Lung cancer

The main risk factors for developing lung cancer are smoking and increasing age, however, between 10 and 20% of lung cancers occur in people who have never smoked.

What to expect from your appointments with us

If you have been referred from your GP then you will be seen in our urgent one stop lung clinic by a respiratory doctor and lung cancer clinical nurse specialist (CNS). This clinic is held at the Community Diagnostic Centre, Quayside House in Gloucester Docks. We call this a one stop clinic as depending on your needs, you may have a CT scan, breathing tests and/or blood tests during your visit. If so, we will try and get these done for you as quickly as possible but you may need to stay for up to 2-3 hours depending on how much needs to be done.

Although we may not be able to tell you exactly what the problem is on the day, we will be able to talk through what the CT scan has shown and whether any more tests are going to be needed.

What to expect from your diagnostic tests and investigations

• CT Scan: Computerised tomography (CT) scans take detailed internal pictures of your body and is usually the first step when assessing a lung abnormality that could be cancerous. Before having a CT scan, you’ll be given an injection containing a special dye, which helps improve the quality of the image.
• MRI Scan: Magnetic resonance imaging (MRI) uses strong magnetic fields and radio waves to create a cross sectional picture of the body. You might have an MRI in selected occasions
• PET Scan: A Positron emission tomography (PET) scan produces a detailed three dimensional image inside of the body. Glucose is injected before the scan to reveal which areas of the body are ‘active’ and can help distinguish cancers from inactive areas like scar tissue. You might have a PET scan to assess whether a CT abnormality is worrying for cancer, or to see if a cancer has spread, or to plan the best target site for a biopsy.
• CT guided biopsy: A CT guided biopsy is a minor invasive procedure performed under local anaesthetic. The CT scan is used to accurately guide a biopsy needle into an abnormality in order to get a sample of tissue that can be examined under a microscope.
• Bronchoscopy: This procedure involves an examination of the main breathing tubes in your lungs by passing a narrow fibre optic tube through the nose or mouth. It is performed under sedation and local anaesthesia to numb the throat. Although this is not done under a full general anaesthetic, it is usually well tolerated and most people are quite drowsy and may not remember too much about it afterwards.
• Endobronchial ultrasound (EBUS): The test is a specialised type of bronchoscopy which includes an ultrasound probe on the end of the camera tube. The ultrasound probe allows us to find lymph glands with the chest and to take biopsies from these. You can read more about this procedure on the Macmillan Website Endobronchial ultrasound scan and biopsy (EBUS) | Macmillan Cancer Support

Treatment options and what to expect

Radiotherapy - This involves using radiation to destroy cancer cells. Radiotherapy may be given in high doses to people who are not fit for surgery or where a tumour is not operable, with the aim of trying to cure the cancer. This is called radical radiotherapy and this is sometimes combined with chemotherapy.

Radiotherapy can also be given in lower doses to try help control symptoms from cancer without curing it. This is called palliative radiotherapy.

Stereotactic Ablative Body Radiotherapy (SABR) – This is a way of giving radiotherapy to precisely target certain cancers, whilst avoiding as much surrounding healthy tissue as possible.

SACT treatments

You may hear the following treatment being described as SACT, which means systemic anti-cancer therapies. These include chemotherapy and immunotherapy and are treatments that work throughout the entire body.SACT treatments

You may hear the following treatment being described as SACT, which means systemic anti-cancer therapies. These include chemotherapy and immunotherapy and are treatments that work throughout the entire body.

Chemotherapy - This uses medicine to destroy cancer cells. When used to treat lung cancer, chemotherapy can be given straight into your vein through an intravenous drip or orally as a tablet. You may receive a combination of chemotherapy and radiotherapy.

Immunotherapy – Works by helping the immune system recognise and attack cancer cells. The type of immunotherapy given to lung cancer patients is known as checkpoint inhibitors, which work by blocking proteins that prevent the immune system from fighting the cancer cells. This treatment is given directly into your vein through an intravenous drip.

Targeted therapies – Targeted cancer drugs work by directly targeting the mutations that are causing cancer cells to divide and grow.

Surgery

Thoracic clinic

If surgery is advised you will attend the thoracic clinic. Thoracic surgery is performed in our nearest thoracic surgical centres in either Bristol or Birmingham, depending where you live. If you are referred for surgery then first the surgeon will see you in clinic to talk this through. This appointment could either be in Cheltenham, in Bristol or Birmingham, or online, depending on your needs and whether further in-person assessments of fitness for anaesthetic is needed.

This is not an option for all patients with lung cancer, as for some, the risks of the procedure may outweigh the benefits, and surgery is only helpful if the cancer has not spread widely. Before lung surgery you will have detailed assessments of your breathing to ensure that your lung function is sufficient to manage OK after a section of lung is removed.

There are three main types of lung surgery:

Lobectomy – A lobectomy is a surgery to remove one of the lobes of the lungs. The lungs have sections called lobes. The right lung has 3 lobes. The left lung has 2 lobes. A lobectomy may be done when a problem is found in just part of a lung.

Wedge resection or segmentectomy – a smaller section of the lung is removed. This is only used when the cancer is small and limited to one area of the lung.

Pneumonectomy – where the entire lung is removed. This is used when the cancer is located in the middle of the lung or has spread within one lung.