LUNG CANCER RESOURCES

Throughout the years, I’ve compiled information and advice from experts in the medical field regarding a variety of health care topics. I’ve tried to cover a variety of relevant subjects to help educate you and your loved ones. However, if there’s still something unclear or you have additional questions, please don’t hesitate to let me know.

Understanding Lung Cancer: Types and What They Mean for You

This information sheet is designed to help you understand more about the different types of lung cancer. Knowing the specific type of lung cancer you have is important because it helps your healthcare team decide on the best course of treatment for you.

What is Lung Cancer?

Lung cancer is a disease where cells in the lungs grow out of control. These abnormal cells can form tumours and spread to other parts of the body.

There are two main categories of lung cancer, based on how the cells look under a microscope:

Non-Small Cell Lung Cancer (NSCLC)
Small Cell Lung Cancer (SCLC)

1. Non-Small Cell Lung Cancer (NSCLC)

NSCLC is the most common type of lung cancer, accounting for about 80% to 85% of all lung cancers. It generally grows and spreads more slowly than SCLC. There are several subtypes of NSCLC, and the main ones are:

Adenocarcinoma:
- This is the most common type of lung cancer in many countries, especially among non-smokers (though it also occurs in smokers).
- It usually starts in the cells that line the air sacs (alveoli) and produce mucus, often in the outer parts of the lungs.
- It tends to grow more slowly than other types of lung cancer.
Squamous Cell Carcinoma (also called Epidermoid Carcinoma):
- This type typically starts in the squamous cells, which are flat cells that line the inside of the airways (bronchi) in the lungs.
- It is often found in the central part of the lungs, near the main airway.
- It is frequently linked to a history of smoking.
Large Cell Carcinoma (Undifferentiated Carcinoma):
- This type can appear in any part of the lung.
- It tends to grow and spread quickly, which can make it harder to treat.
- The cancer cells look large and abnormal under the microscope, but don't fit neatly into the adenocarcinoma or squamous cell categories.

2. Small Cell Lung Cancer (SCLC)

SCLC is less common, making up about 15% to 20% of all lung cancers. It is often called "oat cell cancer" because the cells can look like oats under a microscope.

Characteristics:
- SCLC tends to grow very quickly and spread rapidly to other parts of the body (metastasise) early on.
- It is strongly linked to cigarette smoking; it's rare for someone who has never smoked to develop SCLC.
- Because it often spreads early, SCLC is usually treated with chemotherapy, sometimes in combination with radiotherapy.

There are two main types of SCLC, but they are often grouped together for treatment purposes:

Small cell carcinoma
Combined small cell carcinoma (SCLC mixed with NSCLC cells)

Less Common Types of Lung Cancer

Besides NSCLC and SCLC, there are other, rarer types of tumours that can occur in the lungs:

Carcinoid Tumours: These are slow-growing tumours that rarely spread. They make up less than 5% of lung tumours.
Mesothelioma: This is a cancer of the pleura (the lining around the lungs). It's different from lung cancer that starts within the lung itself and is often linked to asbestos exposure.
Other rare types: These can include sarcomas (cancer of connective tissue) and lymphomas (cancer of immune cells) that can affect the lungs.

How is the Type of Lung Cancer Determined?

To find out what type of lung cancer you have, your doctor will need to take a small sample of cells or tissue from the tumour. This is called a biopsy. The sample is then sent to a laboratory where a specialist doctor called a pathologist will look at the cells under a microscope.

Sometimes, further tests on the biopsy sample, called molecular tests or biomarker tests, are done. These tests look for specific genetic changes or proteins in the cancer cells. This information can help determine which treatments might be most effective, especially for NSCLC.

Why is Knowing the Type Important?

Knowing the exact type of lung cancer (and its subtype, if applicable) is crucial because:

It guides treatment choices: Different types of lung cancer respond differently to various treatments like surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy.
It helps predict the cancer's behaviour: Some types grow and spread faster than others.
It allows for more personalised care: Understanding the specific characteristics of your cancer cells can help your doctors tailor the treatment plan to you.

