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Health condition · Clinically reviewed

Lung cancer, from screening to modern immunotherapy.

The leading cancer cause of death in the UK. Non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) are treated differently. Early diagnosis + targeted therapy + immunotherapy have transformed outcomes.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced, not summarised

    Every claim is checked against NICE, BTOG or a peer-reviewed source you can see at the end.

  • 03

    Updated for 2026

    Reflects current UK guidance on the Targeted Lung Health Check, molecular profiling and modern immunotherapy.

Key facts

Lung cancer at a glance.

The essentials, in plain English — what it is, how common it is, how it’s diagnosed in the UK today, and how treatment is chosen.

  • What it is

    A malignant tumour of the lung — non-small-cell lung cancer (NSCLC) makes up around 85%, small-cell lung cancer (SCLC) around 15%.

  • How common

    Around 48,000 new cases each year in the UK — the leading cancer cause of death.

  • Main cause

    Smoking causes around 80% of cases — but not all. Radon, asbestos and air pollution matter too.

  • UK screening

    The Targeted Lung Health Check offers low-dose CT screening to eligible ex and current smokers aged 55–74.

  • Modern diagnosis

    Molecular profiling — EGFR, ALK, ROS1, KRAS-G12C and PD-L1 — now drives treatment for NSCLC.

  • Modern treatment

    Immune checkpoint inhibitors have transformed outcomes in advanced disease, alongside surgery, SABR and targeted therapy.

Why this guide matters

Lung cancer is no longer a single disease.

The pathway has changed. Screening finds cancers earlier, molecular profiling divides NSCLC into distinct subtypes, and immunotherapy has transformed advanced disease.

  • Screening finds cancers earlier

    The Targeted Lung Health Check offers low-dose CT to eligible smokers and ex-smokers — earlier stage means better outcomes.

  • Molecular profiling drives treatment

    EGFR, ALK, ROS1 and KRAS-G12C mutations, plus PD-L1 expression, shape the first-line choice for NSCLC.

  • Immunotherapy has changed the outlook

    Immune checkpoint inhibitors alone or with chemotherapy have transformed survival in advanced NSCLC and SCLC.

How the diagnosis is made

From first symptom to a clear plan.

The pathway UK lung cancer MDTs now follow, in order — so you know what to expect and why each test matters.

  1. 01

    Assessing

    Symptom + smoking history

    A careful history — cough, breathlessness, weight loss, current or former smoking — sets the pace of investigation.

  2. 02

    Assessing

    Chest X-ray

    A plain chest radiograph is often the first test in primary care and can trigger urgent onward referral.

  3. 03

    Assessing

    CT chest + upper abdomen

    A contrast-enhanced CT is the workhorse of lung cancer diagnosis and initial staging.

  4. 04

    Confirming

    PET-CT for staging

    A whole-body PET-CT looks for nodal and distant spread — essential before curative-intent treatment.

  5. 05

    Confirming

    Endobronchial ultrasound + biopsy

    EBUS-TBNA samples mediastinal lymph nodes and lung lesions to confirm the diagnosis and stage.

  6. 06

    Planning

    Molecular + PD-L1 testing

    Tissue is tested for EGFR, ALK, ROS1, KRAS-G12C and PD-L1 — these drive the choice of targeted therapy and immunotherapy.

  7. 07

    Planning

    Lung cancer MDT

    A specialist multi-disciplinary team recommends the treatment options that fit your stage, biology and fitness.

Typical timeline: 4–6 weeks from first suspicious imaging to a treatment plan.

Symptoms

What lung cancer actually shows up as.

Early lung cancer often has no symptoms at all — which is why screening matters. When symptoms do appear, here is what to watch for and when to act.

  • Persistent cough

    A new cough lasting three weeks or more, or a change in a long-standing cough, warrants a chest X-ray.

  • Haemoptysis

    Coughing up blood — even a small amount — needs urgent investigation, especially in a current or former smoker.

  • Breathlessness

    New or worsening shortness of breath that doesn’t settle with usual treatment deserves imaging.

  • Chest pain

    Persistent chest, shoulder or back pain — particularly if worse on breathing — can be a lung cancer symptom.

  • Weight loss

    Unintentional weight loss and fatigue in a smoker or ex-smoker should trigger urgent assessment.

  • Hoarse voice

    A persistent hoarse voice can signal recurrent laryngeal nerve involvement from a mediastinal tumour.

  • Finger clubbing

    New finger clubbing in an adult smoker is a classic — though not universal — sign that warrants imaging.

  • Red flag

    Massive haemoptysis, or facial swelling with distended neck veins (SVC obstruction) — call 999.

Treatment

How lung cancer is treated in the UK.

Treatment is chosen by cancer type (NSCLC or SCLC), stage, molecular profile and fitness — from curative surgery and SABR to targeted therapy, immunotherapy and structured palliative care.

  • Lobectomy / pneumonectomy

    Surgical removal of a lobe or entire lung for early-stage NSCLC in patients fit for surgery — often minimally invasive (VATS or robotic).

  • Stereotactic ablative radiotherapy

    SABR delivers precisely targeted, high-dose radiotherapy in a few fractions — the standard for medically inoperable early NSCLC.

  • Chemotherapy + radiotherapy

    Concurrent chemoradiotherapy is standard for locally advanced stage III NSCLC and limited-stage SCLC.

