1. Initial investigation and referral
Symptoms of lung cancer may include coughing up blood and/or an unexplained and persistent (lasting more than three weeks) cough/chest infection, chest/shoulder pain, breathlessness and hoarseness.
Your general practitioner (GP) will assess your symptoms, conduct a physical examination and order a chest x-ray. Your GP should also discuss your needs (including physical, psychological, social and information needs) and recommend sources of reliable information and support.
If lung cancer is suspected, you will be referred to a specialist for further testing. Your GP will provide the specialist with information about your medical history, whether there is a history of cancer in your family, and your test results.
It can be helpful to bring a family member or friend with you to your appointments.
2. Diagnosis and staging
The specialist should discuss your test results and options for further testing. This is to find out whether cancer is present, and if it is, its stage of development and if it has spread.
You may have one or more of these tests:
Computed tomography (CT) scan
Computer technology and x-rays are used to create detailed images of the lungs.
A test done under anaesthetic where a flexible tube is used to examine the airways and take tissue samples.
There are several ways to take a small tissue sample (a biopsy) from the lungs to examine under a microscope.
Endobronchial ultrasound (EBUS)
Endobronchial ultrasound (EBUS) is a type of bronchoscopy that uses high-frequency sound waves to create an image.
Positron emission tomography (PET) scan
This produces a three-dimensional colour image that may show where cancers are located. A small amount of radioactive material is injected and the whole body is scanned.
3. Further referral and testing
Some people have further tests such as a bone scan.
It can also be helpful to contact lung cancer peer support groups and support groups for carers.
Here is a list of questions to ask your doctor.
To ensure you receive the best care, your specialist will arrange for a team of health professionals to review your test results and plan your treatment based on your preferences and needs.
The team will be made up of health professionals who have experience managing and supporting a person with lung cancer. Your specialist will tell you when the team will be discussing your case.
Your team should discuss the different treatment options with you including the likely outcomes, expected timeframes, possible side effects, and the risks and benefits. Your doctor may also suggest you consider taking part in a clinical trial. You might want to ask for more time before deciding on your treatment, or ask for a second opinion.
Let your team know about any complementary therapies you are using or thinking about trying. Some therapies may not be appropriate, depending on your medical treatment.
In some cases, more than one type of treatment will be used to get the best outcome.
Surgery is the most common treatment for patients with early lung cancer. It is important that this surgery is performed by a surgeon who is very experienced in performing lung surgery and performs several operations every year.
Radiation therapy (also called radiotherapy) may benefit patients if surgery is not suitable, or may be combined with chemotherapy.
Chemotherapy or drug therapy
Chemotherapy or drug therapy may be given before or after surgery, or if surgery is not suitable, with or without radiation.
Palliative treatment will be used at different stages to relieve various symptoms and help to improve your quality of life.
The treatment options depend on whether the cancer has spread to both sides of your chest or beyond your lungs.
Lung cancer is often not found until it is advanced because it can grow rapidly and symptoms can be vague.
For more information about treatment and treatment side effects ask your doctor or visit our treatment section.
Your doctor should discuss your needs with you during and after treatment (including physical, psychological, social and information needs) and may refer you to another service or health professional for different aspects of your care.
5. After treatment
After treatment is completed, your doctor should provide you with a treatment summary which details the care you received, including:
- diagnostic tests performed and their results
- types of treatment used and when they were performed
- treatment plans from other health professionals
- supportive care services provided to you.
Your doctor will decide whether your ongoing care will be managed by your GP or a palliative care physician. You should both receive a follow-up care plan that tells you about:
- the type of follow-up that is best for you
- care plans for managing any side effects of treatment, should they occur
- how to get specialist medical help quickly if you think the cancer has returned or got worse.
Your doctor should:
discuss your needs with you and refer you to appropriate health professionals and/or community organisations, if support is required
provide information on the signs and symptoms to look out for that might mean a return of the cancer
provide information on prevention and healthy living
6. If cancer returns
Sometimes lung cancer can come back after treatment. This is why it is important that you have regular check-ups. Usually this will be detected at your routine follow-up appointments or if you notice symptoms are coming back.
7. Living with cancer
Some people experience side effects (for example, tiredness) that continue beyond the end of treatment. Sometimes side effects don’t begin until months after treatment has finished. For more information about side effects ask your doctor.
Advance care plan:
Your doctor may discuss with you the option of developing an advance care plan. An advance care plan is a formal way of setting out your wishes for future medical care. For more information about advance care planning ask your doctor or visit advancecareplanning.org.au.
This type of treatment could be used at different stages to help you with pain relief, to reduce your symptoms or help improve your quality of life. For more information about palliative care ask your doctor or visit palliativecare.org.au.
8. Questions of cost
There can be cost implications at each stage of the cancer care pathway, including costs of treatment, accommodation and travel. There can be substantial out-of-pocket costs if you are having treatment in a private health service, even if you have private health insurance.
You can discuss these costs with your doctor and/or private health insurer for each type of treatment you may have. If you are experiencing financial difficulties due to your cancer treatment you can contact the social worker at your local hospital.
For more information visit costs of treatment.
For more information about accommodation and travel costs visit our support section.
9. Further support
Lung cancer support
Call the lung foundation on 1800 654 301 for information about lung cancer and where to go for support and help or visit lungfoundation.com.au
Also, specially trained staff at Cancer Council can answer your questions about the effects of cancer, explain what will happen during treatment and link you to support groups and other community resources. Call Cancer Council 13 11 20.
If you need an interpreter, call TIS (the Translating and Interpreting Service) on 13 14 50.
For support and advice for carers, call the Carers Association on 1800 242 636.
More support options
beyondblue: The National Depression Initiative
Information on depression, anxiety and related disorders, available treatment and support services
• Telephone: 1300 22 4636
• Website: www.beyondblue.org.au
Information on cancer prevention, screening, diagnosis, treatment and supportive care for Australians affected by cancer, and their families and carers
• Telephone: 1800 624 973
• Website: www.canceraustralia.gov.au
Care Search: Palliative Care Knowledge network
Information for patients and carers on living with illness, practical advice on how to care, and finding services
• Telephone: (08) 7221 8233
• Website: www.caresearch.com.au
Lung Foundation Australia
Information about lung cancer and patient support
• Website: www.lungfoundation.com.au
National Health Services Directory
A directory providing information on local hospital and community services
• Website: www.nhsd.com.au
NEMICS A common path: Lung cancer
Videos offering support and advice from people who have been through cancer.
• Visit: www.youtube.com/c/ACommonPathCancersupportandadvice
Clinical versions of the optimal care pathways have been developed for clinicians and general practitioners here.