Questions to Ask Your Doctor

It's important to have open discussions with your healthcare team. Here are some questions you might want to ask:

What type of lung cancer do I have?
If it's NSCLC, what is the subtype?
Has the cancer spread? If so, where?
What stage is my cancer? (This refers to the size of the tumour and if it has spread)
What treatment options are available for my type and stage of lung cancer?
What are the goals of each treatment option?
Are there any specific biomarker tests that are relevant for my type of cancer?
What are the potential side effects of the recommended treatments?

Disclaimer: This information sheet is intended for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with your doctor or other qualified healthcare provider for any questions you may have regarding a medical condition or treatment options. Do not disregard professional medical advice or delay in seeking it because of something you have read in this document.

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Understanding Lung Cancer Surgery: A Patient's Guide to Operations

This information sheet is designed to help you understand more about the different types of surgery used to treat lung cancer. If surgery is a potential part of your treatment plan, it's important to know what it involves.

When is Surgery Used for Lung Cancer?

Surgery is most often used for Non-Small Cell Lung Cancer (NSCLC), particularly in its earlier stages when the cancer has not spread widely. The main goal of surgery is to remove the entire tumour and any nearby affected lymph nodes, with the aim of curing the cancer.

Surgery is less commonly used for Small Cell Lung Cancer (SCLC) because this type of cancer has often spread by the time it's diagnosed. However, it might be an option in very rare cases if the SCLC is found at a very early stage.

Your healthcare team will consider many factors before recommending surgery, including:

The type and stage of your lung cancer
The location and size of the tumour
Your overall health and lung function
Whether the cancer has spread to lymph nodes or other parts of the body

Types of Lung Cancer Surgery

The type of operation depends on the size of the tumour, its location in the lung, and how much of the lung needs to be removed. The surgeon will aim to remove all the cancer while preserving as much healthy lung tissue as possible.

Here are the main types of lung surgery:

Lobectomy:
- The lungs are made up of sections called lobes (the right lung has three lobes, the left lung has two).
- A lobectomy is the removal of an entire lobe of the lung that contains the cancerous tumour.
- This is the most common type of surgery for lung cancer and is often preferred if the patient's lung function allows, as it offers a good chance of removing all the cancer.
Pneumonectomy:
- This operation involves removing the entire lung (either the right or left).
- It's performed if the tumour is large, centrally located, or affects multiple lobes, making it impossible to remove with a less extensive surgery.
- This is a major operation, and your doctors will carefully assess your ability to live with one lung before recommending it.
Segmentectomy or Wedge Resection (Sublobar Resections):
- These operations remove only a part of a lobe.
  - A wedge resection removes the tumour and a small wedge-shaped piece of lung tissue around it.
  - A segmentectomy removes a larger portion of the lobe (a segment) than a wedge resection, but less than a full lobectomy.
- These procedures are often considered for very small, early-stage tumours or for patients who may not tolerate the removal of an entire lobe due to other health conditions or poor lung function.
Sleeve Resection (Sleeve Lobectomy):
- This more complex operation is used when a tumour is in a main airway (bronchus) and also involves a lobe.
- The surgeon removes the cancerous part of the bronchus and the affected lobe. The remaining ends of the bronchus are then reconnected, and the remaining healthy lobes are reattached to the airway.
- This can help avoid having to remove the entire lung (pneumonectomy).

During any of these operations, the surgeon will also usually remove nearby lymph nodes (called lymph node dissection or sampling) to check if the cancer has spread. This helps determine the stage of the cancer and if further treatment after surgery (adjuvant therapy) is needed.

How is Lung Surgery Performed?

