It can start in the windpipe (trachea), the main airways to the lungs (the bronchi), or in the lung tissue, and falls into two main categories: small cell and non small cell. Non small cell lung cancer is the most common, accounting for almost nine in 10 of cases. Lung cancer symptoms aren’t always obvious and can be hard to distinguish from those caused by other health conditions. This can make the disease difficult to spot. It is likely to play a role in why many cases of lung cancer are diagnosed late when the tumour has spread beyond the lung, and the disease is much harder to treat effectively.
How does it start?
People who smoke are most at risk, with tobacco (including second-hand smoke) causing 72 per cent of cases in the UK. Other factors are exposure to air pollution, radon gas, asbestos and other chemicals people may be exposed to through their occupation. As with many cancers, the incidence of lung cancer increases with age, and more than four out of 10 diagnoses occur in people aged 75 and over.
Who’s affected?
Lung cancer is one of the more difficult cancers to diagnose and treat and survival in the UK has changed little in the past 40 years. In 2014, Cancer Research UK launched a strategy – the plan for how to reach its goal of three in four people surviving cancer by 2034. And a key element of this was tackling hard-to-treat cancers, including lung cancer, with a commitment to boost funding threefold over five years.
But while increased investment is necessary, progress also relies on a strong research community to join forces and come up with research ideas, based on an increasing understanding of the biology of these diseases. To strengthen the lung cancer research community, Cancer Research UK opened the Lung Cancer Centre of Excellence – joining up experts based in Manchester and UCL. The Centre helps create an environment in which they can share ideas, results and forge new relationships.
What is Cancer Research UK doing about it?
The timeline:
Charting cancer successes within living memory
1965
Tobacco advertising banned from TV
1950s
Groundbreaking research shows smoking causes lung cancer
2007
UK goes smoke-free
Smoking was banned in all public enclosed spaces and workplaces across the UK, following the lead of Scotland, which had introduced smoke-free legislation the previous year. Research has shown that people who don't smoke but are exposed to second-hand smoke are still at higher risk of developing lung cancer, so this crucial step in tobacco control will help save thousands of
lives. Cancer Research UK was involved throughout these important developments, the implementation of the smoking ban coming as a direct result of the hard work of Cancer Research UK’s Ambassadors and how they influenced MPs and councillors so that smoke-free legislation was rolled out across the UK.
1984
Gene linked with cancer growth
Cancer Research UK’s scientists identified the role of the EGFR (epidermal growth factor receptor) gene in the development of cancer. EGFR is a protein that helps cells divide normally and faults in the gene that codes for it have been linked to multiple cancer types. Non-smokers who develop lung cancer
are more likely to have cells with a fault in the EGFR gene.
At the time, many scientists believed that viruses were to blame for most cancers. This discovery sparked huge interest in genetic causes and paved the way for the development of therapies targeted at specific molecular defects.
advertising was an important step in helping make smoking less attractive.
In the 1960s, around half of the UK population smoked, despite growing awareness of the risks. Banning television
Research published by Professor Sir Richard Doll provided the first clear evidence that lung cancer is linked to smoking. One study concluded that people who smoke 25 cigarettes a day are likely to be 50 times more at risk than non-smokers.
Professor Doll then began a 50-year research project, monitoring 34,439 male doctors, which Cancer Research UK helped fund. This project went on to provide more detailed evidence on the connection between smoking and lung cancer.
My lung cancer story
Agreeing to be part of the TRACERx study means the progress of Lydia Knott’s lung cancer is being closely mapped and monitored
When Lydia Knott, 82, developed a cough, the diagnosis of lung cancer came quickly as she was already under medical supervision, having had a heart valve replacement. Given that she’d never been a smoker, it came as quite a shock, she says.
“After I had had the operation to remove part of my lung, the team discovered that the cancer had spread to other parts of my body. I was prescribed a new drug that has successfully held the tumours at bay.”
She has now been involved in the TRACERx programme for over four years. “I’m pleased to be part of TRACERx as I’m helping other people with cancer. I have also agreed to be part of another study where my body can be used after my death to take the study of the cancer further. I’m hoping that won’t be for a while!
