Different types

Lung cancer is a cancer of the trachea (windpipe), bronchi (airways) or lung air sacs (alveoli).

The two most common types of lung cancer are:

• Non-small cell lung cancer (NSCLC)
  Around 70–80% of people with lung cancer have NSCLC. The most common forms of NSCLC are adenocarcinoma or squamous cell carcinoma.

• Small cell lung cancer (SCLC)
  Around 20% of people with lung cancer have SCLC.

Rarer forms of lung cancer are covered in our rare lung cancers factsheet.

Information on mesothelioma, a type of cancer that grows in the lining around the lungs usually caused by asbestos dust, can be found here occupational lung disease.

The most common signs and symptoms of lung cancer are:

• Chronic cough (lasts 3+ weeks)
• Coughing up blood, or flecks of blood, in phlegm
• Losing weight for no reason
• Being out of breath for no reason
• Not feeling hungry
• Fatigue
• Pain in the chest / bones / shoulder
• Swelling in the neck
• Muscle weakness
• Hoarseness (weak, raspy or strained voice)
• Stridor (high pitched wheezing due to airway blockage)
• Clubbing (swelling) of the fingers and toes

Early symptoms are often not picked up as they are linked to other common conditions. Some people do not have any symptoms at all.

The earlier lung cancer is picked up the easier it is to treat. Visit your doctor if you have any concerns at all, particularly if you are at a higher risk – see our ‘Causes’ section.

How does lung cancer develop?

While smoking tobacco is linked to more than 80% of all lung cancer cases, many people that have never smoked or been exposed to passive smoke develop lung cancer. See our information on the risk factors for tobacco smoking and passive smoking and our Smokehaz website.

Other causes include exposure to: air pollution (including diesel exhaust fumes), work materials (to asbestos, wood dust, welding fumes, arsenic, industrial metals e.g. beryllium and chromium) and indoor air pollution (to radon, coal smoke). There may be other causes, and more will likely be found in the future.

Having the following conditions can also increase your risk of developing lung cancer:

• Chronic obstructive pulmonary disease (COPD)
• Pulmonary fibrosis
• Head, neck or oesophageal cancer
• Lymphoma or breast cancer (treated with thoracic radiotherapy)

Genes can also play a role in some lung cancers. If there is a history of lung cancer in your family, you could be more likely to develop the condition, but this is not the same for everyone.

Generally, the process of being diagnosed with lung cancer is as follows:

An X-ray and a computerised tomography (CT) scan (where your body is X-rayed at a number of angles before a computer puts together a detailed image) of your chest will first be done to show if there is a lung tumour.

Your doctor may confirm the diagnosis of cancer by taking some samples of the cells from your tumour or your glands or second tumour away from your lung tumour (metastasis) and testing them (this is called a biopsy). A biopsy can be carried out in a number of ways, most of which are done as an outpatient (you do not stay over):

• Using an endoscopic camera test (a camera that goes inside your lungs) called a bronchoscopy. This uses a flexible tube that has a video camera at the end (called a bronchoscope). The tube is inserted through your nose or mouth. You will receive a sedative to relax you and a spray to numb your throat. See our bronchoscopy factsheet for more information.
• Endobronchial ultrasound (EBUS) – this is similar to a bronchoscopy. The bronchoscope is fitted with a small ultrasound probe to help guide the physician to the right area to take a sample. This area is usually the area between the two lungs where your glands sit (called mediastinum)
• CT-guided biopsy (where you go through the CT scanner and the X-ray images guide the physician to the right area).
• Surgery (only on rare occasions)

If your doctor has a high suspicion that you have lung cancer, they will request some tests that can show how far the cancer has spread. This process is called staging and could involve further CT scans of the abdomen (stomach area) and brain, or a positron emission tomography CT (PET CT) scan (where a CT scan is combined with a PET scan, which involves a small amount of radioactive dye being injected into your veins to show up anything abnormal in your tissues).

