Lung Cancer – A Guide

Lung cancer is one of the most common and serious types of cancer

Introduction
Symptoms of lung cancer
Causes of lung cancer
Diagnosing lung cancer
Treating lung cancer
Preventing lung cancer
Complications of lung cancer

Introduction

Lung cancer is one of the most common and serious types of cancer.

Some of the symptoms of lung cancer include:

• coughing,
• unexplained weight loss,
• shortness of breath, and
• chest pain.

The lungs

The lungs are a pair of sponge-shaped organs that are located in the centre of the chest. They have two main purposes:

• to transfer oxygen into the blood when you breathe in, and
• to expel carbon dioxide out of the blood when you breathe out.

The lungs are made up of a series of sections called lobes. The left lung consists of two lobes, and the right lung is larger and consists of three lobes.

Types of lung cancer

Cancer that begins in the lungs is known as primary lung cancer. Cancer that begins in another part of the body before spreading to the lungs is known as secondary lung cancer. This article focuses on primary lung cancer.

There are two main types of primary lung cancer which are classified by the type of cells that the cancer starts in. These are:

• non-small cell lung cancer, and
• small cell lung cancer.

Non-small cell lung cancer

Non-small cell lung cancer is the most common type of lung cancer, accounting for around 80% of all cases.

Small cell lung cancer

Small cell lung cancer is less common and accounts for around 20% of all cases. Small cell lung cancer is more aggressive than non-small cell lung cancer, and it usually spreads faster.

How common is lung cancer?

Lung cancer is the second most common cancer (after skin cancer) in England and Wales, with an estimated 31,000 new cases being diagnosed every year.

Lung cancer is the most common cause of cancer-related death in both men and women. During 2007, there were 29,660 deaths in England and Wales as a result of lung cancer.

Lung cancer is primarily a disease that affects older people. Cases are rare in people who are under 40 years of age, but the rates of lung cancer rise sharply with age. The most common age range that lung cancer is diagnosed is between 70-74 years of age.

Smoking is the single biggest risk factor for lung cancer, accounting for an estimated 85-90% of cases. People who smoke more than 20 cigarettes a day are 20 times more likely to develop lung cancer than non-smokers.

Outlook

Lung cancer does not usually cause any noticeable symptoms until it has spread through much of the lungs and/or into other parts of the body. This is known as advanced, or metastatic, lung cancer. Therefore, the outlook for lung cancer is poor in comparison to other types of cancer.

Statistics show that only 25% of people with lung cancer will survive for at least a year after receiving a diagnosis, and just 7% will survive for at least five years.

However, survival rates can vary widely depending on how far the cancer has spread (the stage of the cancer) at the time of the diagnosis. See the ‘diagnosis’ section for more information about staging and survival rates.

Lung cancer is usually treated using a combination of chemotherapy, radiotherapy, and surgery.

Symptoms of lung cancer

Initial symptoms of lung cancer

The most common initial symptoms of lung cancer include:

• a persistent cough,
• a sudden change in a cough that you have had for a long time,
• unexplained weight loss,
• breathlessness,
• chest pain – this is usually intermittent (‘stop-start’) and is often made worse when breathing, or coughing, and
• coughing up blood-stained phlegm (haemoptysis ).

Less common initial symptoms of lung cancer include:

• changes in the appearance of your fingers, such as them becoming more curved, or their ends becoming larger (this is known as finger clubbing),
• a high temperature (fever) or 38C (100.4F), or above,
• fatigue,
• difficulty swallowing and/or pain when swallowing,
• wheezing,
• a hoarse voice, and
• swelling of your face.

Symptoms of advanced lung cancer

Lung cancer can cause additional symptoms if it spreads to other parts of your body. The most common places for lung cancer to spread are:

• the brain,
• the liver,
• the bones, and
• the lymph nodes (glands).

Symptoms of advanced lung cancer can include:

• bone pain,
• jaundice (yellowing of the skin and the whites of the eyes),
• seizures (fits),
• dizziness,
• drowsiness,
• feeling mentally confused,
• swelling of the lymph nodes in your chest and neck, and
• a feeling of weakness in your arms and legs.

