Types of lung cancer
Cancer that started in the lung
Cancer that starts in the lung is called primary lung cancer.
There are several different types and these are divided into two main
groups
Occasionally it is not possible to work out which type of non small cell lung cancer you have. It may not be possible to tell if only a few cells are taken during a biopsy. It can also be difficult if the cells are very undeveloped. Undeveloped cancer cells are known as undifferentiated cells. So your doctor will say that you have undifferentiated non small cell lung cancer. This will not usually make any difference to your treatment, because most non small cell lung cancers are treated in the same way.
Small cell lung cancer
About 18 out of every 100 lung cancers diagnosed are this type. Small cell lung cancer is called this because under the microscope the cancer cells look small and are mostly filled with the nucleus (the control centre of cells). It is also called oat cell cancer. This type of cancer is usually caused by smoking. It is very rare for someone who has never smoked to develop it. Small cell lung cancer often spreads quite early on and so your doctors may recommend chemotherapy treatment rather than surgery.Non small cell lung cancer
There are three common types of non small cell lung cancer. These are grouped together because they behave in a similar way and respond to treatment in a different way to small cell lung cancer. They make up about 78 out of 100 lung cancers in the UK. The three types areOccasionally it is not possible to work out which type of non small cell lung cancer you have. It may not be possible to tell if only a few cells are taken during a biopsy. It can also be difficult if the cells are very undeveloped. Undeveloped cancer cells are known as undifferentiated cells. So your doctor will say that you have undifferentiated non small cell lung cancer. This will not usually make any difference to your treatment, because most non small cell lung cancers are treated in the same way.
Squamous cell cancer
Squamous cell cancer is the most common type of lung cancer. It develops from the cells that line the airways and it is often found near the centre of the lung in one of the main airways (the left or right bronchus). This type of cancer is often due to smoking. The number of people developing squamous cell lung cancer is going down in the UK.Adenocarcinoma
Adenocarcinoma also develops from the cells that line the airways. But it develops from a particular type of cell that produces mucus (phlegm). It is often found in the outer areas of the lungs. The number of people developing adenocarcinoma is increasing and it may soon become more common in the UK than squamous cell lung cancer.Large cell carcinoma
Large cell lung cancer is called this because the cells look large and rounded under a microscope. This type of lung cancer tends to grow quite quickly.
Cancer that has spread from somewhere else in the body is
called secondary cancer. Quite a few different types of cancer can
spread to the lung, including breast cancer and bowel cancer. If you are
diagnosed with lung cancer and have already had another type of cancer,
check with your doctor whether the cancer started in the lung or has
spread into the lung.
If you have secondary cancer you need to look at the section about where the cancer started. For example, if you had breast cancer that has spread to the lungs, then you need to look at the section about breast cancer. It is important to know which type of cancer you have so that you can find the right information. The choice of cancer treatment depends on where the cancer started. When cancer spreads to the lung from the breast, the cells are breast cancer cells, not lung cancer cells. So they respond to breast cancer treatments. And cancer that has spread from the bowel should respond to bowel cancer treatments.
If you have secondary cancer you need to look at the section about where the cancer started. For example, if you had breast cancer that has spread to the lungs, then you need to look at the section about breast cancer. It is important to know which type of cancer you have so that you can find the right information. The choice of cancer treatment depends on where the cancer started. When cancer spreads to the lung from the breast, the cells are breast cancer cells, not lung cancer cells. So they respond to breast cancer treatments. And cancer that has spread from the bowel should respond to bowel cancer treatments.
Lung cancer tests
Seeing your GP
Usually you begin by seeing your GP who will ask you about
your general health and will examine you. They may ask you to breathe
into a small device called a spirometer. The machine measures the amount
of air you breathe in and out and also measures how quickly you
breathe. They call this test spirometry.
Your GP will refer you to hospital for any X-rays or other tests you may need. You will usually be asked to go for a chest X-ray to check for anything that looks abnormal in your lungs.
You may have some routine blood tests. Your GP may also ask you to give some samples of phlegm. They may send them to the hospital for you or may ask you to take them to the hospital. At the hospital the laboratory staff will examine the samples for cancer cells.
Your GP will refer you to hospital for any X-rays or other tests you may need. You will usually be asked to go for a chest X-ray to check for anything that looks abnormal in your lungs.
You may have some routine blood tests. Your GP may also ask you to give some samples of phlegm. They may send them to the hospital for you or may ask you to take them to the hospital. At the hospital the laboratory staff will examine the samples for cancer cells.
At the hospital the doctor will ask about your medical history
and your symptoms. They will then probably arrange for you to have some
tests, which may include any of the following.
This test looks at the inside of the airways.
Your doctor puts a narrow, flexible tube called a bronchoscope down
your throat and into the airway. The tube has a light at the tip and an
eye piece so that the doctor can see inside.
You usually have this test as an outpatient under local anaesthetic. This means you are awake for the test, but your throat is numbed. If you are very anxious about having the test let your doctor know at least a week in advance. They may be able to arrange for you to have a general anaesthetic or an injection of a sedative into a vein. If you have an anaesthetic or sedative, you may need to stay in hospital overnight. This depends on the time of day you have the test and on your general health.
If you are going to have sedation or an anaesthetic, your doctor will ask you not to eat or drink anything on the morning of the test. When you arrive at the outpatient department, a nurse may ask you to change into a gown or you may be able to stay in your own clothes. Then your nurse will show you into the test room. Once you are lying on the couch, you will have a sedative to help you relax. Just before the test, the doctor sprays a local anaesthetic onto the back of your throat.
