Lung Cancer

What Causes Lung Cancer

The main cause of lung cancer is cigarette smoking, which accounts for approximately 90% of cases of lung cancer.  The risk of lung cancer goes up the more you smoke so there is always a good incentive for you to quit smoking.  Other less common risk factors for developing lung cancer include asbestos exposure, radiation therapy for other cancers, pulmonary fibrosis (scarring of the lungs), some environmental toxins and occasionally it can be genetic.

What Types of Lung Cancer Are There

Lung cancer is divided into two main groups according to the size of the cancer cells, as either small cell lung cancer (SCLC), or non-small cell lung cancer (NSCLC).  Finding out whether a lung cancer is small cell or non-small cell is really important for you, as this is used for working the stage of lung cancer and its treatment.

Symptoms of Lung Cancer

It is important to remember that symptoms of lung cancer can also occur in other diseases so if you have any of the following symptoms it does not mean that you have lung cancer but it is important that you discuss these with your GP or myself.  The commonest symptoms seen in lung cancer include cough and weight loss, but other important symptoms that should not be ignored are breathlessness, chest pain, coughing up blood (haemoptysis), bone pain and a hoarse voice.

How Is Lung Cancer Diagnosed

Initially we would start with a consultation (currently via video or in person if required) where I would ask you about your symptoms and whether you have any of the risk factors for lung cancer.  I would also be checking to see whether or not you have any other medical problems or are on any medication, as these could be important for planning any future treatment.  I would then perform a physical examination of your chest and then we would move on to having some tests to investigate whether or not your symptoms are caused by lung cancer.  The history and examination would all occur in the initial consultation and at that stage I can organise any tests that you might require.  If you do have any old chest x-rays or CT scans and their report, then these can be really useful for comparison.

What Tests Are Required to Diagnose Lung Cancer

The purpose of doing tests is to firstly establish whether you have a lung cancer and its stage.  Aside from doing tests to confirm diagnosis of lung cancer, the tests also help in assessing your fitness for potential treatment such as chemotherapy, radiotherapy or surgery.

Blood tests

To check on your blood count, kidney and liver function.

Chest X-ray

A chest X-ray is useful at giving a general overview of the lungs but we will usually need to get a CT scan to give a much clearer picture.

CT scan

A CT scan of the chest is a type of x-ray examination where you lie on a bed and the bed moves into the scanner.  The scanner is quite open and roomy so you shouldn’t get claustrophobic.  This does not usually take very long but it may require injection of a dye called contrast to allow us to clearly see all the structures in the chest.  The CT scan would then be read by a specialist x-ray consultant (radiologist) and would be discussed at our lung cancer MDT (multidisciplinary team) meeting, which is a regular meeting that I have with lots of other lung cancer specialists where we review all the scans and results for patients undergoing investigation for possible lung cancer.

PET scan

A  PET scan is a more complex type of scan, which helps work out whether any nodule or lump is active or inactive.  The more active or “hot” a nodule on the lung is on PET scanning, then the more likely it is that it may be cancerous.  However, it is really important that a PET scan is looked at as part of the overall assessment as there are other potential causes of having a positive PET scan.

Lung function tests

Lung function tests (breathing tests) are done to assess your fitness for treatment including surgery.  This is a straightforward test, which involves blowing into a breathing machine to assess your lung capacity.  Sometimes we may need to do some measurement of your exercise capacity, which can be used to measure your oxygen level whilst you are doing exercise such as walking or pedalling on an exercise bike.


There are different ways of performing a biopsy (taking a small sample of any abnormality).  Before proceeding with the biopsy, I would discuss your case with all the results at our lung MDT so that as a team we can work out the most appropriate and quickest way to get a diagnosis for you.  Possibilities include a biopsy under local anaesthetic in the x-ray department, a bronchoscopy (a camera examination of the airways under local anaesthetic and sedation), and sometimes a biopsy performed under a general anaesthetic.

What Stage Is Your Lung Cancer

The staging of lung cancer goes from stages 1 to 4, with stage 1 being the earliest.  At each stage there are subdivisions according to scan and biopsy results.  The stage is calculated according to the size and location of the tumour, involvement of lymph glands or nodes, and any spread of the cancer.  These features are put together and I can calculate the stage of your lung cancer, and in conjunction with colleagues in Oncology, Radiology and Thoracic Surgery we can then plan your treatment accordingly.

What Treatment Is Available For Lung Cancer

Treatment for lung cancer can include surgery, radiotherapy and medication such as chemotherapy or immunotherapy.  With modern advances in lung cancer treatment, any treatment that you require will be selected to give you the best chance of having successful treatment.  All treatments are discussed at the lung cancer MDT, which I attend, and so you will always be advised to have the most appropriate treatment.

What Should You Do If You Are Worried About Possible Lung Cancer

If you have a cough that will not go away or you are losing weight for no reason, then do not ignore these symptoms but do seek help from myself or your GP so that we may find the cause of your cough as quickly as possible.  Please bear in mind that there are many causes of cough and not all coughs are caused by lung cancer.  You can see me directly but you may need to see your GP first if you are going through your insurance company.  My PA, either James or Genevieve, will book you in and I can normally see you the same week so you do not have to wait.