Lung Cancer

Lung cancer starts in the lungs. It is one of the most common cancers and the leading cause of cancer-related deaths worldwide [1]. The type of lung cancer, where it is in the lung, and how far it has developed all impact the treatment options available.

Overall health and nutrition are also important if you have lung cancer. For example, good nutrition can help you maintain strength and support your body during and after treatment.

While it may feel overwhelming to receive a diagnosis of lung cancer, understanding what it means, and what comes next, can help you feel more in control. This article covers what lung cancer is, how it is diagnosed and treated, and how nutrition can support you throughout your journey.

Lung cancer develops when abnormal cells begin to grow uncontrollably in the lungs, two organs in the chest that are part of the body’s respiratory (or breathing) system.

Unlike healthy cells, these cancer cells don’t work as they should. Over time, they can interfere with breathing and the lungs’ ability to move oxygen around the body. In some cases, cancer cells in the lungs can spread to other parts of the body.

The two main types are non-small cell lung cancer (NSCLC), which is the most common, and small cell lung cancer (SCLC), which tends to grow and spread more quickly than NSCLC [2]. There are also other less common types of cancer that start in the lungs, including mesothelioma, which starts in the covering of the lung (the pleura).

Your care team will be able to help you understand more about the type of lung cancer you have and what that means for you and your treatment.

Lung cancer can develop for different reasons, and there is rarely a single cause. In fact, some people diagnosed with lung cancer have no obvious risk factors.

The most common risk factors include [3]:

• Smoking or exposure to second-hand smoke
• Environmental exposures, such as radon gas or air pollution
• Occupational exposure to substances like asbestos or certain chemicals
• Genetic and biological factors

Emerging evidence suggests that vaping may also increase the risk of lung cancer (and oral cancers) [4].

It is important to know that lung cancer can and does affect people who have never smoked [5]. If you have been diagnosed with lung cancer, understanding the possible causes can be useful — but it doesn't change the care and support available to you.

Possible signs and symptoms of lung cancer to be aware of include:

• A persistent cough that is new or has changed, including coughing after eating or a cough that won't go away
• Shortness of breath or feeling more breathless than usual during everyday activities
• Chest pain or discomfort, or pain in the shoulder blade or back
• Fatigue or a general feeling of being more tired than usual
• Changes in appetite or finding it harder to eat than normal
• Coughing up blood: this may feel alarming, but it's important to see a doctor as soon as possible if this happens
• Recurrent respiratory infections
• Hoarseness of voice, if nerves or voice box are affected.
• Unintentional weight loss, another potential sign worth discussing with your doctor.

Lung cancer may cause a range of symptoms, which can vary from person to person. In some cases, there may be no obvious signs or symptoms at all in the early stages.

The signs of lung cancer can also be caused by other conditions, so noticing one or more of these doesn't mean you have lung cancer. What matters most is that if something doesn't feel right, you speak to your doctor. Early attention to symptoms like these, whatever the cause, is a good idea, and getting checked is not something to put off. So, if you are experiencing any of the above, please speak to your doctor.

If lung cancer is suspected, your doctor will recommend a series of tests to build a clear picture of what is happening in your body, such as:

• Chest X-ray: often the first step, which can sometimes reveal early changes in the lungs
• CT scan: provides a more detailed view of the size and location of any changes
• PET scan: helps show whether cancer may have spread to other areas of the body
• Biopsy: a small sample of tissue is taken and examined to confirm a lung cancer diagnosis. This is sometimes done using a thin camera that is guided through the airways to collect the sample
• Lab work: blood tests, urine tests and, sometimes, genetic testing on tissue samples may be done to support diagnosis and treatment planning.

Once a diagnosis is confirmed, your care team will work out the stage of the cancer.

Staging is a way of describing how advanced the cancer is and whether it has spread beyond the lungs. It is done using what’s called the TNM system (Tumour, Nodes & Metastases) and helps your care team understand your situation and plan the most appropriate treatment for you.

There is no single approach to lung cancer treatment that suits everyone. Treatment is carefully personalised, considering the type and stage of cancer, your overall health, and what matters most to you.

If you have non-small cell lung cancer (NSCLC), treatment options may include:

• Surgery to remove the affected area of the lung
• Radiotherapy, used when surgery isn't suitable (like if your general health means you are at increased risk of complications), or alongside chemotherapy
• Chemotherapy, which may be given before or after surgery, or when the cancer has spread further
• Immunotherapy (a type of medicine that helps your own immune system target and destroy cancer cells), when the cancer has spread too far for surgery or radiotherapy to work, either on its own or combined with chemotherapy
• Targeted therapy, for cases where the cancer has specific genetic characteristics that respond to this approach. A special type of testing, known as biomarker testing, helps to identify which targeted treatments or immunotherapy may be most effective for you. Your treatment will be personalised based on your cancer type, stage, biomarker results and your own preferences.

If you have small cell lung cancer (SCLC), treatment usually involves:

• Chemotherapy, the main treatment, either alone or combined with radiotherapy
• Radiotherapy, sometimes used alongside chemotherapy
• Immunotherapy may be used in certain cases
• Targeted therapy may be considered where the cancer has specific genetic characteristics that respond to this approach
• Surgery may be considered if the cancer is found very early but is usually not used to treat SCLC (as it has often already spread to other parts of the body).

Supportive care, including for nutrition, pain management and emotional wellbeing, also plays an important role alongside medical treatment, helping you feel as well as possible throughout your care.

Recovery from lung cancer looks different for everyone. What helps one person may not be the same for another, but there are things that can support you along the way.

• Regular follow-up appointments help your care team monitor your health, manage any lasting side effects and spot any changes early.
• Rehabilitation, including breathing exercises and gentle physical activity, can help you regain strength and improve your quality of life.
• Good nutrition can also help you rebuild strength and help your body recover. If eating has been difficult during treatment, recovery is a good time to revisit what your body needs nutritionally with the support of your care team.

Don't hesitate to ask your care team questions throughout your recovery journey. They are there to support you and answer any questions you may have.

For some people, treatment can bring lung cancer under control to the point where signs of cancer are no longer noticeable. This is known as remission.

Some people may experience a recurrence, when the cancer returns after a period of remission. This is why ongoing monitoring and follow-up care remain so important, even when you are feeling better. Regular check-ups allow your care team to track your health and respond quickly if needed.

Whether you've just been diagnosed or are mid-treatment, understanding your nutritional needs can make a real difference. Many cancer care teams include a dietitian for this reason. If you haven't already spoken to one, it's worth asking your care team about the nutritional support available to you.