Lung cancer is the fifth most common cancer in Australia.
Four out of five lung cancers are non small cell lung cancers, broadly divided by their main cell type into squamous cell, adenocarcinoma and large cell.
If detected early they can initially be managed with local treatments such as surgery and/or radiotherapy.
Incidence and mortality
There are approximately 9700 cases of lung cancer diagnosed in Australia each year (small cell and non small cell), about 9% of all cancers. The risk of being diagnosed by age 85 is 1 in 12 for men and 1 in 23 for women.
Lung cancer causes more than one in five cancer deaths. In 2007, there were 7626 deaths from lung cancer.
Screening
There is no routine screening test for lung cancer.
Symptoms and diagnosis
Patients may present with specific symptoms related to the lung including:
- shortness of breath and wheezing
- chest pain
- cough which can produce blood stained sputum
or general symptoms which may include:
- weight loss
- lethargy
- loss of appetite.
Diagnostic options include a biopsy of the mass during a bronchoscopy (a tube inserted into the airways) or examining the sputum for cancer cells.
Staging
Staging is based on the
TNM system and classified by the size of the primary tumour, or whether it has spread to the draining lymph nodes or more widely, particularly to the liver, bones, adrenal glands and brain. The staging scans are essentially a CT scan of lungs and centre of the chest (mediastinum), liver and adrenals. A PET scan can add additional information about distant spread including to bones. If PET is not available a bone scan is done.
In early stage disease, a mediastinoscopy may be performed to see the mediastinal lymph nodes, in order to work out whether surgery is possible.
Causes
Cigarette smoking is the major cause, although some people diagnosed with lung cancer have never smoked. Occupational exposures to asbestos, radon, hydrocarbons and metals (e.g. chromium, nickel) are also associated with lung cancer.
Prevention
The major way to prevent lung cancer is by not smoking or quitting smoking.
Treatment
For small tumours surgery alone can be curative. For operable tumours with spread to the lymph nodes, chemotherapy in addition to surgery can improve the outcome. In cancer confined to the chest, but thought to be inoperable, chemotherapy combined with radiotherapy can be used. For widespread disease, chemotherapy doublets such as cisplatin with vinorelbine, or gemcitabine or paclitaxel with carboplatin, can be used.
Second line chemotherapy with docetaxel or pemetrexed can induce a further response after relapse in patients who maintain a good performance level. With some lung cancers (particularly in non-smoking women, and more commonly in people of Asian extraction), agents targeted at the Epidermal Growth Factor Receptor can be beneficial.
Prognosis
An individual’s prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis. For small operable cancers, up to 80% patients can be alive at five years. This drops to a 25-30% five year survival rate for tumours with spread to the lymph nodes, but still treatable by surgery. For patients with spread to other parts of the body who are fit enough to receive chemotherapy, 15-35% will be alive at five years.
For further information, contact
Cancer Council Helpline on 13 11 20 (cost of a local call within Australia).