When to seek medical advice

You should always visit your GP if you experience any of the symptoms listed above. While your symptoms are unlikely to be the result of lung cancer, all of the symptoms listed above require further investigation.

Causes of lung cancer

How does cancer begin?

Cancer begins with an alteration to the structure of the deoxyribonucleic acid (DNA) that is found in all human cells. This is known as a genetic mutation. The DNA provides the cells with a basic set of instructions, such as when to grow and reproduce.

The mutation in the DNA changes these instructions so that the cells carry on growing. This causes the cells to reproduce in an uncontrollable manner, producing a lump of tissue, known as a tumour.

How does cancer spread?

Most cancers grow and spread to other parts of the body via the lymphatic system. The lymphatic system is a series of glands (or nodes) that are spread throughout your body, much like your blood circulation system. The lymph glands produce many of the specialised cells that are needed by your immune system.

Lung cancer is somewhat unusual in that as well as spreading via the lymphatic system it can also spread via the blood. This is why bone cancer often spreads to the brain, as cancerous cells can ‘leak’ out of the bone and into the blood before travelling up towards the brain.

Risk factors:

Smoking

Smoking cigarettes is the single biggest risk factor for lung cancer and responsible for 90% of all cases. Tobacco smoke contains over 60 different toxic (poisonous) substances which are known to damage DNA and can trigger the development of cancer. These substances are known as carcinogenic (they are cancer-producing).

If you smoke just one cigarette a day, you are three times more likely to get lung cancer than a non-smoker. If you smoke more than 20 cigarettes a day, you are 20 times more likely to get lung cancer than a non-smoker.

In England and Wales, each year an estimated 26,500 people die each year as a result of smoking-related lung cancer.

While cigarettes are the biggest risk factors, using other types of tobacco products can also increase your risk of developing lung cancer, as well as other types of cancer, such as mouth cancer. These products include:

• cigars,
• pipe tobacco,
• snuff (a powdered form of tobacco), and
• chewing tobacco.

Smoking cannabis has also been linked to an increase risk of lung cancer. Most cannabis smokers mix their cannabis with tobacco, and although they tend to smoke less than tobacco smokers, they usually inhale more deeply and hold the smoke in their lungs for longer.

One researcher has estimated that smoking four ‘joints’ (home made cigarettes mixed with cannabis) may be as damaging to the lungs as smoking 20 cigarettes.

Even smoking cannabis without mixing it with tobacco is potentially dangerous. This is because cannabis also contains substances that can damage DNA and potentially trigger cancer.

Passive smoking

Even if you do not smoke, frequent exposure to other people’s tobacco smoke (passive smoking) can increase your risk of developing lung cancer.

For example, research has found that non-smoking women who share their house with a smoking partner are 27% more likely to develop lung cancer than non-smoking women who live with a non-smoking partner.

Radon

Radon is a naturally occurring radioactive gas that is created when uranium in the earth’s crust decays. Radon has been known to seep up from the ground into buildings.

If radon is breathed in, it can cause damage to your lungs, particularly if you are also a smoker. Radon is estimated to be responsible for about 3% of all lung cancer deaths in England.

Local authorities are responsible for monitoring the levels of radon in the soil. If radon levels are too high, extraction systems can be used to remove the gas.

Occupational exposure

Exposure to certain chemicals and substances that are used in a number of different occupations and industries has been linked to a slightly increased risk of developing lung cancer.

These chemicals and substances include:

• arsenic,
• asbestos,
• beryllium,
• cadmium,
• coal and coke fumes,
• silica, and
• nickel.

Occupations that carry an increased risk of exposure to these types of chemicals and substances include:

• agriculture,
• mining,
• metal production,
• shipbuilding,
• coke and gas production,
• construction, and
• lorry and taxi driving.

People who work in these occupations are 2-4 times more likely to develop lung cancer than the population at large (if there are no other associated risk factors).

