Non-small cell lung cancer (NSCLC): types, symptoms, diagnosis and treatment

Lung cancer is described by the type of cell the cancer started in, and that tells doctors which treatment is likely to work best. Cancer Research UK divides primary lung cancer into two main groups: small cell lung cancer and non-small cell lung cancer (NSCLC). NSCLC is the more common group, making up around 80 to 85% of lung cancers. Cancer that has spread to the lungs from somewhere else is called secondary lung cancer and is treated differently.

Within NSCLC, Cancer Research UK describes two main types. Squamous cell cancer develops in the flat cells that cover the airway surface and tends to grow near the centre of the lung. Non-squamous cancer includes adenocarcinoma, which starts in the mucus-making gland cells lining the airways and is the most common type, and large cell carcinoma, in which the cells look larger than usual under the microscope. Less common types include adenosquamous and sarcomatoid carcinomas.

The NHS lists a cough that is not going away, shortness of breath, coughing up blood, chest or shoulder pain, frequent chest infections or one that will not clear, losing weight without trying, loss of appetite and feeling tired all the time as common symptoms. Less common ones include swelling of the face or neck, difficulty swallowing, a hoarse voice that does not go away and changes in the fingers, called clubbing. You may not notice any symptoms in the early stages.

Many of these symptoms are very common and usually caused by other conditions, so having them does not mean you have lung cancer. The NHS still advises seeing a GP if you have had a cough for longer than 3 weeks or have any other symptom. Ask for an urgent GP appointment or contact NHS 111 if you have coughed up blood. Dial 999 or go to A&E if you are struggling to breathe or have pain in the chest or upper back.

The NHS says it is not always known what causes lung cancer, but lifestyle, genetic changes and environmental factors can all play a part. It lists these as factors that may make it more likely, and the same list applies to NSCLC.

• Smoking, and long-term passive smoking.

• Having chronic obstructive pulmonary disease (COPD).

• A close relative who has had lung cancer.

• Past work in the building industry with long-term asbestos exposure.

• Long-term exposure to air pollution.

• Long-term exposure to radon, a natural gas found at high levels inside buildings in some areas of the UK.

At the GP appointment the doctor will ask about your symptoms, general health, medical history and family history, may listen to your chest, and may arrange a blood test or a chest X-ray. If they think the symptoms could be cancer you may receive an urgent referral for more tests or to see a hospital specialist; the NHS stresses this does not mean you definitely have cancer.

The NHS names a CT scan and a bronchoscopy as the main tests. In a bronchoscopy a thin flexible tube with a small camera is passed down the throat into the lungs. If cancer is found, further tests can include an MRI scan, PET scan, biopsy, blood tests and genetic testing. These show what type of cancer it is, how far it has spread and whether it has been caused by particular gene changes, and help the specialist team choose treatment. You may get some results on the day of the test or after a few days or weeks. A clinical nurse specialist is your main point of contact.

The NHS says treatment depends on the size and location of the cancer, the type, whether it has spread, whether it has certain genetic changes, your general health and which options you decide are right for you. You may be offered a combination of surgery, chemotherapy, radiotherapy and targeted medicines. Your specialist treatment team explains benefits and side effects, and agrees a plan with you.

Surgery aims to remove the cancer, and part or all of a lung may need to be removed. Chemotherapy, which uses medicines to kill cancer cells, may be given if surgery is not possible, if the cancer has spread, before surgery to shrink the tumour or after it to stop the cancer coming back. Radiotherapy uses beams of radiation aimed at tumours and may be used if surgery is not possible, after surgery or if the cancer has spread. Targeted medicines kill cancer cells or slow their growth, and immunotherapy helps the immune system fight cancer; the NHS says these are sometimes used for advanced lung cancer that has spread.

If cancer is advanced and cannot be cured, the NHS says the aim of treatment is to slow growth and spread, help with symptoms and help you live longer, and a symptom control or palliative care team will support you and your family. Which of these options suits a particular person is a matter for the specialist team; no general page can say.

The NHS highlights the Roy Castle Lung Cancer Foundation, Macmillan Cancer Support and Marie Curie for information and support, and Macmillan has a free helpline open every day from 8am to 8pm. Cancer Research UK also runs a nurse helpline.

Diagnosis and treatment on the NHS follow referral from a GP to a hospital team. Some people also seek a private consultation or second opinion to discuss test results or treatment options, or to see a specialist more quickly, and may have private scans. Costs vary by hospital and by test, so ask for an itemised estimate.