Lung Cancer - Types, Signs, Stages, Prognosis, Treatment

Lung cancer affects around 47,800 people in the UK every year. It is one of the most common and serious types of cancer. It tends to affect older people, with around 45% of those diagnosed in the UK aged 75 and older.

There are two main types: non-small cell and small cell.

Non-small Cell Lung Cancer

This is the most common and makes up more than 87% of cases. The three types of non-small cell lung cancers are adenocarcinoma, squamous cell carcinoma, or large-cell carcinoma.

Small Cell Lung Cancer

Sometimes known as “oat cell cancer” due to its appearance under a microscope, this type of lung cancer is less common than non-small cell and it usually spreads faster to other parts of the body. It is usually caused by smoking.

Since this cancer grows quickly, it tends to respond well to chemotherapy and radiation therapy. Unfortunately, there is a greater risk of recurrence than with non-small cell lung cancer, usually within one to two years. However, the recurrence of small cell lung cancer after five years of disease-free survival is very rare.

Signs and Symptoms

In the early stages of lung cancer, there are usually no signs or symptoms, but as the cancer progresses many people 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

Many of the above symptoms can also be caused by other medical conditions but finding lung cancer early can mean that it is easier to treat so it is important to visit your GP if you are experiencing these symptoms.

Stages and Grades

The stage of a cancer tells you how big it is and whether it has spread. The grade of a cancer is based on how the cells look under a microscope. This can indicate how quickly or slowly the cancer might grow and whether it is likely to spread.

Cancer is usually staged using the TNM (Tumour, Node, Metastasis) system to create a number staging system, with stages 1 to 4. Stage 4 is advanced lung cancer where the cancer has spread. For small cell lung cancer, there is also a simplified staging system called limited and extensive stage. For more information on how lung cancer, or indeed any cancer, is staged you can visit Cancer Research UK.

Cancer cells are graded 1 to 4 with 1 tending to be slow growing and less likely to spread than grades 3 and 4 where the cells look very abnormal and tend to grow quickly and are more likely to spread. These are also called poorly differentiated or high grade.

Prognosis

As lung cancer does not usually cause noticeable symptoms until it has spread through the lungs or into other parts of the body, the outlook is not as good as many other types of cancer. However, survival depends on many factors including the spread of the cancer at diagnosis.

There are no UK-wide statistics available for survival of different stages of lung cancer or individual treatments. The figures below are for survival by stage in England for people diagnosed between 2013 and 2017.

Stage 1 - More than 55 out of 100 people (more than 55%) will survive their cancer for five years or more after diagnosis.

Stage 2 - Around 35 out of 100 people (around 35%) will survive their cancer for five years or more after diagnosis.

Stage 3 - Almost 15 out of 100 people (almost 15%) will survive their cancer for five years or more after diagnosis.

Stage 4 - Almost 5 out of 100 people (almost 5%) will survive their cancer for five years or more after they are diagnosed.

Treatment

How lung cancer is treated will also depend on a number of factors including the type of lung cancer, where it is, its size, whether it has spread and a person’s general health.

Researchers around the world are always searching for improved treatments for lung cancer. One of those of particular note is a tablet called sotorasib, which will soon be offered on the NHS to eligible lung cancer patients in England following approval by the UK Medicines and Healthcare products Regulatory Agency (MHRA). It will be used to treat adults with non-small cell lung cancer with KRAS G12C mutation.

This mutation is present in a quarter of all tumours and is referred to as the “Death Star” because of its spherical appearance and impenetrable nature. The sotorasib tablet attaches with the KRAS G12C mutation and inactivates it, thereby hindering cell division and cancer growth. It is expected that nearly 600 NHS patients in England will benefit from the treatment annually.

Here at Lanyon Bowdler we understand the difficulty our clients have in coming to terms with a cancer diagnosis, particularly when there are questions about the standard of care they have received. If you consider that your care has been affected by a delay in diagnosis, it is important to consider all the options available to you. Our team is happy to discuss the matter with you and guide you through the process sensitively.