Lung surgery can be performed in different ways:

Thoracotomy (Open Surgery):
- This is the traditional approach where the surgeon makes a larger incision (cut) on the side of the chest, between the ribs.
- The ribs are spread apart to allow the surgeon to directly see and access the lung.
Minimally Invasive Surgery:
- These techniques use smaller incisions and specialised instruments.
- Video-Assisted Thoracoscopic Surgery (VATS): The surgeon makes a few small incisions and inserts a thorascope (a thin tube with a camera and light) and surgical tools. The camera sends images to a video monitor, guiding the surgeon.
- Robot-Assisted Thoracic Surgery (RATS): Similar to VATS, but the surgeon controls robotic arms holding the surgical instruments from a console. This can offer greater precision and dexterity.
- Minimally invasive approaches often lead to less pain after surgery, a shorter hospital stay, and a quicker recovery compared to open surgery. However, they may not be suitable for all tumours or patients.

What to Expect Before, During, and After Surgery

Before Surgery: You'll undergo various tests to ensure you are fit for surgery. These may include lung function tests, heart tests, blood tests, and imaging scans. You'll also meet with the anaesthetist.
During Surgery: You will be under general anaesthesia (asleep and pain-free). The operation can last several hours.
After Surgery:
- You will wake up in a recovery room and then be moved to a hospital ward, possibly a high-dependency or intensive care unit initially.
- You will likely have chest tubes in place to drain fluid and air from around your lung.
- Pain relief will be provided.
- You'll be encouraged to do deep breathing exercises and get mobile as soon as possible to help your lungs recover and prevent complications like chest infections or blood clots.
- Hospital stay can vary from a few days to over a week, depending on the type of surgery and your recovery.

Potential Risks and Complications

All surgeries carry risks. For lung cancer surgery, these can include:

Bleeding
Infection (wound infection or pneumonia)
Air leak from the lung (prolonged air leak)
Blood clots (e.g., deep vein thrombosis or pulmonary embolism)
Heart problems (e.g., irregular heartbeat, heart attack)
Pain
Reactions to anaesthesia
Shortness of breath (which usually improves over time)

Your surgical team will discuss these risks with you in detail.

Recovery at Home

Recovery takes time. You will likely feel tired and have some pain or discomfort for several weeks or months.

Follow your doctor's instructions regarding wound care, activity levels, and pain management.
Attend follow-up appointments.
Gradually increase your activity as you feel able. Pulmonary rehabilitation (a programme of exercise and education) may be recommended.
It can take several months to feel back to your usual self.

Questions to Ask Your Doctor

What type of surgery are you recommending for me and why?
What are the goals of this surgery?
Will it be open surgery or a minimally invasive approach (VATS or RATS)?
What are the potential benefits and risks of this operation in my specific case?
How much of my lung will be removed? How will this affect my breathing in the long term?
Will my lymph nodes be removed?
What can I expect my recovery to be like? How long will I be in the hospital?
What are the common side effects or complications I should watch out for?
Will I need further treatment (like chemotherapy or radiotherapy) after surgery?
Who can I contact if I have questions or problems after I go home?

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Understanding Other Lung Cancer Treatments: Immunotherapy, Chemotherapy, and Radiotherapy

This information sheet is designed to help you understand more about three important treatments for lung cancer: immunotherapy, chemotherapy, and radiotherapy. These treatments can be used alone, in combination with each other, or alongside surgery. Your healthcare team will recommend the best approach for you based on your specific type and stage of lung cancer, as well as your overall health.

1. Immunotherapy

What is Immunotherapy?

Immunotherapy is a type of cancer treatment that helps your own immune system fight cancer. The immune system is your body's natural defence against disease, but cancer cells can sometimes find ways to hide from it or stop it from working properly. Immunotherapy drugs help the immune system recognise and attack cancer cells more effectively.

How Does it Work?

Many immunotherapy drugs used for lung cancer are called "immune checkpoint inhibitors."

Checkpoints: Your immune system has "checkpoints" – proteins on immune cells that need to be activated (or inactivated) to start an immune response.
Cancer's Evasion: Cancer cells can sometimes use these checkpoints to avoid being attacked by the immune system. For example, they might produce proteins that tell immune cells (like T-cells) to "turn off."
Checkpoint Inhibitors' Role: These drugs block these signals, essentially "releasing the brakes" on the immune system, allowing it to recognise and kill cancer cells. Common checkpoint proteins targeted in lung cancer include PD-1, PD-L1, and CTLA-4.

