Lung cancer

Lung cancer, lung carcinoma and bronchial carcinoma are the terms medical practitioners use to refer to malignant tumors that occur in the bronchia of the lungs. These bronchial carcinomas are divided into two large groups: non-small cell tumors and small cell tumors.  

57,000 people get lung cancer every year in Germany. In most patients, the disease is only identified when it is at an advanced stage. There are 2 main reasons for this: firstly, a lung carcinoma only usually reveals itself through symptoms at a late stage. Secondly, these signs of illness are usually non-specific. This means that complaints such as coughing and abnormal fatigue may also be caused by another illness such as bronchitis (inflammation of the bronchia).

The symptoms of a bronchial carcinoma may include:

• persistent coughing
• shortness of breath, breathing difficulties through to breathlessness
• phlegm
• pain in the lung and chest area
• general weakness and fatigue
• weight loss
• bone pain
• high temperature
• neurological symptoms such as headaches

Symptoms such as coughing or abnormal fatigue do not only occur with lung cancer, but often also with benign conditions. If these symptoms persist over several weeks and if there are typical risk factors for lung cancer, a visit to the doctor is recommended. General Practitioners can already narrow down what is causing the symptoms and, if necessary, initiate further diagnostic steps with specialists.

In terms of the causes and risk factors for lung cancer, the research distinguishes between factors that can be influenced, such as smoking, and factors that cannot be influenced, such as a congenital risk of the illness. A congenital disposition to lung cancer is debated in expert circles, but there is no definitive answer yet. 

However, there has long been no doubt that smoking is a very crucial risk factor for the occurrence of lung carcinomas. Amongst lung cancer patients, 9 out of 10 men and 6 out of 10 women have probably become ill due to years of smoking. The reason: tobacco smoke contains a large amount of carcinogens – these are agents that are classified as causing cancer. The longer and more intensively these carcinogens are breathed in, the more the risk of lung cancer increases. On the other hand, a person can get a bronchial carcinoma without having smoked.

Not only tobacco smoke, but also certain types of radiation and harmful substances in the workplace or everyday life can damage the lungs. Unfortunately, not all of these risk factors can be eliminated – particularly fine dust. However, someone who gives up smoking now can significantly reduce their risk of getting ill within a few years.

Someone who does not smoke, or who gives up smoking now, has already taken the main measure to prevent lung cancer. Even for non-smokers, if a person is often exposed to tobacco smoke, their risk of getting ill increases.

The risk of lung cancer increases: 

• the longer a person smokes.
• the earlier a person starts to smoke.
• the more cigarettes (or cigars or pipe tobacco) a person smokes.
• the more often a person passive-smokes.

Moreover, a healthy lifestyle in general helps prevent cancer – not only lung cancer. Key habits are a balanced diet and sufficient activity: at least 150 minutes light exercise per week.

When there is a suspicion of bronchial carcinoma, a range of diagnostic methods which complement one another are available to doctors.  

To start with, there is always the basic diagnosis, which consists of the following elements: 

• question the patient (case history) about pre-existing conditions and symptoms 
• physical examination 
• laboratory tests 
• X-rays, computed tomography of the chest, and ultrasound 
• bronchoscopy 

General practitioners can take the first steps of a basic diagnosis themselves. Radiologists and lung specialists, for example, are responsible for subsequent steps. Specialist outpatient clinics also have trained staff and the medical equipment required. 

When a bronchoscopy is done, tissue samples can be taken from the lung. Doctors use these to confirm their diagnosis. If a tumor is found, laboratory staff can use the sample to determine the type of tumor, which is vital for the choice of therapy.  

If a lung cancer diagnosis is confirmed, various imaging methods are used to find out whether, and to what extent, the cancer has spread through the body. 

Do you want to know what other tests are done when the diagnosis of lung cancer is confirmed? On the website of the Cancer Information Service of the German Cancer Research Center you can read more about the test methods (in German). 

With a common type of cancer such as lung cancer, the question arises as to whether screening is a good idea. Up to now, however, there is no suitable, low-risk, reliable test method for everyone.

Lung cancer screening using computed tomography may be a good idea only for particular at-risk groups, such as heavy, long-term smokers. So the authorities are currently looking at what benefits and risks are involved in this test for people with a high risk of lung cancer.

Would you like to know more about current lung cancer screening options? You can find out more on the website of the Cancer Information Service of the German Cancer Research Center (in German).