On some rare occasions, your doctor may suggest that you have a biopsy of your axillary (armpit) and neck lymph nodes.

Staging tests also give useful information as to which is the most appropriate site to take a biopsy from.

How will I know what stage my lung cancer is at?

The stage of your lung cancer is one of the factors that will help your healthcare professionals to decide on the best kind of treatment to offer you.

Your doctor will be able to give you information on the stage of the cancer. This is based on:

• Tumour size
• How much it has spread into your lymph nodes/glands, and
• Whether there is another tumour in your body that the doctor thinks is related to the main tumour in your lung (metastasis)

This staging process is sometimes referred to as TNM (tumour, node, metastasis).

Being told that you have lung cancer can be devastating. Many people with lung cancer have told us that being able to talk to someone outside of their family, such as a counsellor or psychologist, can often help. If you feel this might be helpful for you, talk to your doctor about what services might be available.

Everyone is different - statistics may not reflect what will happen to you

Lung cancer is a serious illness, and unfortunately, the prognosis for many is not very good overall, mainly because it is not diagnosed early enough. However, lots of work is being done to develop new treatments to help people live longer and with a better quality of life with lung cancer.

Most prognosis information is given in terms of a ‘5-year survival rate’. This term is often used by healthcare professionals, and refers to the number of people studied in research who lived for 5 years or more after being diagnosed with this type of lung cancer.

It is important to remember that everyone is different, and that you may not have the same reaction to a treatment as another person. Statistics do not necessarily reflect what will happen to you. You should see your prognosis as a guide – and discuss it with your consultant or doctor.

Range of treatments for different types of lung cancer

There are several different types of lung cancer, requiring a range of different treatments.

Your treatment plan will be based on the type and stage of lung cancer you have, your general state of health, and your personal preferences.

Treatments may be focused on either curing your lung cancer (curative treatments), or on helping you live longer and with a better quality of life with lung cancer (palliative treatments).

The main forms of treatment are surgery, chemotherapy, radiotherapy, biological and targeted treatments (including immunotherapy). Your options will be discussed with you as not all treatments may be suitable for your type of lung cancer.

• Surgery

  Having surgery

  If you are fit enough for surgery, you may be offered an operation to remove the tumour.

  Surgery is mainly used to treat non-small cell lung cancer (NSCLC). However, if you are diagnosed with small cell lung cancer (SCLC) at a very early stage and it is very limited, some doctors may suggest surgery. If your cancer has spread then surgery is unlikely to be the right treatment for you.

  The lungs are made up of different sections or ‘lobes,’ with three in the right lung and two in the left lung. The usual operation for lung cancer is called ‘lobectomy’. The surgeon will completely remove the part of the lung (lobe) which contains the cancer and the glands around the lung (lymph nodes) to which cancer can spread. Sometimes, it may be recommended that one lung is removed completely (pneumonectomy). Breathing tests before surgery will help to decide if this operation is right for you.

  You will receive a general anaesthetic (medication to make you fall asleep) for the duration of these operations and given pain medication following the operation.

  Before surgery, you may receive a type of chemotherapy that contains platinum in order to shrink the tumour as much as possible before the operation. This makes it easier to remove surgically.

  Keyhole surgery

  New, less-invasive surgical techniques have been developed to try to remove the cancer. This means there is less damage to your tissue during surgery. This includes a type of keyhole surgery, known as video-assisted thoracic surgery (VATS), in which a small video camera and instruments are placed through small cuts into your chest to guide the surgeon during the operation. Recovery time for keyhole surgery is quicker so may be a possibility for more people.

  Your options

  Surgery is not always the best option for everyone – it could be better to tackle your lung cancer with chemotherapy, often depending on where the tumour is and what stage of cancer you have. Your healthcare professional will discuss your treatment options with you.

• Chemotherapy

  Chemotherapy (also called chemo) uses drugs to treat cancer. It works to slow down the growth of the cancer.