  • Targeted therapy (TKIs)

    EGFR, ALK and ROS1 inhibitors are highly effective oral treatments for NSCLC with the matching mutation.

  • Immunotherapy

    Pembrolizumab and nivolumab — immune checkpoint inhibitors — have transformed outcomes in advanced NSCLC.

  • Combination chemo-immunotherapy

    First-line chemotherapy combined with immunotherapy is now standard for many advanced NSCLC and extensive-stage SCLC patients.

  • Adjuvant durvalumab (stage III)

    After chemoradiotherapy for stage III NSCLC, adjuvant durvalumab consolidates the response and extends survival.

  • Palliative + supportive care

    Early palliative care — symptom control, oxygen, drainage of effusions, radiotherapy for pain — improves both quality and length of life.

What this guide is based on

The sources behind every number on this page.

UK guidance, specialist society standards and patient-organisation resources, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or lung cancer team knows your history and can tell you which parts apply to you.

  • National Institute for Health and Care Excellence (NICE). Lung cancer: diagnosis and management (NG122).

  • British Thoracic Oncology Group (BTOG). UK consensus statements on lung cancer.

  • Roy Castle Lung Cancer Foundation. Patient information and support resources.

  • NHS England. Targeted Lung Health Check programme guidance.

Red flags

When lung cancer becomes an emergency.

These are the situations where you should act today — either by calling 999, attending A&E, or contacting your oncology team the same day.

  • Massive haemoptysis

    Coughing up more than a teaspoon of blood — or repeated bleeds — needs immediate hospital assessment via 999.

  • Superior vena cava obstruction

    Facial swelling, distended neck veins and breathlessness — an oncological emergency needing urgent imaging and treatment.

  • Spinal cord compression

    New back pain with leg weakness, numbness or bladder/bowel change — call 999 or attend A&E immediately.

  • Malignant pleural effusion

    Rapidly worsening breathlessness with fluid on chest imaging often needs drainage and pleurodesis.

  • Neutropenic sepsis on chemo

    Fever within weeks of chemotherapy — go to A&E and quote the chemotherapy alert card without delay.

  • Immune-mediated toxicity

    New breathlessness (pneumonitis), diarrhoea (colitis) or rashes on immunotherapy need same-day specialist review.

  • Post-op complications

    Fever, severe pain, worsening breathlessness or wound problems after lung surgery — seek urgent help.

  • Post-radiotherapy pneumonitis

    New cough and breathlessness weeks after chest radiotherapy can be treatable pneumonitis — contact your oncology team.

  • Palliative-stage crisis

    Uncontrolled pain, delirium or breathlessness at end of life warrants urgent palliative care input.

Living with it

A long-term journey, with structured support.

Four things that make the biggest difference day to day — stopping smoking, controlling breathlessness, multi-disciplinary support and structured follow-up.

A quiet reminder

Ask about your lung cancer nurse early.

A named lung cancer nurse specialist is one of the most valuable parts of your care — ask for their contact details from the start.

  1. 01 Stopping smoking

    Quitting still helps — at any stage

    Stopping smoking improves treatment tolerance, reduces complications and helps survival, even after diagnosis.

  2. 02 Symptom control

    Breathlessness is treatable

    Handheld fans, breathing techniques, pulmonary rehabilitation and, where appropriate, low-dose opioids all help.

  3. 03 Support

    Structured multi-disciplinary follow-up

    Lung cancer nurse specialists, dietitians and palliative care work alongside oncology from diagnosis onward.

  4. 04 Reviews

    Regular imaging surveillance

    After curative treatment, structured CT follow-up watches for recurrence and second primary lung cancers.

Frequently asked

Everything we get asked about lung cancer.

Quick answers on screening, molecular testing, immunotherapy and when to worry.

  • What is lung cancer?

    A malignant tumour arising from the cells of the lung. There are two broad types — non-small-cell lung cancer (NSCLC), which makes up around 85% of cases, and small-cell lung cancer (SCLC), around 15%. They behave differently and are treated differently.

  • Do only smokers get lung cancer?

    No. Around 80% of lung cancers in the UK are caused by smoking, but roughly one in five occurs in people who have never smoked. Radon exposure, asbestos, air pollution, family history and certain gene mutations all play a role.

  • What is the Targeted Lung Health Check?

    The NHS Targeted Lung Health Check invites eligible current and former smokers aged 55–74 for a risk assessment. Those at higher risk are offered a low-dose CT scan of the chest, which finds many lung cancers at an earlier, more treatable stage.

  • What is molecular profiling and why does it matter?

    Molecular profiling tests the cancer tissue for mutations — EGFR, ALK, ROS1, KRAS-G12C — and for PD-L1 expression. These results determine whether targeted therapy or immunotherapy is the best first-line treatment for non-small-cell lung cancer.

  • How has immunotherapy changed lung cancer treatment?

    Immune checkpoint inhibitors such as pembrolizumab, nivolumab and durvalumab have transformed outcomes in advanced NSCLC and are now used in combination with chemotherapy, after chemoradiotherapy, and as adjuvant treatment after surgery in selected patients.

  • When should I worry about symptoms?

    A new cough lasting more than three weeks, coughing up blood, unexplained weight loss, persistent chest pain or new breathlessness — especially in a current or former smoker — should be discussed with your GP. Massive haemoptysis or facial swelling with distended neck veins is an emergency — call 999.

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