Lung Cancer

What is Lung Cancer?

Lung cancer is caused by abnormal and uncontrolled cell growth in either one or both of the lungs.1

There are two main sub-classifications of primary lung cancer:

  • Non-small cell lung cancer (NSCLC) – this is the most common form of lung cancer, making up approximately 85% of all lung cancer cases. NSCLC can be classified into a number of types, including:1
    • Adenocarcinoma – typically found on the outer area of the lungs, in cells that produce mucus
    • Squamous cell carcinoma – typically found in the airways of the lungs
    • Large cell undifferentiated carcinoma – this type of cancer can not be classified as either adenocarcinoma or squamous cell carcinoma.
  • Small cell lung cancer (SCLC) – this type of lung cancer tends to spread faster than NSCLC, however it is less common than NSCLC, accounting for approximately 15% of all lung cancers.1

Lung cancer is the leading cause of cancer in Hong Kong.11

Is lung cancer hereditary?

For most lung cancer cases, genetic mutations are somatic (meaning they happen in cells only specific to that individual and are not inherited).4

In rare cases, genetics may play a role in the development of lung cancer, particularly for people who have inherited gene mutations on chromosome 6 (which accounts for approximately 6% of all DNA in cells).2,3

However the most common cause of lung cancer is cigarette smoking. 1

Stages of lung cancer

The stages of lung cancer are classified by the TNM system which stands for: 7

  • Tumour (T) – describes the size of the tumour and the extent the cancer has spread into the tissue of the lung. The tumour can be graded from T1a (which describes a tumour under 1cm) to T4 (which describes a tumour larger than 7cm).
  • Nodes (N) – describes whether the tumour has spread to nearby lymph nodes. Nodes can be graded from N0, where there has been no spread, through to N3, where the cancer has spread to other areas of the body, such as the other side of the chest or collarbone.
  • Metastasis (M) – describes whether the cancer has spread to other areas of the body outside of the lung. Metastasis can be graded from M0, where there has been no spread through to M1c, where the cancer has spread to other organs of the body and produced additional tumours.

Signs and symptoms of lung cancer

There are a number of conditions that can cause the below symptoms besides lung cancer; however, it is important to see your doctor and discuss your individual symptoms. Seeking treatment as soon as you notice symptoms will enable the best chance for successful treatment. 6

Some common symptoms of lung cancer include: 5

  • Weight loss that can not be explained by diet or exercise
  • Loss of appetite
  • Difficulty breathing or breathlessness
  • Wheezing and coughing
  • A chronic (ongoing) cough that doesn’t go away
  • Difficulty swallowing
  • Shoulder or chest pain that may be worse with breathing
  • Chronic infections such as bronchitis or pneumonia
  • Coughing up blood
  • Unexplained tiredness or fatigue
  • Swollen face or enlarged veins in the neck

Some lung cancers can also cause a collection of specific symptoms which are termed syndromes. Syndromes which have been associated with lung cancer include:

  • Superior Vena Cava (SVC) syndrome – the SVC is a large blood vessel that carries blood away from the head and arms to the heart. Tumours near the lung area can press against this large blood vessel causes swelling in the face and neck, chest and upper arm area.6
  • Paraneoplastic syndromes – some lung cancers make substances which act like hormones and can affect other tissues and organs in the body. Some paraneoplastic syndromes include:
    • Cushing Syndrome – adrenal glands in the body may produce too much cortisol (due to cancer cells producing specific hormones), this can lead to weight gain, as well as symptoms of dizziness/tiredness and weakness.6
    • SIADH (Syndrome of inappropriate anti-diuretic hormone) – cancer cells can make a hormone which encourage the kidneys to hold onto water, reducing the amount of salt in the blood. Symptoms can include; cramps and muscle weakness, tiredness, nausea and/or vomiting. In severe cases without treatment, seizures and coma may occur.6

Diagnosis

Lung cancer diagnosis involves a number of tests. You may undergo a bronchoscopy, which allows the doctors to look directly into your lungs; a mediastinoscopy, where a tube is inserted through your neck and down the outside of your trachea so the mediastinum (area between the lungs) can be inspected; or a lung biopsy, which involves removing tissue from the tumour to examine.

