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What is lung cancer?

Lung cancer starts when abnormal cells grow and multiply in an uncontrolled way. 

Lung cancer is the leading cause of cancer death and the fifth most common cancer diagnosed in Australia excluding non-melanoma cancers. It is responsible for almost one in five cancer deaths in Australia. 

In 2016, 12,216 new cases of lung cancer (including small cell and non-small cell lung cancers) were diagnosed in Australia. This accounts for close to 9% of all cancers diagnosed. The risk of being diagnosed with lung cancer in Australia by age 85 is 1 in 13 for men and 1 in 21 for women. 

In 2018, there were 8586 deaths caused by lung cancer in Australia.   

The five year survival rate for lung cancer is 18%. 

There are two main types of lung cancer: 

Non-small cell lung cancer (NSCLC) 

Non-small cell lung cancer is the most common type of lung cancer, accounting for around 85% of cases. There are sub-types of non-small cell lung cancer. The most common are: 

  • adenocarcinoma - begins in mucus-producing cells and makes up about 40% of lung cancers. While this type of lung cancer is most commonly diagnosed in current or former smokers, it is also the most common lung cancer in non-smokers. 
  • squamous cell (epidermoid) carcinoma - commonly develops in the larger airways of the lung. 
  • large cell undifferentiated carcinoma - can appear in any part of the lung and are not clearly squamous cell or adenocarcinoma. 

Small cell lung cancer (SCLC)  

Small cell lung cancer usually begins in the middle of the lungs and spreads more quickly than non-small cell lung cancer. It accounts for around 15% of lung cancers. 



Lung cancer symptoms

Symptoms of lung cancer may include: 

  • shortness of breath

  • changes to the voice such as hoarseness

  • chest pain

  • coughing or spitting up blood

  • a new cough that does not go away

  • recurring bronchitis or pneumonia

  • enlarged fingertips

  • loss of appetite

  • unexplained weight loss

  • tiredness.



Causes of lung cancer

Factors that can increase your risk of lung cancer include: 

  • smoking tobacco

  • second-hand smoke

  • exposure to asbestos

  • exposure to radon (radioactive gas)

  • exposure to occupational substances such as arsenic, cadmium, nickel, diesel fumes and soot 

  • HIV infection

  • family history

  • history of lung diseases such as lung fibrosis or emphysema.



Diagnosis of lung cancer

You may have a number of tests to determine if you have lung cancer.

Chest x-ray

An x-ray can show larger tumours (more than 1cm wide). 

CT scan

A computerised tomography (CT) scan uses x-ray beams to take pictures inside your body and create a cross-sectional image. A CT scan is able to detect smaller tumours as well as providing information about the tumour and lymph nodes.  

PET scan

A positron emission tomography (PET) scan is used to stage lung cancer after a diagnosis. 

Lung function test

You may have a lung function test known as spirometry which checks how well your lungs are working. 

Biopsy

A small sample of tissue will be taken if a tumour is suspected after a CT scan or x-ray. There are different types of biopsy including a bronchoscopy, CT-guided core biopsy and endobronchial ultrasound. 

Sputum cytology

The sputum (mucus) from your lungs will be examined under a microscope to check for abnormal cells. 



Treatment for lung cancer

 Treatment will depend on the type of lung cancer you have, how advanced it is and your general health. 

Surgery

if you have early stage non-small cell lung cancer you will most likely have surgery to remove the tumour. There are three main types of surgery:

  • lobectomy - a lobe is removed
  • wedge resection - part of the lobe is removed
  • pneumonectomy - a whole lung is removed.

Surgery is rarely used to treat small cell lung cancer. The main treatment for small cell lung cancer is chemotherapy. In addition, radiation therapy can be used to treat stages I-III small cell lung cancer.   

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. 

Radiation therapy (radiotherapy)

Radiation therapy (also known as radiotherapy) uses x-rays to kill or damage cancer cells and may be offered alone or in combination with surgery or chemotherapy. Radiation therapy can be used to treat locally advanced (stage III) non-small cell lung cancer. You may have radiation therapy for early stage lung cancer if surgery is not an option. Radiotherapy may also be used after surgery or as a palliative treatment. 

Thermal ablation

If surgery or radiation therapy are not suitable, you may be offered ablation treatment for localised, stage I non-small cell lung cancer. You will have needles inserted into the cancer to destroy cancer cells by heating them. 

Chemotherapy

Chemotherapy uses anti-cancer drugs to destroy cancer cells. It can be used to treat both small cell and non-small cell lung cancer. Chemotherapy may be used before surgery to shrink a tumour. It may be used before or in conjunction with radiation therapy to improve its effectiveness, before surgery to shrink the cancer, or after surgery to reduce the risk of cancer coming back. 

Immunotherapy

Immunotherapy uses specific drugs to stimulate the body's immune system and can be used to treat some forms of non-small cell lung cancer. 

Targeted therapies

Targeted therapy or personalised medicine targets specific mutations in cancer cells. Targeted therapy is generally used for advanced non-small cell lung cancer or if the cancer has returned. 

Palliative care

Palliative care seeks to improve quality of life by reducing cancer symptoms without aiming to cure the disease. Palliative treatment can be used at any stage of advanced lung cancer to assist with managing symptoms such as pain and nausea as well as slow the spread of the cancer. 

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • GP (General Practitioner)- looks after your general health and works with your specialiststo coordinate treatment.
  • Respiratory physician- investigates symptoms, is involved in diagnosis and determines initial treatment options.
  • Thoracic (chest) surgeon- diagnoses and performs surgery for cancer and other diseases of the lungs and chest.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Cancer nurses- assist with treatment and provide information and support throughout your treatment.
  • Dietitian- recommends an eating plan to follow while you are in treatment and recovery.
  • Speech pathologist- helps with swallowing and communication difficulties during and after treatment.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.


Screening for lung cancer

There is currently no routine screening test for lung cancer in Australia. Health authorities in Australia agree that there are a number of unresolved issues requiring further consideration before lung cancer screening could be feasible in Australia. 



Preventing lung cancer

The most comprehensive study of cancer causation in Australia estimated that 81% of lung cancers in 2010 were caused by tobacco smoking. 

While there is no proven way to prevent lung cancer you can greatly reduce your risk by not smoking or quitting smoking tobacco, avoiding second-hand smoke and avoiding cancer-causing agents (carcinogens) at work.   



Prognosis for lung cancer

Prognosis refers to the expected outcome of a disease. While it is not possible for a doctor to predict the exact course of the disease, they can give you an idea about the general outlook for people with the same type and stage of cancer. 

Your doctor will consider your test results, the type of lung cancer you have, the rate and extent of tumour growth, and other factors including your age, overall health and whether you are a smoker. 

The earlier the cancer is found the better the treatment outcomes will be. 



Sources

Understanding Lung Cancer, Cancer Council Australia, ©2018. Last medical review of source booklet: October 2018. 

Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW. 

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