Lung Cancer - The Important Facts

This fact sheet on lung cancer provides you with useful information on lung cancer, its causes, types, and treatment.
Originally published in August 2003 icon
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Every year nearly 40,000 people in the UK are diagnosed with lung cancer. Its the most common form of cancer in men and a greater threat to womens lives than breast cancer. Recent research suggests that women are genetically more inclined to develop lung cancer than men; they can contract it earlier and after less risk exposure.

Open quotesIts the most common form of cancer in men and a greater threat to womens lives than Breast CancerClose quotes

Cigarette smoke contains more than 4,000 different chemicals, many of them carcinogenic; 40 per cent of those who lit up their first cigarettes in early teenage will not live to collect their pension if they continue to smoke. People who live with smokers also have a 20-30 per cent higher risk of lung cancer. Changing to low tar or light cigarette brands is not the solution : smokers compensate by using more and inhaling more deeply.

Relatively heavy smokers who live in areas of environmental pollution seem to be at particular risk. Statistics from Cancer Research UK suggest that radon is the cause of one in 20 cases of lung cancer, although American cancer charities disagree and put the "solus" cause figure at 20%. Worse, smoking and radon multiply up and may account for another 25-30%.

Fruit and vegetables

Radon is an odourless, invisible gas given off from uranium which occurs naturally in areas underlain by granite and limestone. Breathe the gas and it collects in the deepest recesses of your lungs where its radioactivity causes cellular damage. Devon and Cornwall, Somerset, Derbyshire and parts of Northants are counties rated high in Radon - the National Radiological Protection Agency will send someone to monitor your home if you are worried. Workplace chemicals such as asbestos, chromium, talc, hard metal dusts and synthetic fibres are contributors to risk, as well as diesel exhaust fumes, which like Radon collect on dust particles and remain in the lungs for very long periods. Even X-rays have been blamed for some lung cancers as has radiotherapy on breast tumours. A diet low in fresh fruit and vegetables is also significant.

One of the main challenges is to develop early detection screening: 90 per cent of patients are only identified when the cancer is too advanced for potentially curative treatment.

Your GP should refer you for a chest x-ray or a second opinion if you have any of the following symptoms, particularly if you are, or have been, a smoker:

  • repeated chest infections that fail to respond to antibiotics after three weeks;

  • unexplained weight loss or fatigue;

  • persistent cough;

  • blood in your sputum;

  • increased production of phlegm;

  • breathlessness;

  • loss of voice without any sore throat;

  • chest pains and swelling in the face or neck.

Early detection can increase the chance of surviving five years by as much as 70 per cent. So great hopes are invested in the dedicated research team led by the Roy Castle Lung Cancer Foundation. This team is targeted to devise sensitive and specific molecular tests that will identify abnormal DNA in the lung many years before it progresses to malignancy or in the very early stages of malignancy, before a lump appears and when simple medication can stop the genetic process in its tracks.

Open quotesEarly detection can increase the chance of surviving five years by as much as 70%Close quotes

At present, the success of treatment varies with the type of lung cancer and the stage of presentation: small cell lung cancer (SCLC) accounts for a quarter of all cases and is more aggressive than other forms. This is the type that Roy Castle had. SCLC forms as fleshy lumps usually in the larger airways, grows fast, may spread to the lymph nodes and to other organs and often reoccurs quickly. Chemotherapy with Cisplatin, Etoposide, Adriamycin, Ifosfamide and Vincristine singly or in combination, is the current treatment of choice for SCLC, sometimes combined with radiotherapy.

Non-small cell lung cancers (NSCLC) include Adenocarcinoma, which is more often found in women and usually occurs in the smaller airways. Squamous or epidermoid carcinoma affects more men or older people of both sexes. It presents as an irregular growth of pearl like cells, is the most common type of lung cancer in Britain and the most likely to be treated surgically.

Large cell lung cancer grows as a large soft mass usually close to the centre of the chest though it can present in any part of the lung. It often spreads at an early stage. Promising new combinations of chemotherapy drugs for NSCLC include Cisplatin with Taxol, Vinorelbine or Gemcitabine.

Iressa, a new class of drug from pharmaceutical accompany AstraZeneca, has shown promising results in people with inoperable or recurrent non-small-lung cancer. In clinical trials, 40 per cent of patients with advanced disease, who had received no benefit from at least two prior treatments, experienced symptom relief and 40-50 per cent were more likely to achieve better survival outcomes as well as tumour shrinkage. Iressa is a small molecule that passes into the cell and selectively blocks an enzyme tyrosine kinase which instructs cancer cells to grow and multiply.

Radiotherapy can be particularly effective with the slow-growing tumours that characterise NSCLC and may also be used in addition to chemotherapy for SCLC, or to treat parts of the body affected by secondary tumours. It can be used post-surgically to treat any residual part of a tumour. Radical radiotherapy may also be the first line of treatment for early stage lung cancer where the patient is not a suitable candidate for surgery.

Open quotesRadiotherapy can be particularly effective with the slow-growing tumours that characterise
NSCLCClose quotes

Doctors at UCLAs Jonsson Cancer Center in the States have identified a protein called SLC, which is found in lymph nodes and stimulates an immune response to lung cancer. They hope this finding will help develop a genetic immunotherapy, which could begin human trials in the next two years. At the University Hospital, Pennsylvania Photodynamic Therapy (PDT) is occasionally used on lesions of the airway, and trials are in progress on cancers that have spread to the lung cavity fluid. PDT involves injecting the patient with a drug that is taken up selectively by cancer cells and then become light sensitive. When the right kind of light is shone on the tumour, the drug is activated, killing the cancer cells.

In the US, too, early screening is already starting and is a big new buzz in the fight against lung cancer. High-tech spiral CAT scans with very fine definition can pick up tiny lung nodules that would previously have gone undetected for years. Similar screenings are just beginning on the European mainland - and we need pilot projects here in the UK too. Some health experts are understandably cautious, fearing that anxiety could be heightened by discovery of what may be harmless, benign growths. But until screening is trialled the very real potential for saving lives remains untapped.

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