Lung cancer is commonly divided into a number of different sub types. Small cell lung cancer (SCLC) which represents about 10 -15% of all lung cancers the remainder being non small cell lung cancer (NSCLC) which can be further divided into squamous cell cancer, adenocarcinoma and large cell or undifferentiated cancer. Around 30,000 people will be diagnosed in England each year with lung cancer.
The main risk factor for getting lung cancer is smoking, either past or present. However around 10% of patients diagnosed with lung cancer will have never smoked and the cause in these cases is unknown.
Lung cancer can present in many ways, most commonly with chest symptoms such as a cough which does not get better, coughing up blood or increasing breathlessness. Other ways it can present include non-specific symptoms of weight loss, tiredness, and loss of appetite or in relation to any spread of the cancer – for example to the liver, bones or brain.
Diagnosing lung cancer usually involves having a chest x-ray, CT scan, blood tests and a biopsy. The biopsy may be done using a CT scanner, ultrasound scan or a bronchoscopy (a fibre optic tube inserted under sedation in to the lungs). Further tests might involve having a PET-CT scan, MRI scan and lung function (breathing) tests. These tests are designed to find out what type of lung cancer is present and how far the disease has spread.
All cases of lung cancer are discussed in a joint multidisciplinary team at Addenbrooke’s and Papworth Hospitals. The MDT includes specialist surgeons, oncologists, radiologists, pathologists and specialist nurses to ensure the best possible treatment plan is put in place.
Treatment for lung cancer will depend on how fit and well someone is and how advanced the tumour is (the stage of the cancer).
Treatment options for cancers which are confined to the chest can include surgery or radiotherapy, sometimes in a combination with chemotherapy. Lung cancer which is more advanced or spread may be treated with combinations of chemotherapy and radiotherapy. In recent years research has shown that some cancers with specific molecular abnormalities which can be targeted by specific drugs if that abnormality is present in the tumour, research is ongoing to identify new abnormalities which can be treated in this way.
Cambridge Oncology Partners offers a full range of non-surgical treatments for lung cancer. Patients can access a full range of chemotherapy and newly licenced targeted treatments including drugs which target EGFR mutations and ALK translocations. Radiotherapy is undertaken at Addenbrooke’s Hospital with fully equipped state of the art linear accelerators. Concomitant chemoradiotherapy is available (chemotherapy and radiotherapy given together) as well as advanced radiotherapy technologies such as intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT). We also offer, where appropriate, stereotactic lung radiotherapy (SABR).
Mesothelioma is a cancer of the pleura, or lining of the lung. It can also less commonly affect the lining of the abdomen. It is usually associated with previous exposure to asbestos although this is often many decades before diagnosis.
Mesothelioma often presents with increasing breathlessness or pain over one side of the chest due to the accumulation of fluid in the space between the lungs and the chest.
A diagnosis is often made after a chest x-ray which shows this fluid and an ultrasound examination of the chest which allows some of the fluid to be drained away which can relieve symptoms and the fluid can be examined for mesothelioma cells. Further tests usually include a CT scan and a biopsy the pleural which is frequently thickened.
Initial treatment is usually directed at draining and preventing re-acumulation of the fluid. This can be done by thoracoscopy (a fibre optic tube inserted under local anaesthetic) or VATS (keyhole surgery). Sometimes a sterile semi-permanent tube (in-dwelling pleural catheter) is left in place so that fluid can be drained at more frequent intervals.
Further treatments may involve surgery which strips away as much of the tumour on the pleura as possible. Chemotherapy and radiotherapy are used to further shrink the tumour and help symptoms.
Cambridge Oncology Partners offers a full range of chemotherapy and radiotherapy for mesothelioma.
Thymic tumours are rare tumours of the thymus gland. The thymus is a gland which in childhood and puberty is involved in the development of the immune system but normally in adulthood shrinks to almost nothing. The thymus lies just behind the sternum (breast bone).
Thymic tumours are often not associated with symptoms as they are very slow growing and diagnosed incidentally, for instance when a scan or x-ray is being done for another reason. They can be associated with other illness such as the neuro-muscular condition myasthenia gravis.
A CT scan and possibly a biopsy will be used to diagnose a tumour of the thymus.
Most thymic tumours are removed by surgery. If the tumour is more advanced or has spread radiotherapy or chemotherapy may be used in addition to surgery. Rarely, in more advanced cases surgery is not possible and chemotherapy may be used.
Cambridge Oncology Partners offers a full range of non-surgical treatments for thymic tumours.