Professor Margaret Johnson, one of the country’s leading consultants in Thoracic medicine focusing on chest and respiratory conditions involving the lungs, spoke to us about the causes, signs and treatment of lung cancer.

What is lung cancer, and what are its symptoms?

Lung cancer refers to malignancies that originate in the airways or lung parenchyma. It may present in many different ways, the most common presentation is a persistent cough. The other common presenting symptoms are chest pain, coughing up blood, shortness of breath, wheeze and weight loss. Unfortunately, many patients present with advanced disease reflecting the aggressive biology of lung cancer.

What causes lung cancer?

The primary risk factor for the development of lung cancer is cigarette smoking and this accounts for approximately 90% of all lung cancers. We do not yet know the risk from vaping and that is partly because most people who vape have previously smoked but the likelihood is that this is less of a risk than tobacco.

Other factors that increase the risk of lung cancer include environmental toxins, asbestos exposure, pulmonary fibrosis, radiotherapy for other malignancies and HIV infection.

How do you diagnose lung cancer?

Diagnosing lung cancer usually starts with a chest x-ray followed by a CT scan and often a PET scan. If there are changes that look like lung cancer the next step is to establish a definitive diagnosis to identify the type and the stage of lung cancer so that decisions can be made on the optimal way to confirm the diagnosis and to decide on treatment.

At this stage, patients should be discussed at a multidisciplinary team meeting to decide how a tissue biopsy would be obtained. This could be either via a bronchoscopy which in some patients may be combined with endobronchial ultrasound. For other patients, a CT or ultrasound-guided percutaneous needle biopsy may be undertaken. The specimens are then sent for cytology, histology and often include molecular tests. These results can take some time but it is very important to get as much information about the type of lung cancer to ensure the right treatment decisions are made.

How can lung cancer be treated?

Having confirmed the diagnosis, treatment is largely determined by the type of tumour and the stage of disease. For patients with non-small cell lung cancer with early disease surgical removal offers the best opportunity for cure. If this is not possible other options include radiotherapy, chemotherapy, targeted therapies and immunotherapies.

It is important to get symptoms checked as soon as possible

Lung cancer outcomes have significantly improved over the past few years. For that reason it is very very important, particularly in COVID times, when people have been reluctant to come to hospital, to realise that if you have worrying chest symptoms you should seek help as soon as possible without delay. There are many other causes for these symptoms but if it is lung cancer the sooner it is diagnosed the better the outlook.

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