“My condition is tracked through regular blood tests and CT scans every three or four months. Giving blood isn’t easy for me because my veins are narrowed through the chemo and other treatments.
The medication I take for the ongoing condition does have some minor side effects such as skin irritation and tenderness, but I accept those for the greater good. I’ve never really regained my appetite and things don’t taste the same but, all in all, it’s not bad for an 82-year-old.”
‘I’m pleased I can help other people with cancer’
Lung cancer: know the symptoms
With more than 200 different types of cancer, it’s not possible to learn all the possible symptoms. The key is to get to know what’s normal for you, and if you notice anything unusual or anything that sticks around for a while, visit your GP and get it looked at. Most of the time it won't be cancer but it’s important to get checked out.
What to look for
Pain in your chest or shoulder
Loss of appetite
Weight loss
Fatigue
Reduce your risk
Smoking is the biggest preventable cause of cancer in the UK and is responsible for around seven in 10 lung cancer cases.
Cut back on red
and processed meat.
Stop Smoking Services have been shown to roughly triple the likelihood of success compared to going “cold turkey” alone. They help thousands of people stop smoking every year. They combine the support of trained advisors with a suite of options to help you quit.
Eat more high-fibre foods.
If you smoke, the best thing you can do for your health is to stop smoking completely. Stopping can be hard, but there are free services and treatments available to help.
Donate today to help Cancer Research UK make more incredible strides forward in diagnosis, prevention and treatment of cancer. No matter how small or large, your gift will lead to dramatic changes to cancer outcomes in your lifetime. For example:
£40 could pay for a cancer biopsy, where a tiny sample of someone’s tumour is taken for research
£250 could buy 500 plastic dishes, essential for scientists to grow and study cells in the lab
£1,000 could help fund a clinical trial of a new, more effective treatment for lung cancer
Join Cancer Research UK on its mission towards the day when all cancers are cured.
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THE FUTURE:
Lung cancer risk begins to rise steeply from age 45
70%
of lung cancer cases are diagnosed at a late stage (3 or 4) in the UK
£42 million
44%
of lung cancer cases occur in people aged 75 and over
Lung health checks target people at higher risk
It’s hoped that improvements in diagnosis will mean a better outcome for lung cancer patients, says Sara Hiom, director of early diagnosis and health professional engagement at Cancer Research UK. “The best way to detect lung cancer early is to do it before the person gets symptoms. It has been shown that this can be done by being proactive in identifying people at high risk and giving them a low-dose CT scan, which is much better at picking up lung cancer than X-rays.” Two pilot projects have already demonstrated that a much earlier diagnosis is possible. While there are still many questions about the impact of targeting people at high risk of developing lung cancer, including how to balance detecting the disease early with minimising the risk of unnecessary procedures, evaluation of NHS England’s Targeted Lung Health Check programme may help to shine a light on the answers.
“By 2034, blood-based or imaging-based screening should be the norm to detect lung cancer at an early stage when it can be cured,” says Professor Charles Swanton, Cancer Research UK’s chief clinician. “We’ll be treating the disease early, which has dramatically better outcomes for patients. When the tumour is more advanced, we’ll be able to hit it harder by targeting mutated cells but sparing the normal tissue. I’m incredibly optimistic about the future.”
Team tactics streamline diagnosis
Since 2014, the ACE (Accelerate, Coordinate, Evaluate) project, led and part-funded by Cancer Research UK, has been looking at a range of different initiatives across the country designed to provide a more rapid diagnosis and treatment for lung and colorectal cancer. The second phase of the project involves trialling multidisciplinary diagnostic clinics (MDCs) for patients with vague symptoms that may suggest cancer. These patients are often passed between the GP and several hospital departments before being diagnosed, and the aim is to speed up the process with a one-stop, collaborative approach.
Blood tests track tumours’ return
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Saving lives in our lifetime: Lung cancer
Challenges with diagnosing and treating lung cancer mean survival is still low. But by mapping the tumours’ growth, combining drug therapies and bringing clinicians together to speed up the diagnostic process means Cancer Research UK scientists are optimistic that the future might soon be brighter for patients
JUMP TO
Timeline
Case Study
Symptoms
Prevention
Lung cancer is the third most common cancer in the UK, with around 47,000 people diagnosed each year. It can start if abnormal cells in the lungs begin to divide in an uncontrolled way.