Diagnosing lung cancer

If you are experiencing symptoms such as breathing difficulties, and a persistent, long-term cough, your GP will run a number of routine tests in order to rule out other possible causes of your symptoms, such as a chest infection. Two tests that you are likely to have are:

• a blood test, and
• a urine test.

If the results of these tests prove to be inconclusive, it is likely that you will be referred to your local hospital for further testing.

If your symptoms strongly suggest that you have lung cancer, such as having blood in your phlegm (haemoptysis) and a hoarse voice, you may be referred directly to a cancer treatment team for diagnosis.

Chest X-ray

A chest X-ray is usually the first test that is used to diagnosis lung cancer. Most lung tumours show up on X-rays as a ‘white-grey’ mass.

However, chest X-rays cannot provide a definitive diagnosis because they often cannot distinguish between tumours and other abnormalities, such as a lung abscess (a collection of pus that forms in the lungs).

Also, in some cases, lung cancer has been found even when the X-rays appeared to be normal (a false-negative result). Therefore, further testing will be required.

CT scan

Acomputer tomography (CT) scan is usually performed after a chest X-ray.

Before having a CT scan, you will be given a drink, or an injection, of a slightly radioactive dye. The dye is used to make the lungs show up more clearly on the scan. The scan itself is painless and takes between 10-30 minutes to complete.

bronchoscopy

A bronchoscopy is a procedure that allows a doctor or nurse to take some cells from the inside of your lungs.

During a bronchoscopy, a thin tube, called a bronchoscope, is used to examine your lungs and to take a sample of cells. The bronchoscope is passed through either your mouth or nose, down through your throat, and into the airways of your lungs.

The procedure may be uncomfortable, but you will be given a mild sedative beforehand to help you relax, and a local anaesthetic that will make your throat numb. The procedure is also very quick and will only take a few minutes.

Further testing

The combination of a chest X-ray, CT scans, and a bronchoscopy can usually confirm (or rule out) a diagnosis of lung cancer.

Further testing may still be required in order to determine exactly what type of lung cancer you have and to assess how far the cancer has spread (the stage of the cancer).

These tests are outlined below.

Sputum cytology

A sputum cytology involves taking a sample of your phlegm. This will then be checked under a microscope for the presence of cancerous cells.

Percutaneous transthoracic needle biopsy

A percutaneous transthoracic needle biopsy is a way of removing a sample of a suspected tumour in order to test it at a laboratory for cancerous cells (biopsy).

The doctor carrying out the biopsy will use a CT scanner to guide a needle to the site of a suspected tumour. 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 are likely to need a general anaesthetic before having a thoracoscopy. Two or three small incisions (cuts) will be made in your chest to allow a tube that is similar to a bronchoscope to be passed 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 having a thoracoscopy, you may need to stay in hospital overnight while any further fluid in your lung (or lungs) is drained out.

Mediastinoscopy

A mediastinoscopy allows the doctor to examine the area between your lungs at the centre of your chest (mediastinum).

For this test, you will need to have a general anaesthetic, and will to stay in hospital for a couple of days. The doctor will need to make a small cut at the bottom of your neck so that they can pass a thin tube down into your chest.

The tube has a camera at the end which allows the doctor to see inside your chest. They will also be able to take samples of your cells and lymph nodes at the same time. The lymph nodes are tested because they are usually the first place that lung cancer spreads to.

Positron emission tomography scan

Apositron emission tomography (PET) scan is often used if the results of a biopsy are inconclusive, or if it is not possible to carry out a biopsy due to the physical location of the suspected tumour.

PET scanners are a new and expensive piece of technology, and there are only a limited number of hospitals and specialist centres that currently have them. Therefore, depending on where you live, you may have to travel to another part of the country to have a PET scan.

A PET scans are similar to computer tomography (CT) sans and magnetic resonance imaging (MRI) scans, except that they can be used to study how a part of the body actually works, rather than just producing images of what it looks like. This is useful in diagnosing cancer because cancerous cells use more energy than normal cells. PET scans can be used to study the energy profile of cells, with cancerous cells appearing as bright spots on the PET scan.