In choosing the best type of therapy, doctors consider 3 main factors:

• The stage of the disease: how advanced is the lung cancer?
• The type of tumor: is it non-small cell or small cell?
• The patient’s general health: do any other conditions need to be taken into account when planning the treatment?

In their early stages, bronchial carcinomas can be operated on – with the aim of removing a tumor completely. However, this is on condition that the tumor has not yet grown into neighboring organs, that no metastases have formed, and that no lymph nodes have been affected. Because small cell tumors form metastases more quickly than non-small cell tumors, an operation is rarely suitable for small-cell lung cancer.

In any case, an operation is only considered if the patient’s condition in general is stable enough. For example, an existing condition such as cardiac insufficiency may constitute a risk that is too great for a surgical intervention. As the average age for getting lung cancer is around 70, many lung cancer patients are affected by other, age-related conditions.

Usually, though, lung cancer is only detected at an advanced stage. For patients who cannot be operated on, chemotherapy is one of the main treatments. Chemotherapy involves administering drugs that slow down cell growth or block cell division: so-called cytostatics. Before or instead of an operation, chemotherapy is used to reduce the size of tumors. After an operation, chemotherapy aims to prevent tumors growing again (relapse).

Other forms of therapy that can be combined with the operation or chemotherapy include:

• Radiotherapy: this aims to use radiation to damage tumor cells while protecting the surrounding tissue as much as possible.
• So-called targeted therapies: drugs are used to attack surface features of cancer cells. Healthy cells have little or none of these features.
• Immunotherapy: drugs stimulate certain of the body's own defense cells to fight the cancer cells themselves.
• Supportive treatment methods: these include ways of alleviating adverse symptoms and improving the general quality of life.

Would you like to know how therapy options differ for non-small cell and small cell lung cancer? And which treatment options there are if the lung cancer can no longer be cured? There are detailed descriptions of the therapy methods on the website of the Cancer Information Service of the German Cancer Research Center (in German).

Cancer treatment can be both mentally and physically exhausting. Medical rehabilitation (rehab) after cancer therapy aims to help patients regain their strength. It also aims to help them deal with the consequences of the disease and its treatment in the best possible way. A medical rehab program thus focuses on the personal medical history and existing limitations. 

A medical rehab program after lung cancer therapy may include: 

• breathing training to reduce breathlessness after a lung cancer operation 
• psychological support 
• dietary advice 
• physiotherapy and sport 
• smoking cessation 

Lung cancer aftercare is intended to detect any recurrence at an early stage as well as any delayed effects of the treatment. Once treatment has been completed, patients are examined regularly, initially at short intervals, then at longer ones. However, if patients have any problems they can also visit their doctor more often. Doctors question them about symptoms, examine them physically, and may have an X-ray done of their chest. 

If the cancer is incurable, regular checkups help to identify adverse symptoms at an early stage. The aim is to maintain the patient’s quality of life for as long as possible. 

Many lung cancer patients want to take an active part in order to affect their illness positively. There are a number of ways they can do this. What can help them to cope better with the disease and the consequences of treatment depends on the individual situation:

• Exercise can help overcome tiredness and weakness. It should be adapted to the patient’s physical ability.
• A balanced, healthy diet or nutritional therapy can prevent or treat malnourishment.
• Psycho-oncological counseling can help if worry and anxiety becomes overwhelming.

If it is no longer possible to cure the cancer and it is becoming more advanced, good medical and nursing care are very important. Adverse symptoms such as coughing and breathlessness can be alleviated. And psychosocial support can help maintain quality of life for as long as possible.

Doctors with different specializations work closely together to treat lung cancer. Hospitals that are particularly experienced in treating patients with lung cancer can get certification to prove this. The German Cancer Society (DKG) regularly checks their compliance with certain professional requirements.  

You can find the addresses of the certified centers on the OncoMAP website.  

The German Society for Thoracic Surgery (Deutsche Gesellschaft für Thoraxchirurgie – DGT) centers are certified by the independent body Doc-Cert AG.

Do you have any questions about everyday life with lung cancer and other support options? You can find information about this on the German Cancer Research Center’s Cancer Information Service website (in German).

If you have any questions about lung cancer you can also make personal contact with the Cancer Information Service by dialing the freephone number 0800 - 420 30 40 or writing an email to krebsinformationsdienst@dkfz.de.