Lung cancer is one of the most common and serious types of cancer.
Around 44,500 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 your GP if you have these symptoms.
Types of lung cancer
Cancer that begins in the lungs is called primary lung cancer. Cancer
that spreads from the lungs to another place in the body is known as
secondary lung cancer. This page is about primary lung cancer.
There are two main types of primary lung cancer. These are classified by the type of cells in which the cancer starts. They are:
- non-small-cell lung cancer – the most common type, accounting for more than 80% of cases; can be either squamous cell carcinoma, adenocarcinoma or large-cell carcinoma
- small-cell lung cancer – a less common type that usually spreads faster than non-small-cell lung cancer
The type of lung cancer you have determines which treatments are recommended.
.
Diagnosing lung cancer
See your GP if you have symptoms of lung cancer, such as breathlessness or a persistent cough.
Your GP will ask about your general health and what symptoms you've
been experiencing. 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.
In 2015, the National Institute for Health and Care Excellence (NICE)
published guidelines to help GPs recognise the signs and symptoms of
lung cancer and refer people for the right tests faster. To find out if
you should be referred for further tests for suspected lung cancer, read
the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.
Chest X-ray
A chest X-ray is usually the first test used to diagnose lung cancer. Most lung tumours show up on X-rays as a white-grey mass.
However, chest X-rays can't give a definitive diagnosis because they
often can't distinguish between cancer and other conditions, such as a
lung abscess (a collection of pus that forms in the lungs).
If your chest X-ray suggests you may have lung cancer, you should be
referred to a specialist (if you haven't already) in chest conditions
such as lung cancer. A specialist can carry out 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 computerised tomography (CT) scan
is usually carried out 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 of a contrast
medium. This is a liquid containing a dye that makes the lungs show up
more clearly on the scan. The scan is painless and takes 10-30 minutes
to complete.
PET-CT scan
A PET-CT scan (which stands for positron emission
tomography-computerised tomography) may be carried out if the results of
the CT scan show you have cancer at an early stage.
The PET-CT scan can show where there are active cancer cells. This can help with diagnosis and 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 around 30-60
minutes.
Bronchoscopy and biopsy
If the CT scan shows there might be cancer in the central part of
your chest, you'll have a bronchoscopy. A bronchoscopy is a
procedure that allows a doctor or nurse to remove a small sample of
cells from inside your lungs.
During a bronchoscopy, a thin tube called a bronchoscope is used to
examine your lungs and take a sample of cells (biopsy). The bronchoscope
is passed through your mouth or nose, down your throat and into the
airways of your lungs.
The procedure may be uncomfortable, but you'll be given a mild sedative
beforehand to help you relax and a local anaesthetic to make your throat
numb. The procedure is very quick and only takes a few minutes.
Other types of biopsy
If you're not able to have one of the biopsies described above, or
you've had one and the results weren't clear, you may be offered a
different type of biopsy. This may be a type of surgical biopsy such as a
thoracoscopy or a mediastinoscopy, or a biopsy carried out using a
needle inserted through your skin.
These types of biopsy are described below.
Percutaneous needle biopsy
A percutaneous needle biopsy involves removing a sample from a suspected tumour to test it at a laboratory for cancerous cells.
The doctor carrying out the biopsy will use a CT scanner to guide a
needle to the site of a suspected tumour through the skin. A local
anaesthetic is used to numb the surrounding skin, and the needle is
passed through your skin and into your lungs. The needle will then be
used to remove a sample of tissue for testing.
Thoracoscopy
A thoracoscopy is a procedure that allows the 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.
The doctor will use the tube to look inside your chest and take samples.
The samples will then be sent away for tests.
After a thoracoscopy, you may need to stay in hospital overnight while any further fluid in your lungs is drained out.
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