When is it Used?

Immunotherapy can be used for both Non-Small Cell Lung Cancer (NSCLC) and, less commonly, Small Cell Lung Cancer (SCLC). It may be used:

As a first-line treatment for some advanced NSCLC, sometimes in combination with chemotherapy.
For patients whose cancer has spread or returned after other treatments.
After treatment with chemotherapy and radiotherapy (consolidation therapy) for some stage III NSCLCs.
Your doctor will likely test your tumour for specific biomarkers (like PD-L1 expression) to help predict how well immunotherapy might work for you.

How is it Given?

Immunotherapy is usually given intravenously (IV), meaning directly into a vein through a drip. Treatments are typically given at regular intervals (e.g., every 2, 3, 4, or 6 weeks) at a hospital or clinic. The duration of treatment can vary.

Common Side Effects:

Because immunotherapy boosts your entire immune system, it can sometimes cause the immune system to attack healthy cells in your body, leading to side effects. These are often called immune-related adverse events. Common side effects can include:

Fatigue (tiredness)
Skin rash or itching
Diarrhoea or colitis (inflammation of the bowel)
Cough or shortness of breath (pneumonitis – inflammation of the lungs)
Hormone gland problems (e.g., thyroid, pituitary, adrenal glands)
Liver problems (hepatitis)
Joint pain

It's crucial to report any new or worsening side effects to your healthcare team promptly, as many can be managed effectively if caught early.

2. Chemotherapy

What is Chemotherapy?

Chemotherapy (often called "chemo") uses anti-cancer drugs to kill cancer cells or stop them from growing and dividing. These drugs travel throughout the body, so they can treat cancer cells almost anywhere.

How Does it Work?

Chemotherapy drugs target rapidly dividing cells. Since cancer cells usually divide much faster than most normal cells, they are more susceptible to these drugs. Different chemotherapy drugs work in different ways.

When is it Used?

Chemotherapy can be used for both NSCLC and SCLC at various stages:

Adjuvant therapy: After surgery to kill any remaining cancer cells and reduce the risk of the cancer coming back.
Neoadjuvant therapy: Before surgery to shrink a tumour, making it easier to remove.
As the main treatment for advanced lung cancer (cancer that has spread).
In combination with radiotherapy (chemoradiation), often for locally advanced NSCLC or SCLC.
To relieve symptoms caused by advanced cancer (palliative chemotherapy).

How is it Given?

Chemotherapy is most commonly given intravenously (IV) into a vein. Some chemotherapy drugs can be taken as tablets or capsules. It's usually given in cycles, with a period of treatment followed by a rest period to allow your body to recover. A cycle might be, for example, treatment on one day or over a few days, followed by a few weeks off. The number of cycles depends on the type of cancer, the drugs used, and how well the treatment is working.

Common Side Effects:

Because chemotherapy drugs affect rapidly dividing cells, they can also damage healthy cells that divide quickly, such as those in the bone marrow, hair follicles, mouth, and digestive system. Side effects vary depending on the specific drugs and doses used, but can include:

Fatigue
Nausea and vomiting
Hair loss
Mouth sores
Loss of appetite or changes in taste
Increased risk of infections (due to low white blood cell counts)
Bruising or bleeding easily (due to low platelet counts)
Anaemia (due to low red blood cell counts)
Diarrhoea or constipation
Numbness or tingling in hands and feet (peripheral neuropathy)

Many side effects can be prevented or managed with other medicines.

3. Radiotherapy (Radiation Therapy)

What is Radiotherapy?

Radiotherapy uses high-energy rays (like X-rays) or particles to kill cancer cells or damage their DNA so they can no longer grow and divide.

How Does it Work?