The doctor puts a long, thin, flexible tube called a bronchoscope either down your nose, or into your mouth and down the airway. This will be a bit uncomfortable, but it doesn't last long. The doctor then looks for anything abnormal and can take tissue samples (biopsies) for testing. They can take photographs of the inside of your airways if necessary.
After the bronchoscopy, you will not be able to eat or drink anything until the local anaesthetic has worn off. Your throat will be too numb to swallow safely at first. The numbness usually passes off after about an hour. You should not drive until the day after the test because of the sedative. Someone should collect you from the hospital and make sure that you get home safely. You may have a sore throat for a couple of days after the test because of the tube, but it will soon go.
You usually have this test as an outpatient under local anaesthetic. This means you are awake for the test, but your throat is numbed. If you are very anxious about having the test let your doctor know at least a week in advance. They may be able to arrange for you to have a general anaesthetic or an injection of a sedative into a vein. If you have an anaesthetic or sedative, you may need to stay in hospital overnight. This depends on the time of day you have the test and on your general health.
If you are going to have sedation or an anaesthetic, your doctor will ask you not to eat or drink anything on the morning of the test. When you arrive at the outpatient department, a nurse may ask you to change into a gown or you may be able to stay in your own clothes. Then your nurse will show you into the test room. Once you are lying on the couch, you will have a sedative to help you relax. Just before the test, the doctor sprays a local anaesthetic onto the back of your throat.
The doctor puts a long, thin, flexible tube called a bronchoscope either down your nose, or into your mouth and down the airway. This will be a bit uncomfortable, but it doesn't last long. The doctor then looks for anything abnormal and can take tissue samples (biopsies) for testing. They can take photographs of the inside of your airways if necessary.
After the bronchoscopy, you will not be able to eat or drink anything until the local anaesthetic has worn off. Your throat will be too numb to swallow safely at first. The numbness usually passes off after about an hour. You should not drive until the day after the test because of the sedative. Someone should collect you from the hospital and make sure that you get home safely. You may have a sore throat for a couple of days after the test because of the tube, but it will soon go.
A CT scan takes X-rays through sections of the body. The
scanner feeds the pictures into a computer and they form a detailed
image of the inside of your body. You might have a CT scan done before
having a bronchoscopy or biopsy. The scan can show the area where the
cancer is. You will have an injection of dye before the scan to help
show up any abnormal areas. There is detailed information about having a CT scan in the cancer tests section.
A PET-CT scan is a combination of a PET scan and a CT scan. A
PET-CT scan takes CT pictures of the structures of your body. At the
same time, a mildly radioactive drug shows up areas of your body where
the cells are more active than normal. The scanner combines both of
these types of information. This allows your doctor to see any changes
in the activity of cells and know exactly where the changes are
happening.
You may have a PET-CT scan instead of a CT scan before having a bronchoscopy or biopsy. The scan can show the area where the cancer is. You will have an injection of dye before the scan to help show up abnormal areas. There is detailed information about PET-CT scans in the cancer tests section. PET-CT scans are not available in every hospital so you may need to travel to have one.
You may have a PET-CT scan instead of a CT scan before having a bronchoscopy or biopsy. The scan can show the area where the cancer is. You will have an injection of dye before the scan to help show up abnormal areas. There is detailed information about PET-CT scans in the cancer tests section. PET-CT scans are not available in every hospital so you may need to travel to have one.
This type of biopsy is called a percutaneous lung biopsy. The
doctor puts a thin needle through the skin and muscle of your chest to
take samples of cells from the lung tumour. The area of the test depends
on the position of the abnormal area in the lung. The test can be
uncomfortable. The actual biopsy only takes a few minutes but getting
ready may take between 30 minutes and an hour.
You usually have this test in the X-ray department or a special procedures room. You have a local anaesthetic injection into the area where the needle is to be put in. The doctor will ask you to hold your breath for a moment while they put the needle through the skin into the lung. Once the needle is in, the doctor uses X-ray, CT scan or ultrasound to make sure the tip is in the tumour. The doctor then sucks out a sample of cells with a syringe. They send the cells to the laboratory for examination under a microscope.
After a biopsy through the skin your nurse will monitor you closely for a few hours. You may need to stay in hospital overnight. There is a small risk that the lung may collapse after the biopsy (pneumothorax). Let your nurse know if you suddenly feel breathless or dizzy.
You usually have this test in the X-ray department or a special procedures room. You have a local anaesthetic injection into the area where the needle is to be put in. The doctor will ask you to hold your breath for a moment while they put the needle through the skin into the lung. Once the needle is in, the doctor uses X-ray, CT scan or ultrasound to make sure the tip is in the tumour. The doctor then sucks out a sample of cells with a syringe. They send the cells to the laboratory for examination under a microscope.
After a biopsy through the skin your nurse will monitor you closely for a few hours. You may need to stay in hospital overnight. There is a small risk that the lung may collapse after the biopsy (pneumothorax). Let your nurse know if you suddenly feel breathless or dizzy.
If it is difficult to get enough tissue using a biopsy through
the skin, your doctor may do an open lung biopsy under general
anaesthetic in a similar way to mediastinoscopy. Or you may have a thoracoscopy to get a biopsy.
While you are waiting for results it may help to talk to a close friend or relative about how you are feeling. You may want to contact a cancer support group to talk to someone who has been through the same experiences.
You can phone the Cancer research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. Our lung cancer organisations page gives details of other people who can help and support you. You can find details of counselling organisations in our counselling section. Our lung cancer reading list has information about books and leaflets about lung cancer and its treatment.
If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.
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