What is it?
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When diagnosed with lung cancer at the earliest stage (stage 1), almost nine in 10 people in England survive their disease for a year or more, compared with around two in 10 when diagnosed at the latest stage (stage 4) in the UK
One of the most striking developments of the TRACERx study is the ability to track a patient's tumour DNA in blood samples. “If we take blood every 6-12 weeks, we now find that there’s evidence of a tumour coming back 6-12 months before it appears on a CT scan,” explains Professor Swanton. “We are now setting up trials where we can use this bespoke approach to identify patients who are going to develop recurrent disease in the next year or two and treat them in advance of disease recurrence with the aim of curing more patients with this disease. This early intervention is so important because the greater the number of tumour cells, the less chance we have of treating it effectively.”
Even if you notice a change that isn’t on the list, talk to your doctor
Could a breath test detect cancer in the future?
What does the future of cancer research look like?
Scientists say ‘thank you’ to cancer trial participants
Related content
2013
Large study to track evolution of lung cancer
As a cancer grows and develops its genetic make-up changes. Over time, the cancer cells even become different to one another, giving rise to an evolving ‘patchwork’ of cancer cells. This is particularly true of lung cancer and presents both a challenge and an opportunity to researchers. As a cancer progresses, its genetic diversity makes it increasingly resistant to treatment, and this is particularly true of lung cancer.
Using cutting-edge methods to collect and analyse genetic data, the
TRACERx programme is tracking a total of 842 patients with non-small cell lung cancer, the most common type, to see how the genetic make-up of their cancer changes over the course of the disease. Scientists are hoping to get a better understanding of how cancer’s genetic diversity develops and how to curtail it. The groundbreaking study will last for more than a decade, supported by £14 million from Cancer Research UK, the charity's single biggest investment in lung cancer research.
2014
New model for drug trials
The National Lung Matrix Trial was launched by Cancer Research UK to test new, targeted treatments on small groups of patients who share similar faults in their tumours, helping to match the right treatment to the right patient. Drugs with promising results can then be prioritised for larger trials. The small-scale starting point means that many more new drugs can be tested across a wide range of genetic faults.
The people taking part in this trial have already agreed to have their cancer tested to look for any gene changes as part of Cancer Research UK’s Stratified Medicine Programme,
a national collaboration between patients, the research community, the NHS, the pharmaceutical and diagnostics industry, and the Government to enable widespread genetic testing that will in future be crucial for accommodating new targeted treatments.
Then in 2015, a blanket ban on the display of tobacco products in shops across the UK was introduced. We now know, thanks to a Scotland-based study funded by Cancer Research UK, that the ban contributed to a reduction in the number of young people at risk of taking up smoking.
2013
Large study to track evolution of lung cancer
As a cancer grows and develops its genetic make-up changes. Over time, the cancer cells even become different to one another, giving rise to an evolving ‘patchwork’ of cancer cells. This is particularly true of lung cancer and presents both a challenge and an opportunity to researchers. As a cancer progresses, its genetic diversity makes it increasingly resistant to treatment, and this is particularly true of lung cancer.
Using cutting-edge methods to collect and analyse genetic data, the TRACERx programme is tracking a total of 842 patients with non-small cell lung cancer, the most common type, to see how the genetic make-up of their cancer changes over the course of the disease. Scientists are hoping to get a better understanding of how cancer’s genetic diversity develops and how to curtail it. The groundbreaking study will last for more than a decade, supported by £14 million from Cancer Research UK, the charity's single biggest investment in lung cancer research.
2014
New model for drug trials
The National Lung Matrix Trial was launched by Cancer Research UK to test new, targeted treatments on small groups of patients who share similar faults in their tumours, helping to match the right treatment to the right patient. Drugs with promising results can then be prioritised for larger trials. The small-scale starting point means that many more new drugs can be tested across a wide range of genetic faults.