As with a CT scan, before having a PET scan, you will be injected with a slightly radioactive material. You will be asked to lie down on a table which will be pushed into the PET scanner. The scan is painless and takes around 30 minutes to complete.

Staging

Once the above tests have been completed, it is usually possible to tell what stage your cancer is at and the implications this will have, both in terms of your treatment and the possibility of achieving a complete cure.

Non-small cell lung cancer

The stages of non-small lung cancer are outlined below.

Stage 1

The cancer is contained within the lung and has not spread to nearby lymph nodes. Stage 1 can also be divided into two sub-stages:

• stage 1A – the tumour is less than 3cm in size (1.1 inches), and
• stage 1B – the tumour is between 3-5 cm (1.1-2 inches).

Stage 2

Stage 2 is divided into two sub-stages – 2A and 2B.

In cases of stage 2A lung cancer:

• the tumour is between 5-7 cm, or
• the cancer is less than 5cm, but cancerous cells have spread to nearby lymph nodes.

In cases of stage 2B lung cancer:

• the tumour is larger than 7cm, or
• the tumour is between 5-7 cm, and cancerous cells have spread to nearby lymph nodes, or
• the cancer has not spread to lymph nodes but has spread to surrounding muscles and/or tissue, or
• the cancer has spread to one of the main airways (bronchus), or
• the cancer has caused the lung collapse, or
• there are multiple small tumours in the lung.

Stage 3

Stage 3 is divided into two sub-stages – 3A and 3B.

In cases of stage 3A lung cancer, the cancer has either spread to the lymph nodes in the middle of the chest, or into surrounding tissue. This can be:

• the covering of the lung (the pleura),
• the chest wall,
• the middle of the chest, or
• into other lymph nodes near to the affected lung.

In cases of stage 3B lung cancer, the cancer has either spread to:

• to lymph nodes on either side of the chest, above the collarbones, or
• to another important part of the body, such as the gullet (oesophagus), windpipe (trachea), heart, or into a main blood vessel.

Stage 4

In cases of stage 4 lung cancer, the cancer has spread to a remote part of the body, such as the bones, liver, or brain.

Small cell lung cancer

Cases of small cell lung cancer only have two possible stages:

• limited disease – the cancer has not spread beyond the lung, and
• extensive disease – the cancer has spread beyond the lung.

Treating lung cancer

Cancer treatment team

Many primary care trusts (PCTs) have multi-disciplinary teams (MDTs) that treat lung cancer.

An MDT is made up of a number of different specialists.

These include:

• a thoracic surgeon (a specialist in lung surgery),
• a clinical oncologist (a specialist in the non-surgical treatment of cancer),
• a pathologist (a specialist in diseased tissue),
• a radiologist (a specialist in radiotherapy),
• a social worker,
• a psychologist, and
• a specialist cancer nurse, who will usually be your first point of contact with the rest of the team.

If you have lung cancer, you may see several, or all, of these healthcare professionals as part of your treatment.

Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.

Your treatment plan

Your recommended treatment plan will depend on the type and stage of your lung cancer.

In cases of stage 1 and 2 non-small lung cancer, it may be possible to achieve a complete cure by removing the cancer using surgery.

In cases of stage 3A non-small lung cancer, surgery is not usually possible because the cancer has spread too far. Instead, an intensive course of radiotherapy is used to try to achieve a cure, or at least to slow the spread of the cancer and prolong survival times.

In cases of stage 3B and 4 non-small lung cancers, the cancer has usually spread too far for a cure to be possible. Chemotherapy and radiotherapy can be used to help control the symptoms.

In cases of small cell lung cancer, surgery is only usually possible if the cancer is diagnosed when it is in its earliest stages. However, in most cases of small cell lung cancer, a cure is not possible. Radiotherapy and chemotherapy can be used to control the symptoms and slow the spread of the cancer.

