Lung cancer

Each year in Queensland, around 2,300 (58% males and 42% females) learn they have lung cancer, contributing to around 14,500 Australians being diagnosed. With the average age of diagnosis around 72, it’s the fifth most common cancer in Australia – touching the lives of many people and families.

Lung cancer starts when abnormal cells in one or both lungs grow and multiply within the lung tissue. When these changes originate in the lungs, your healthcare team will refer to this as primary lung cancer.

Primary lung cancer consists of two main types:

• Non-small cell lung cancer (NSCLC) – This is the most common type, accounting for over 85% of diagnosed cases. It can be classified into three subcategories: squamous cell carcinoma, adenocarcinoma and large cell undifferentiated carcinoma.
• Small cell lung cancer (SCLC) – This rarer type occurs in about 15% of cases. It starts in the middle of the lungs and tends to spread faster than NSCLC.

Cancer cells from the lungs can sometimes spread (also known as metastasising) to other areas of the body, leading to what is called secondary cancer. These cells can travel to other tissues, such as the lymph nodes, brain, adrenal, liver, and bones, often requiring different treatment approaches. Cancerous cells in another part of the body, such as the liver, can travel to the lungs, causing secondary cancer to develop within the lung tissue.

Several other cancers can impact lung health without being classified as lung cancer. These include tumours between the lungs (mediastinum) or in the chest wall. Pleural Mesothelioma, which affects the lung’s protective covering (or pleura), is another related condition typically caused by asbestos exposure.

While not everyone who develops lung cancer has identifiable risk factors, understanding what may increase your risk can help with prevention. Though the exact causes aren’t fully understood, knowing these risk factors allows for more informed health decisions.

Common risk factors include:

• Tobacco smoking – In Australia, tobacco smoking accounts for around 90% of cases in men and 65% in women, with an increased risk from prolonged exposure. But 21% of people diagnosed are non-smokers, with passive smoking (exposure to second-hand smoke) raising the risk for non-smokers by 30%. <link to Living smoke-free> Learn more about living smoke free.
• Asbestos exposure – People who come in contact with asbestos have an increased risk of developing lung cancer or pleural mesothelioma. Although asbestos use in building materials was banned in 2004, it can still be present in older buildings and fences.
• Workplace toxic exposure – People exposed to radioactive gases like radon (such as uranium miners) and those working in industrial jobs with arsenic, cadmium, steel, nickel, or diesel have a higher risk of contracting lung cancer.
• Pre-existing health conditions – Conditions such as lung fibrosis, chronic bronchitis, pulmonary tuberculosis, emphysema or human immunodeficiency virus (HIV) may increase the risk of developing lung tumours.
• Older age – Most people diagnosed with lung cancer are over 60, but it can also occur in younger people.

If you’re concerned about any of the above factors, it might be helpful to talk to your GP or dedicated healthcare team.

Recognising potential signs and symptoms of lung cancer can lead to earlier medical care, although it’s important to remember that each person’s experience is different.

Some common signs to look for are

• A new persistent cough lasting more than three weeks, or noticeable changes to an existing cough.
• Unexplained breathlessness.
• Pain in the chest, upper back, and shoulder unrelated to any known injury. The chest pain may worsen with deep breathing, laughing, or coughing, and discomfort can be felt in the upper back and along the shoulder.
• A persistent and recurrent chest infection that lasts more than three weeks.
• Coughing up blood or rust coloured phlegm.

Lung cancer can also cause additional symptoms to the ones mentioned above, such as wheezing, fatigue, weight loss, hoarse voice, difficulty swallowing, abdominal pain, joint pain, neck or face swelling, and enlarged fingertips (finger clubbing).

Many of these symptoms can be caused by other conditions like long-term smoking, and sometimes lung cancer can be diagnosed during routine tests without people experiencing any symptoms at all. Although these signs don’t always mean you have cancer, it’s best to discuss any persistent or unusual changes with your GP so you can rule it out or take action early.

If your doctor is concerned that you may have cancer, they will conduct several tests to help them with a more accurate diagnosis and to create the best treatment plan for you.

Your initial testing may include:

• Chest X-ray or CT (computed tomography) scan (and sometimes both).
• Tissue biopsies of the lungs and nearby lymph nodes may be performed using various methods, including CT-guided lung biopsy, bronchoscopy, endobronchial ultrasound (EBUS), mediastinoscopy, or thoracoscopy. These are often done under anaesthesia and are generally considered low risk with minimal pain.
• Sputum testing samples mucus from the lungs.
• Pleural tap procedures sample fluid drained from the lungs.

To better guide your ongoing care, your doctor may need to collect more detailed information about the cancer. This will help assess the tumour’s growth stage and determine whether it has spread. These may include one or more of:

• PET-CT (positron emission tomography) scan combines with a CT scan to give them a comprehensive overview.
• CT or MRI (magnetic resonance imaging) of the brain and, in some cases where a PET scan is unavailable or the results unclear, you may also have a CT scan of the abdomen or bones.

Facing a cancer diagnosis can be an anxious time, but your healthcare team will be with you every step of the way. You are not alone, and you can always reach out to your GP or Cancer Council Queensland at 13 11 20 for more information and support.

Your healthcare team will create a treatment plan for you, taking into consideration the type and stage of cancer, your breathing capacity, and your overall health. Your treatment approach will vary depending on whether you have non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC).

For early stage NSCLC (stage I or II), surgery to remove the cancer and nearby lymph nodes is often the first step. When surgery isn’t possible, radiation can be an effective alternative. Chemotherapy may also be offered as part of your post-surgery care – alone or alongside radiation as a targeted approach.

If the NSCL is locally advanced (stage III), your team may suggest a combination treatment based on the specific location and the extent of lymph node involvement. These options may include surgery, chemotherapy, radiation and immunotherapy medications.

In advanced NSCLC (stage IV) cases, depending on your symptoms, your care team will focus on maintaining your quality of life with palliative treatment. This treatment protocol aims to support your body, manage symptoms, and make you as comfortable as possible rather than trying to cure the disease. This type of treatment can help many people dealing with cancer to live fulfilling lives.

Treatment options may include one or both of the following: palliative drug treatment (targeted therapy, immunotherapy, and chemotherapy) or palliative radiation therapy. Palliative treatment goes beyond medication. It’s about offering assistance and care that nurtures your physical, emotional, spiritual, and social wellbeing.

If you would like to learn more about treatment options or how to support a loved one going through lung cancer, download our comprehensive Understanding Lung Cancer booklet.

During your diagnosis, your specialist will likely discuss the prognosis of your cancer (the expected outcome of the disease). While your specialists will do their best to give you a clear idea of what lies ahead, this is not always possible to predict.

When discussing your outlook with you, your doctor can help you understand what to expect based on their experience with similar situations. They will explain the nature of your cancer, its stage, whether it has spread, and your treatment options.

Receiving a prognosis can be a daunting part of your journey. It’s completely natural to need time to process this information. If you have any questions or concerns, talk with your specialist so you feel comfortable as you move forward.