  The drugs can be given over different lengths of time and either injected directly into a vein or through an intravenous drip or pump. You will usually receive the chemo as an outpatient at the hospital every 3 or 4 weeks.

  Most chemotherapy drugs cause side effects and nausea and being sick are the most common. Anti-nausea drugs will be given to help with this. Other side effects may include hair loss (regrows after treatment has ended), feeling more tired than usual, losing your appetite or changes in your sense of taste.

  Chemotherapy affects people in different ways so it is hard to say how you may be affected in advance. Many people are able to carry on with their normal activities during their treatment.

  Just as patients with different types of lung cancer respond differently to surgery, it is possible to tailor chemotherapy depending on the type of tumour a person has.

• Radiotherapy

  Options

  Radiotherapy can be offered either as a standalone treatment, after surgery or in combination with chemotherapy.

  If your tumour is at an early stage and you are not able to have surgery (if your lungs are not working as well as they should do or you have other significant diseases that increase the risk of surgery) you may be offered modern radiotherapy called SABR (stereotactic ablative radiotherapy). This is almost as effective as surgery and also reduces the damage caused to the areas surrounding the tumour.

  How does it work?

  Radiotherapy uses high energy X-rays to destroy the cancer cells. You typically receive this treatment every day, 5 days a week, for about 6 weeks.

  You do not need an anaesthetic and receive the treatment lying on a table while a linear accelerator (the machine that delivers the radiation) moves around you at different angles. You do not feel the radiation. Short-term side-effects may include skin inflammation (swelling and soreness), sore throat and trouble swallowing, cough and breathlessness. Most people do not have any long-term side-effects, although some people can get swelling and soreness in their lungs (called radiation pneumonitis), which is treated with steroids.

  If you have undergone surgery to remove your tumour, then you may also receive radiotherapy as an additional treatment after surgery to make sure any remaining cancer cells are killed.

  Help with symptoms

  Sometimes radiotherapy is also prescribed to help with symptoms, such as treating blockages in your windpipe to make it easier to breathe. This type of radiotherapy is the more usual type and is not as highly targeted as modern radiotherapy. It is usually offered as a standalone treatment or in combination with chemotherapy.

  In some cases, you may be offered radiotherapy to treat areas outside your lungs, such as brain or bone, if the disease has spread.
  

• Biological or Targeted Therapies

  What are biological or targeted therapies?

  As experts have understood more about the biology of lung cancer, they have also been able to develop new drugs that target specific parts of the cancer. These are called biological therapies or targeted therapies.

  Targeted therapies for specific types of lung cancer come in tablet form, e.g. EGFR (epidermal growth factor receptor) inhibitors, with the drugs erlotinib or gefitinib found to be particularly beneficial for people who are unable to have their tumour removed surgically. Also ALK (anaplastic lymphoma kinase), with the drug crizotinib found to be effective.

  How do they work?

  These drugs work to block the growth of cancer cells and can control this for a long time. You take the tablets at home, rather than having to travel to a clinic as you would for chemotherapy treatment. Targeted therapies tend to come with fewer side effects than other types of treatment.

  Not everyone will benefit from targeted therapies as this depends on the type of tumour you have. Access to these drugs may also depend on your own country’s recommendations for lung cancer treatment and funding by national health care systems.

  Immunotherapy

  Immunotherapy (a type of biological therapy) is a new treatment approach which has shown some promising results among people with advanced-stage NSCLC. It works by encouraging our natural immune system processes to fight cancers.

  Lots of research is going on in the field at the moment, and an immunotherapy treatment for people with a type of advanced-stage squamous lung cancer was recently approved by the European Medicines Agency.

  Molecular testing

  To find out if your type of lung cancer could be treated with a targeted therapy, you will need a molecular diagnostic test. These tests look at biological markers in a tissue sample of your tumour and help to find out more information about whether a particular drug or targeted treatment would be likely to work for you.