There are also a number of newer treatments that can be used in certain circumstances. These include:

• radiofrequency ablation – where heat is used to kill cancer cells,
• cryotherapy – where cold is used to kill cancer cells,
• photodynamic therapy – where lasers are used to kill cancer cells, and
• growth inhibitors – which is medication that interferes with the processes that cancer cells need to multiple and grow – a medication callederlotinib is used in the treatment of lung cancer.

Surgery

There are three types of lung cancer surgery:

• wedge resection – where a small piece of the lung is removed; used to treat very early stage non-small cell lung cancer,
• lobectomy – where one, or in the case of the right lung, two lobes are removed; used when the cancer is confined to the lobe(s), and
• pneumonectomy – where the entire lung is removed; used when the cancer has spread throughout the lung.

People are naturally concerned that they will not be able to breathe if some, or all, of a lung is removed, but it is possible to breathe normally with only one lung. However, if you have problems with your breathing before the operation, such as breathlessness, it is likely that these symptoms will persist after surgery.

Before surgery can take place, you will need to have a number of tests to check your general state of health and your lung function. This will ensure that your body can withstand the effects of the surgery.

These tests may include:

• an electrocardiograph (ECG) – where electrodes are used to monitor the electrical activity of your heart, and
• spirometry – where you will be asked to breath into a machine called a siprometer which measures how much air your lungs can breathe in and out.

If the test results confirm that your health is good enough to undergo surgery, then surgery can go ahead.

Surgery is usually performed by making an incision (cut) in your chest, or side, and removing a section, or all, of the affected lung. Nearby lymph nodes may also be removed if it is thought that the cancer may have spread to them.

In some cases, an alternative to this approach called video-assisted thoracoscopic surgery (VATS) may be suitable. VATS is a type of keyhole surgery where small incisions are made in the chest. A small fiber-optic camera is inserted into one of the incisions which transmits images of the inside of your chest to a monitor.

The surgeon is able to insert surgical instruments through the other incisions, guided by the images on the monitor, in order to remove affected lung tissue.

VATS is usually only recommended for early stage non-small lung cancers because the technique is not suitable when anything larger than a lobe of the lung needs to be removed.

As with all surgery, lung surgery carries a risk of complications which are estimated to occur in 1 out of every 5 cases.

Complications of lung surgery includes:

• inflammation or infection of the lung (pneumonia),
• excessive bleeding,
• a leak of air from the lung wall and, most seriously,
• a blood clot in the leg (deep vein thrombosis) which potentially could travel up to the lung (pulmonary embolism).

These complications can usually be treated using medication and/or additional surgery, which means that you may have stay longer in hospital.

In the absence of any complications, you will probably be ready to go home about 5-10 days after your operation. However, it can take many weeks to recover fully from a lung operation. After your operation, you will be encouraged to start moving about as soon as possible.

Movement is very important and, even if you have to stay in bed, you will need to keep doing regular leg movements to help your circulation and prevent blood clots from forming. You will be shown breathing exercises by the physiotherapist to help prevent complications.

When you go home, you will need to exercise gently to build up your strength and fitness. Walking and swimming are good forms of exercise that are suitable for most people after treatment for lung cancer. You should discuss with your care team which types of exercise are suitable for you.

Chemotherapy uses powerful cancer-killing medication to treat cancer. There are a number of different ways chemotherapy can be used to treat lung cancer.

For example, it can be:

• given before surgery in order to shrink the tumour(s) which increases the chance of the surgery being successful,
• given after surgery to prevent the cancer returning,
• used to relieve symptoms and slow the spread of cancer when a cure is not possible, and
• combined with radiotherapy (chemoradiation); this can be given before and after surgery and/or it can be used to relieve symptoms.

Chemotherapy treatments are usually given in cycles. A cycle involves taking the chemotherapy medication for several days before having a break for a few weeks to allow your body to recover from the effects of the treatment.

The number of cycles of chemotherapy that you require will depend on the type and the grade of your lung cancer. Most people require 4-6 courses of treatment over the space of 3-6 months.

Chemotherapy for lung cancer involves taking a combination of different medications. The medications are usually delivered via a drip into your vein, or into a tube that is connected to one of the blood vessels in your chest.

