Lung cancer is the third commonest cause of death in the UK. More than 90% of cases are due to smoking. The outlook for most is poor. Only 20% survive one year and 5% five years - partly because many patients are elderly and suffer other smoking-related diseases. Yet services could be significantly improved, enabling some patients to live longer and improving quality of life for others. Treatment by a specialist team is key.
Symptoms include coughing (which may bring up blood), breathlessness, weight-loss, fatigue and chest pain. About 80% of tumours are non-small cell lung cancer (NSCLC) and 20% small cell (SCLC). Identifying the type - by bronchoscopy or a biopsy with a fine needle guided by a CT scan - is crucial in determining best treatment. Assessing how far the cancer has spread is also essential: patients with early disease have the best chance of survival. With advanced cancer, radical treatment is not appropriate.
Surgery - to remove a lung or lung lobe - offers the best chance of long-term survival for some patients with early NSCLC. More work is needed to identify those who can most benefit. A US study found 70% of patients undergoing surgery with early NSCLC survive five years. UK survival rates are lower, suggesting some people are denied potentially life-saving surgery and that cancer is too advanced in others undergoing surgery. More than one in 10 operations reveals cancer too extensive to remove, meaning people undergo stressful surgery unnecessarily. With locally advanced NSCLC, radiotherapy can prolong life. Chemotherapy may improve medium-term survival.
Chemotherapy is the main treatment, sometimes alongside radiotherapy. Combination therapy - using two or more drugs together - works best. Research is still awaited on new generation anti-cancer drugs, such as the taxanes. Surgery usually offers no benefit.
Radiotherapy, chemotherapy and drugs to control pain can all help improve quality of life for those with advanced cancer. Specialist palliative care teams - now available to half of patients - can reduce symptoms and prolong survival.