  This test could happen at the time you are diagnosed, or at a later stage in your treatment. Talk to your specialist to find out if molecular testing is an option for you.
  

• Multidisciplinary Teams

  In some European countries the decision to treat, and the type of treatment, is discussed among a panel of experts in the field, called a multidisciplinary team (MDT). An MDT usually includes:

  • a surgeon
  • respiratory doctors (specialising in lung health)
  • oncologists
  • a pathologist (doctor who will examine your biopsy and decide your type of cancer)
  • a radiologist (specialising in lung imaging)
  • a palliative care physician (specialising in looking after patients in pain and disability due to their lung cancer)
  • a psychologist
  • a nurse (specialising in lung cancer)

  MDTs are becoming more common in the treatment of lung cancer however in some countries they would not include all the experts mentioned here. If you are managed by an MDT, you will normally have one or two healthcare professionals as your main points of contact, and you may visit other healthcare professionals for specific treatments.

  However, there are still many countries where the decision to treat relies on a single doctor, usually a lung health specialist.

  The European Respiratory Society is currently working closely with the ELF on recommendations for the use and structure of MDTs in treating people with lung cancer.

  
  

A tool for people diagnosed with stage III / N2 lung cancer to explore their treatment options

This interactive patient decision aid tool gives information on treatment options offered to people diagnosed with stage III / N2 lung cancer. These options include surgery or radiotherapy, both in combination with chemotherapy.

The aim of this tool is to support your decision-making when both surgical and radiotherapeutic options are available.

This tool is not intended to replace a consultation with the radiation oncologist and the thoracic surgeon and we recommend that you discuss all options in detail with your doctors as each individual is unique with different levels of fitness and medical needs.

Find out more about the tool

Remember you are not alone in what you are going through

You may find that you experience negative, upsetting and confusing feelings. It is important to remember that you are not alone in what you are going through. There are many online and in-person support groups for people in your position where you can talk about and hear other people’s experiences with lung cancer and build up your own support group.

You may find it helpful to talk to friends and family about the way you are feeling. This is also a difficult time for them, and their feelings may be similar or different to your own.

It may also be useful to speak to a counsellor or psychologist for some help with dealing with your feelings. Sometimes it is easier to talk to a stranger (or you may not have friends and family around to support you). A counsellor/psychologist can give you space to talk and think about how you feel.

Ask your doctor to provide some guidance on dealing with your feelings and if there is any access to psychological support.

You can find useful links to support in your country on our In your language page.

How to help yourself everyday

People who have experience of lung cancer and healthcare professionals recommend that, after a lung cancer diagnosis, or during treatment, you try to go on living your life as it was before as best you can.

There are a number of things you can do to help yourself on a daily basis:

• Eat a healthy diet

  
  Try to eat a diet that helps you maintain a healthy weight and gives you all of the nutrients your body needs (protein, fruit and vegetables). You may find that certain foods make side effects of your treatment worse - in this case, try to avoid these. Talk to your healthcare professional if you need advice on this.

• Do things you enjoy

  
  

  Try to keep doing things that you enjoy e.g. go shopping, visit friends, travel. The aim is to keep your life as normal and free of stress as possible.

• Exercise

  Physical activity has been shown to be very beneficial for people with all stages of lung cancer. Try to be as active as possible when you can – for example, yoga, swimming or walking to the shops rather than driving. Your doctor should be able to help you develop a tailored fitness plan.

• Pulmonary rehabilitation

  You may, especially if you have other lung health issues, be offered pulmonary rehabilitation as a way of improving your physical strength and reducing the impact of your symptoms on your life.

  Pulmonary rehabilitation is a type of treatment that aims to reduce the physical and emotional impacts of a lung condition on a person’s life. It is a personalised programme that combines exercise training with education about ways you can help keep yourself as healthy as possible. See our pulmonary rehabilitation factsheet.

  There is some evidence that pulmonary rehabilitation after surgery for individuals treated for lung cancer is both possible and effective. It can help to reduce fatigue and enable you to cope with more exercise.