Side effects of chemotherapy include:

• your skin can be easily bruised,
• unusual spontaneous bleeding, such as bleeding gums, or nosebleeds,
• breathlessness,
• fatigue,
• nausea,
• vomiting,
• mouth ulcers, and
• hair loss.

These side effects should gradually pass once your treatment has finished. It usually takes between 3-6 months for your hair to grow back.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. You should inform your care team and/or your GP as soon as possible if you experience the possible signs of an infection such as:

• a high temperature (fever) of 38 degrees Centigrade (100.4 degrees farenheit), or above, and/or
• a sudden feeling of being generally unwell.

Radiotherapy

Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancerous cells.

Radiotherapy can be used after surgery to treat lung cancer, or it can be used to control the symptoms and slow the spread of cancer when a cure is not possible (palliative radiotherapy).

A more intensive course of radiotherapy, known as radical radiotherapy, can also be used to try to achieve a cure in cases of non-small cell lung cancer when a person is not healthy enough to have surgery.

A type of radiotherapy known as prophylactic cranial irradiation (PCI) is also used to treat small cell lung cancer. PCI involves directing high energy pulses at your brain. It is used as a preventative measure because there is a risk that small cell lung cancer will spread to your brain.

The two ways that radiotherapy can be given are described below.

• External beam radiotherapy – where a machine is used to beam high energy pulses of radiation at affected parts of your body.
• Internal radiotherapy – where a catheter (thin tube) is inserted down a bronchoscope and into your lung. A small piece of radioactive material is placed inside the catheter and positioned against the site of the tumour before being removed after a few minutes.

There are also several different ways that a course of radiotherapy treatment can be planned.

Radical radiotherapy is usually given five days a week with a break at weekends. Each session of radiotherapy lasts between 10-15 minutes. The course of radiotherapy usually lasts between 3-7 weeks.

Continuous hyperfractionated accelerated radiotherapy (CHART) is an alternative method of delivering radical radiotherapy. CHART is given three times a day for 14 days in a row.

As CHART is usually only available in specialist cancer centres, you may have to travel to another part of the country for treatment.

Palliative radiotherapy usually only requires one or two sessions in order to control your symptoms.

A course of internal radiotherapy usually takes 1-3 sessions to complete. Internal radiotherapy tends to cause no, or few, side effects because the radiation is beamed directly at the tumour.

External radiotherapy can cause side effects because the radiation can also damage healthy tissues and cells.

Side effects of radiotherapy include:

• chest pain,
• fatigue,
• persistent cough that may bring up blood-stained phlegm (this is normal and nothing to worry about),
• difficulties swallowing (dysphagia),
• redness and soreness of the skin – which looks and feels like sunburn,
• hair loss – which can occur on your chest and, if you are receiving PCI, also on your head.

Side effects should pass once the course of radiotherapy has been completed.

Erlotinib

Erlotinib (Tarceva) is a medication that can be used to treat people with non-small cell lung cancer who have failed to respond to chemotherapy.

Erlotinib works by blocking the actions of proteins called epidermal growth factors (EGFs) which cancer cells use to reproduce and multiply. Erlotinib is taken in tablet form, one tablet a day, taken one or two hours before food.

Common side effects of erlotinib include:

• skin rash,
• itchy skin,
• diarrhoea,
• fatigue,
• nausea,
• vomiting,
• sore red eyes (conjunctivitis) or dry eyes, and
• mouth ulcers.

The side effects of erlotinib are usually mild. If they do become troublesome, you should contact your care team because additional treatments are available to treat them.

If you develop a skin rash, you should avoid exposing any affected skin to the sun. You should not smoke when taking erlotinib because it will make the medication less effective.

There is no evidence whether erlotinib is safe to take during pregnancy. Therefore, if you are a sexually active, fertile woman, you should use a reliable method of contraception to avoid becoming pregnant.

Erlotinib can react unpredictably with other medicines, including non-prescription medication and complimentary therapies, such as St John’s Wort. You should therefore inform your care team about any medication or therapies that you are using before you start taking erlotinib.