The people taking part in this trial have already agreed to have their cancer tested to look for any gene changes as part of Cancer Research UK’s Stratified Medicine Programme, a national collaboration between patients, the research community, the NHS, the pharmaceutical and diagnostics industry, and the Government to enable widespread genetic testing that will in future be crucial for accommodating new targeted treatments.
Then in 2015, a blanket ban on the display of tobacco products in shops across the UK was introduced. We now know, thanks to a Scotland-based study funded by Cancer Research UK, that the ban contributed to a reduction in the number of young people at risk of taking up smoking.
What is chemotherapy?
Chemotherapy drugs circulate in the bloodstream and kill cancer cells when they are in the process of dividing into two. Because cancer cells divide much more often than most normal cells, chemo is more likely to kill them. Some chemo drugs kill dividing cells by interrupting the chemical processes involved in cell division, while others damage part of the cell's control centre that carries the instructions for division. However, the drugs also affect normal cells that are constantly growing and renewing, such as in the hair, skin and bone marrow. The damage to healthy tissue is usually short-lived, because normal cells can replace or repair the damage done by chemo. And most side effects disappear once treatment is over.
2016
Blood test could point to best lung cancer treatment
It’s difficult to take a biopsy, or sample, of lung cancer tumours as they are hard to reach. Cancer Research UK-funded TRACERx scientists at UCL and the Francis Crick Institute found that it’s possible to get a snapshot of the genetic make-up of a cancer from a blood sample. The ‘liquid biopsy’ could help predict which patients will develop
disease recurrence after surgery and how patients will respond to chemotherapy, and assist doctors in choosing the best treatment for each patient.
Plain and standardised cigarette packaging, with no branding or imagery to attract new smokers, was also introduced by law this year.
2016
Large study to track evolution of lung cancer
As a cancer grows and develops its genetic make-up changes. Over time, the cancer cells even become different to one another, giving rise to an evolving ‘patchwork’ of cancer cells. This is particularly true of lung cancer and presents both a challenge and an opportunity to researchers. As a cancer progresses, its genetic diversity makes it increasingly resistant to treatment, and this is particularly true of lung cancer.
Using cutting-edge methods to collect and analyse genetic data, the TRACERx programme is tracking a total of 842 patients with non-small cell lung cancer, the most common type, to see how the genetic make-up of their cancer changes over the course of the disease. Scientists are hoping to get a better understanding of how cancer’s genetic diversity develops and how to curtail it. The groundbreaking study will last for more than a decade, supported by £14 million from Cancer Research UK, the charity's single biggest investment in lung cancer research.
How Cancer Research UK plans to continue tackling lung cancer in the next 25 years
Therapy rule book allows for bespoke treatment plans
Professor Swanton also leads RUBICON, a collaborative project launched in 2018 between Cancer Research UK, the Francis Crick Institute and Bristol-Myers Squibb, which aims to create a ‘rule book’ for combination immunotherapies targeted at lung cancer. “We have to understand tumour evolution in the context of its environment and the cell types that are constraining or supporting tumour growth,” he says. “One of the problems we have is understanding which of these cells different drugs act on. Through RUBICON, we're going to map out the activity of cells across the tumour and work out how to more effectively tackle cancer using targeted combinations of treatments.”
How Cancer Research UK plans to continue tackling lung cancer in the next 25 years
Therapy rule book allows for bespoke treatment plans
Professor Swanton also leads RUBICON, a collaborative project launched in 2018 between Cancer Research UK, the Francis Crick Institute and Bristol-Myers Squibb, which aims to create a ‘rule book’ for combination immunotherapies targeted at lung cancer. “We have to understand tumour evolution in the context of its environment and the cell types that are constraining or supporting tumour growth,” he says. “One of the problems we have is understanding which of these cells different drugs act on. Through RUBICON, we're going to map out the activity of cells across the tumour and work out how to more effectively tackle cancer using targeted combinations of treatments.”
A persistent cough, or a change in a cough you’ve had for a long time
Shortness of breath
Coughing up blood
Persistent chest infections
Find your free, local service at NHS Smokefree, or talk to your doctor or pharmacist for support and advice
Around
Cancer Research UK spent
on lung cancer research in 2017/18.