Further tests may also be required, often to see if the cancer has spread beyond the lungs. These include a CT scan and Virtual Bronchoscopy, Ultrasound, PET scan or MRI scan.

Treatment

Frequently asked questions

Are there risk factors for lung cancer?

Exact causes of lung cancer are not fully known, especially in those people who develop lung cancer without any known risk factors. 1

However, there are a number of lifestyle-related factors which increase the risk of developing lung cancer, including: 8

  • Smoking – cigarette smoking carries a significantly higher risk of developing lung cancer when compared with non-smokers. It is estimated that lung cancer cases as a result of cigarette smoking contribute to 90% of all cases in men and 65% in women. 1
  • Second-hand smoking – there is an increased risk for non-smoking people who breath in the cigarette smoke of others. Living with someone who smokes can increase your risk for lung cancer by approximately 20-30%. 1
  • Exposure to asbestos and other toxins – people who have been exposed to asbestos (traditionally used in building materials) and other toxins such as radon (a radioactive gas used in the mining industry) have an increased risk of developing lung cancer.1

Additional risk factors include:

  • Age – the risk of developing lung cancer increases as people age. Most lung cancers are diagnosed in people over the age of 60.1
  • Medical history – for people who have a medical history of lung disease such as emphysema or fibrosis of the lung may have an increased risk of developing lung cancer. 1

References

For a full list of references, click here.
  1. Cancer Council. (2018). Lung Cancer. Retrieved on 22nd April 2019 from https://www.cancercouncil.com.au/lung-cancer/?gclid=EAIaIQobChMIhueBgeDk4QIVygorCh1USgkBEAAYASAAEgIrR_D_BwE#types
  2. American Cancer Society. (2016). What causes non-small cell lung cancer? Retrieved on 22ndApril 2019 from https://www.cancer.org/cancer/non-small-cell-lung-cancer/causes-risks-prevention/what-causes.html
  3. Genetics Home Reference. (2019). Chromosome 6. Retrieved on 22nd April 2019 from https://ghr.nlm.nih.gov/chromosome/6#conditions
  4. Genetics Home Reference. (2019). Lung Cancer. Retrieved on 22nd April 2019 from https://ghr.nlm.nih.gov/condition/lung-cancer#genes
  5. Australian Government: Cancer Australia. (2018). Lung Cancer. Retrieved on 22nd April 2019 from https://lung-cancer.canceraustralia.gov.au/symptoms
  6. American Cancer Society. (2016). Signs and Symptoms of Lung Cancer. Retrieved on 22nd April 2019 from https://www.cancer.org/cancer/lung-cancer/prevention-and-early-detection/signs-and-symptoms.html
  7. Cancer Council. (2018). Staging and prognosis for lung cancer. Retrieved on 22nd April 2019 from https://www.cancercouncil.com.au/lung-cancer/diagnosis/staging-prognosis/
  8. Australian Government: Cancer Australia. (2018). What are the risk factors for lung cancer?Retrieved on 25th April 2019 from https://lung-cancer.canceraustralia.gov.au/risk-factors
  9. Australian Government: Cancer Australia. (2014). Risk factors for lung cancer: an overview of the evidence. Retrieved on 25th April 2019 from https://canceraustralia.gov.au/system/tdf/publications/risk-factors-lung-cancer-overview-evidence/pdf/2014-risk_factors_for_lung_cancer_an_overview_final_lr.pdf?file=1&type=node&id=4062
  10. Australian Institute of Health and Welfare. (2011). Lung cancer in Australia: an overview. Retrieved on 7th November 2019 from https://www.aihw.gov.au/report/lung-cancer-in-australia-an-overview/contents/summary
  11. HealthyHK, Department of Health. (2019). Lung Cancer. Retrieved on 15 November 2019 from https://www.healthyhk.gov.hk/phisweb/en/healthy_facts/disease_burden/major_causes_death/cancers/lung_cancer/

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