Radiofrequency ablation

Radiofrequency ablation is a new type of treatment that can be used to treat cases of stage 1 non-small cell lung cancer.

The doctor carrying out the treatment will use a CT scanner to guide a needle to the site of the tumour. The needle will be pressed into the tumour and radiowaves will be sent through the needle. These waves generate heat which kills the cancer cells.

The most common complication of radiofrequency ablation is that a pocket of air gets trapped between the inner and outer layer of your lungs (pneumothorax). This can be treated by placing a tube into the lungs in order to drain away the trapped air.

Cryotherapy

Cryotherapy is a treatment that can be used in cases where the cancer starts blocking your airways. This is known as endobronchial obstruction and can cause symptoms such as:

• breathing problems,
• cough, and
• coughing up blood.

Cryotherapy is performed in a similar way to internal radiotherapy except a device known as a cryoprobe is placed against the tumour rather than a radioactive source. The cryoprobe can generate very cold temperatures which help to shrink the tumour.

Photodynamic therapy

Photodynamic therapy is a treatment that can be used to treat early stage lung cancer when a person is unable or unwilling to have surgery. Alternatively, as with cryotherapy, photodynamic therapy can be used to remove a tumour that is blocking the airways.

Photodynamic therapy is carried out in two stages. Firstly, you will be given an injection of a medication called porfimer sodium, which will make all the cells in your body very sensitive to light.

The next stage is carried out between 24-72 hours later. A bronchoscope will be guided to the site of the tumour(s), and a laser will be beamed through it. The cancerous cells which are now light sensitive to will be destroyed by the laser beam.

Side effects of photodynamic therapy include:

• inflammation of the airways, and
• a build up of fluid in the lungs.

Both of these side effects can cause symptoms of breathlessness and lung and throat pain. However, these symptoms should gradually pass as your lungs recover from the effects of the treatment.

Your skin will also be very sensitive to light for up to 60 days after treatment. You will therefore need to avoid exposure to bright light including sunlight. Most people are unable to leave their house during the daytime unless all of their body is covered and they are wearing sunglasses.

You should gradually build up your exposure to bright light during the end of this 60 day period. Your care team will be able to provide you with more information and advice about the best way to do this.

Preventing lung cancer

Not smoking is the most effective way to prevent getting lung cancer. If you are a smoker, the best way to prevent lung cancer, plus other serious conditions, is to stop smoking as soon as possible.

However long you have been smoking, it is always worth quitting. Every year that you do not smoke, your risk of getting serious illnesses, such as lung cancer, will start to decrease. After 10 years of not smoking, your chances of developing lung cancer falls to half that of a smoker.

The NHS Smoking Helpline can offer advice and encouragement to help you quit smoking. You can call on 0800 022 4 332, or visit the NHS Go Smokefree website.

Your GP, or pharmacist, will also be able to provide you with help and advice about giving up smoking.

Diet

Research suggests that eating a low fat, high fibre diet, including plenty of fresh fruit and vegetables (at least five portions a day) and whole grains, can help to reduce the risk of lung cancer, and other types of cancer, plus heart disease.

Exercise

There is a strong body of evidence to suggest that regular exercise can lower the risk of developing lung cancer as well as other types of cancer.

A minimum of 30 minutes of vigorous exercise a day, at least five times a week, is recommended. The exercise should be strenuous enough to leave your heart beating faster, and you should feel slightly out of breath afterwards. Examples of vigorous exercise include going for a brisk walk and walking up a hill.

Complications of lung cancer

The complications of lung cancer depend on the type, size, position within the lung, and spread of the cancer. A tumour can cause a blockage of one of the main breathing tubes (bronchi), leading to collapse of part of the lung, or a build up of fluid in the lung cavity (called an effusion) may develop.

Spread of the cancer to the bones or pressure on nerves from the tumour can cause pain, and some types of lung cancer produce hormones which can cause a number of unusual symptoms, such as flushing and diarrhoea.