The radiation is precisely targeted at the cancerous area to minimise damage to surrounding healthy tissues. While normal cells can also be affected by radiation, they can usually repair themselves better than cancer cells.

When is it Used?

Radiotherapy can be used for both NSCLC and SCLC:

As the main treatment for early-stage lung cancer if surgery is not an option.
In combination with chemotherapy (chemoradiation), often for locally advanced NSCLC or limited-stage SCLC.
After surgery (adjuvant radiotherapy) to kill any remaining cancer cells.
Before surgery (neoadjuvant radiotherapy) to shrink a tumour.
To treat cancer that has spread to other parts of the body, such as the brain or bones (palliative radiotherapy).
To relieve symptoms such as pain, bleeding, or blockage of an airway.
Prophylactic Cranial Irradiation (PCI): For SCLC, radiotherapy to the brain may be given even if there's no visible cancer there, to prevent it from spreading to the brain.

How is it Given?

External Beam Radiotherapy (EBRT): This is the most common type for lung cancer. A machine outside the body directs radiation beams at the cancer. Treatments are usually given in small daily doses (called fractions) over several weeks, typically Monday to Friday.
Stereotactic Body Radiotherapy (SBRT) or Stereotactic Ablative Radiotherapy (SABR): This is a specialised type of EBRT that delivers very high doses of radiation to a small, well-defined tumour in fewer sessions (e.g., 1-5 treatments). It's often used for small, early-stage NSCLC when surgery isn't possible.
Internal Radiotherapy (Brachytherapy): Less common for lung cancer, this involves placing a radioactive source inside the body, in or near the tumour, for a short time. It might be used to relieve a blockage in an airway.

Common Side Effects:

Side effects depend on the area of the body being treated, the dose of radiation, and your general health. They often start during treatment and may continue for a short time after treatment ends.

Fatigue
Skin changes in the treated area (redness, soreness, like sunburn)
Sore throat or difficulty swallowing (if the oesophagus is in the treatment area)
Cough or shortness of breath (radiation pneumonitis – inflammation of the lungs)
Nausea (less common with lung radiotherapy unless a large area near the stomach is treated)

Long-term side effects are possible but less common and can include permanent changes to the lung tissue (fibrosis).

Questions to Ask Your Doctor

It's important to discuss your treatment options thoroughly with your healthcare team. Here are some questions you might consider asking about immunotherapy, chemotherapy, or radiotherapy:

What is the goal of this treatment for me? (e.g., cure, control growth, relieve symptoms)
How will this treatment be given, how often, and for how long?
What are the potential benefits of this treatment?
What are the common short-term and long-term side effects? How can they be managed?
Are there any serious or rare side effects I should be aware of?
How will this treatment affect my daily life, including work and other activities?
Will I need other treatments in combination with this one?
How will we know if the treatment is working? What tests or scans will be done?
Who should I contact if I experience side effects or have urgent questions?
Are there any clinical trials I might be eligible for?

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LUNG CANCER RESOURCES

Understanding Lung Cancer: Types and What They Mean for You

​

What is Lung Cancer?

​

1. Non-Small Cell Lung Cancer (NSCLC)

​

2. Small Cell Lung Cancer (SCLC)

​

Less Common Types of Lung Cancer

​

How is the Type of Lung Cancer Determined?

​

Why is Knowing the Type Important?

​

Questions to Ask Your Doctor

Understanding Lung Cancer Surgery: A Patient's Guide to Operations

​

When is Surgery Used for Lung Cancer?

​

Types of Lung Cancer Surgery

​

How is Lung Surgery Performed?

​

What to Expect Before, During, and After Surgery

​

Potential Risks and Complications

​

Recovery at Home

​

Questions to Ask Your Doctor

Understanding Other Lung Cancer Treatments: Immunotherapy, Chemotherapy, and Radiotherapy

​

1. Immunotherapy

​

2. Chemotherapy

​

3. Radiotherapy (Radiation Therapy)

​

Questions to Ask Your Doctor

​