• Practical matters

  You may also need to deal with issues relating to your work, finances and social activities. Making a list of questions to ask your doctor or specialist can help you manage these things and find out what support may be available to help you.

What is palliative care?

Palliative care (also called supportive care) aims to improve the quality of life of people affected by serious illness such as lung cancer and their family members.

Palliative care will not cure the condition but it can prevent and treat the symptoms and side effects experienced. It is offered alongside other therapies.

Accessing palliative care services can help people affected by lung cancer to live their life as best as possible even though they are ill.

Palliative care can be accessed at any stage from diagnosis onwards and can provide relief from pain, nausea and other symptoms and offer support and comfort to people affected by lung cancer. It involves caring for people's physical, emotional and spiritual needs in the best way possible.

Palliative care can be provided in many settings such as the hospital, community or hospice. Finding out what palliative care support is available for you can help you make decisions about how you want to be cared for now and in the future.

Talk things through with any of your healthcare professionals. Ask questions and tell them about any concerns you have now and for the future. You may also want to talk things through with your family and friends. If they know how you feel they might be better able to support you.

In-depth medical information​

You can find more in-depth medical information about lung cancer in the European Respiratory Society publications below.

This information is designed for healthcare professionals but will be of interest to some individuals in search of more advanced information.

Please note that some of the links below contain detailed information and survival rates for different stages of lung cancer.

• Guidelines

  What are guidelines?

  Guidelines supported by the European Respiratory Society (ERS) are developed by healthcare practitioners, often with patient input facilitated by the European Lung Foundation, to provide recommendations, strategies or information to guide physicians, other healthcare practitioners and patients make decisions relating to diagnosis, management and treatment.

  Lung cancer guidelines:

  • Combined endobronchial & oesophageal endosonography for the diagnosis & staging of lung cancer (2015)
  • Lung cancer screening (2015)
  • The European initiative for quality management in lung cancer care (2014)
  • Clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy) (2009)

  ERS guidelines are based on searching published research and formally grading the evidence and guidance using the GRADE approach, a systematic approach that helps assess the quality of evidence.

  New ERS lung cancer guidelines

  Guidelines on various aspects of quality in thoracic oncology care are currently being developed by a working group of ERS members with patient input provided by our lung cancer patient advisory group. They are due to be completed in 2017.
  

• Handbooks and Journals

  Handbooks
  
  

  • European Lung White Book
    Draws on the latest data from the World Health Organization and European Centre for Disease Prevention and Control, and input from experts across Europe to present a rigorous examination of lung health and disease in Europe.
    European Lung White Book - Lung cancer (chapter 19)
    European Lung White Book - Thoracic surgery (chapter 32)

  • ERS Monograph
    ERS Monograph: Lung cancer. (2015). Accessible to ERS Members (price $75)
    Lung transplantation. (2009). Accessible to ERS Members (price $45)

  Journals
  

  
  These journals contain articles on a wide range of lung cancer research. Search the resources below and see Research & news for most recent articles.

  • European Respiratory Journal (ERJ)
    Search ERJ archive for article abstracts about lung cancer.
  • European Respiratory Review (ERR)
    Search ERR archive for lung cancer articles.
  • Breathe
    Search Breathe archive for lung cancer information
    
  • ERJ Open Research
    Search ERJ Open Research for lung cancer articles.

• E-learning

  • Targeted therapy in lung cancer; Research Seminar; Paris 2015
    
  • The changing face of lung cancer treatment. Sylvia Hartl. ERS Respiratory matters: the experts' blog: the clinician's perspective; December 2015
    
  • Medical Procedure video: Lung examination, ERS 2012
    
  • ERS School Course on Lung cancer, Berlin 2011
    
  • ERS School Course on Nonsmall Cell Lung Cancer, Leuven 2008
    
  • ERS School Course on Early Stage Lung Cancer, Strasbourg 2006