Key Facts
Lung cancer is the third most common cancer across Europe - breast and rectal cancers are more common.
Lung cancer is the leading cause of cancer deaths in Europe.
Lung cancer is approximately three times more common in men, however, the number of women developing lung cancer is increasing as more women smoke.
There are two main types of lung cancer, but all forms of lung cancer are caused by smoking or exposure to other people’s cigarette smoke.
The risk of developing lung cancer decreases gradually once an individual stops smoking.
In addition to causing lung cancer, smoking is a major risk factor for developing other cancers, coronary heart disease, peripheral vascular disease, cerebrovascular disease, chronic bronchitis and emphysema.
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Key Figures
| Total number of new cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7. million |
| Number of new lung cancer cases (2006) |
386,300 |
|
(292,200 men) |
|
(94,100 women) |
|
271,600 (EEA) |
|
265,600 (EU25) |
| Number of lung cancer deaths (2006) |
334,600 |
|
(253,300 men) |
|
(81,500 women) |
|
241,000 (EEA) |
|
236,000 (EU25) |
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Cancer Types
Non-small cell and small cell lung cancer are the two main types of lung cancer.
- Non-small cell lung cancer, which makes up around 80% of lung cancers, can be divided into different types (although sometimes it can be difficult to tell them apart even when samples are examined under the microscope). The three types of non-small cell cancer are:
- Small Cell Lung Cancers (SCLC) - about 15% of all lung cancers, made up as the name suggests of small round cells.
- Mesothelioma is another type of cancer that affects the covering of the lungs (the pleura). It is relatively rare and usually occurs in people who have been exposed to asbestos.
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Causes of Lung Cancer
Smoking – including passive as well as active smoking and cannabis as well as tobacco.
If you stop smoking, the risk of developing lung cancer falls. After about fifteen years, the risk of developing lung cancer falls back to that of a non-smoker. (The risk of developing other diseases associated with smoking falls off much more quickly.)
Some people seem more likely to develop lung cancer due to genetic factors, however, no genes have yet been identified as responsible.
Mesothelioma is a rare cancer of the covering of the lungs (the pleura). It is specifically linked with exposure to asbestos fibres.
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Prevention of Lung Cancer
- Stopping smoking
- Avoiding exposure to other people’s cigarette smoke (passive smoking)
- Avoiding exposure to asbestos (mesothelioma)
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Common Symptoms
- coughing up blood
- a persistent cough
- shortness of breath
- wheezing
- a hoarse voice
- chest and shoulder pain
- tiredness
- weight loss
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Diagnostic Tests
- Chest X-rays never provide a certain diagnosis but may show that there is an abnormality requiring additional tests.
- Sputum examination – cancer cells can often be identified in a sputum sample.
- Computerised Tomography (CT scan) is a type of X-ray that shows the body organs in cross section, allowing localisation of any abnormalities present.
- Positron Emission Tomography (a PET scan) uses small amounts of radioactive material to detect cancer and other diseases in the body.
- Bronchoscopy – a thin flexible telescope that is used to look directly into the lungs, taking photographs and biopsies.
- Lung biopsy – a sample of lung tissue is taken for examination under a microscope. The sample is obtained by passing a needle through the skin into the part of the lung where something abnormal has been found on an X-ray.
- Mediastinoscopy – a test to look directly at the centre of the chest and take biopsies.
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Treatment
Surgery
Non-small cell lung cancers that have not spread to nearby lymph nodes in the centre of the chest, or to other parts of the body can be treated using surgery.
Small Cell Lung Cancers (SCLC), are rarely found in just one place, so surgery is not usually a good option.
External beam radiotherapy
External beam radiotherapy uses high energy X-ray beams, generated from linear accelerators to kill cancer cells, and is given as a series of short regular treatments over a period of several weeks. Treatments for reducing symptoms (palliative treatments) are commonly completed in a few visits and in less than 2 weeks.
Stereotactic radiotherapy (SRT) is a new form of high-precision radiotherapy available in specialized centres. SRT provides radiotherapy focused on the whole tumour, with very little effect on surrounding normal tissues. This allows the use of very high doses of radiation in 3-8 treatment sessions or fractions over a two week period, which is of great convenience to the patient.
Concurrent chemotherapy and radiotherapy (chemoradiation). When given at the same time, the combined effect of radiotherapy and chemotherapy together is more effective than when given separately. It is particularly useful for patients for whom surgery is inappropriate or carries high risks.
Endobronchial laser treatments. Specific symptoms such as breathlessness caused by obstruction of the trachea (wind pipe) or one of the main airways can be relieved using laser beams.
Lasers are powerful light beams that can be used to destroy lung cancers that are blocking the larger airways, causing symptoms like wheezing and breathlessness.
Brachytherapy delivers radiotherapy directly to the cancer site, by putting a radiation source in or beside the tumour. Damage to healthy lung tissue in minimised. Brachytherapy is effective in stopping bleeding from tumours and opening up blocked areas of the lung. However, in many centres, laser treatments are now used instead.
Chemotherapy
Small cell lung cancer usually responds well to cisplatin and etoposide, but other combinations are also used across Europe.
Chemotherapy is not routinely used for non small cell lung cancer, as it is not very sensitive to chemotherapy. Instead, surgery and/or radiotherapy are the main treatments.
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Key Trends
In many countries the numbers of young people who smoke continues to rise.
The use of surgery as a treatment for lung cancer is declining, and the use of non-surgical techniques is increasing.
PET scans are providing more accurate identification of patients with limited disease who are more suitable for aggressive treatments.
SRT seems to provide very good local tumour control in very early-stage non-small cell lung cancer, however, no long term data is available yet.
From the patient perspective, SRT is very convenient as it is an outpatient treatment and patients can generally resume their normal activities directly following treatment.
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Important Research Areas
Genomics may help in determining which patients are best suited to particular treatments, thus avoiding the toxic side effects of treatment in patients where treatment is unlikely to succeed.
New so-called ‘molecular targeted agents’ have been shown to improve survival in advanced stages of lung cancer. These include monoclonal antibodies and small molecules which target cell growth pathways, and are currently being investigated for their ability to enhance the effectiveness of radiotherapy as well.
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Unresolved Questions
The use of screening for lung cancer in patient populations at high risk of developing the disease is the subject of two large clinical trials. Whilst screening may lead to earlier diagnosis and better results from treatment, that benefit must be weighed against the cost of screening, the frequency of detecting conditions including benign diseases which do not require treatment, the toxicity of invasive procedures required to establish a diagnosis and the anxiety this causes to patients.
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