What is lung cancer?
Lung cancer is a growth of abnormal cells inside the lungs. Cancer cells divide and grow faster than healthy cells, forming into clusters called tumours. The cancer cells destroy and replace the healthy tissue around them. Lung cancer can also spread (metastasize) to other parts of the body.
Lung cancer happens when the cells in the lungs become damaged by smoke, pollution, or other toxins in a person’s environment. The process of aging can also contribute. It is possible for lung cancer to develop in people who have not smoked or been exposed to toxic substances.
Nearly 30,000 Canadians will be diagnosed with lung cancer this year.
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If you (or a loved one) have been diagnosed with lung cancer and need support, we are here to help. Reach out to our Lung Health Line for free one-on-one guidance from a Certified Respiratory Educator.
Lung cancer quick facts
- Lung cancer can occur anywhere in the lungs, from the bronchus – which brings air in – to the pleura – the thin tissue that covers the lungs and lines the chest cavity – and anywhere in between.
- There are two main types of lung cancer: non-small cell lung cancer (NSCLC), which accounts for 80-85% of cases, and small cell lung cancer (SCLC), which accounts for the rest
- About half of lung cancer cases are diagnosed at a late stage. At later stages, lung cancer is harder to treat.
- Screening can help find lung cancer early.
Types of lung cancer
Depending on where cancer cells are found and how they’re growing and spreading, lung cancer is put in one of two main categories: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
Importantly, the terms “small” and “non-small” have nothing to do with the size of the tumours or the extent of the cancer. They are referring to the kinds of cells found in the cancer and how they look under the microscope.
| Non-small cell lung cancer (NSCLC) | Small cell lung cancer (SCLC) | |
|---|---|---|
| How common is it? | This is the most common type of lung cancer, accounting for around 85% of cases. | This type of lung cancer is less common, accounting for around 10 to 15% of cases. |
| How does it spread? | NSCLC usually spreads more slowly than other lung cancers. | SCLC is usually more aggressive and can result in larger tumours. |
| Why’s it called that? | “Non-small” doesn’t have anything to do with the size of the tumours or extent of the cancer. It refers to the kind of cells found in the cancer, and how they look under the microscope. | “Small” doesn’t have anything to do with the size of the tumours or extent of the cancer. It refers to the kind of cells found in the cancer, and how they look under the microscope – small and round. |
| Major sub-types | - Adenocarcinoma (the most common form of lung cancer in general) - Squamous cell carcinoma - Large cell carcinoma | - Small cell carcinoma - Mixed small cell/large cell - Combined small cell carcinoma |
| How it’s staged | Stage I, II, III, or IV. | Limited Stage, Extensive stage |
| Treatment options | Chemotherapy, surgery, and radiation therapy are all common treatments for non-small cell lung cancer. Targeted treatments are an option for some patients. These drugs affect cancer’s ability to grow by targeting specific genes or other factors. To find out if you qualify for any of these treatments, you will need to undergo molecular testing. Immunotherapy, a kind of treatment that boosts the immune system’s ability to defend against cancer, is an option for some patients. Like targeted treatments, immunotherapies require further testing. | Systemic (whole body) treatments like chemotherapy are more effective in fighting small cell lung cancer than localized treatments like surgery. Surgery is rare, but may be an option if the cancer has not reached the lymph nodes. Depending on the stage of the cancer, radiation therapy may be used in combination with chemotherapy (chemoradiation), or could be used to prevent the spread of cancer to the brain. There are currently no immunotherapy or targeted treatments for SCLC. |
Lung cancer risk factors
With or without a history of smoking, we will be here for you.
The best action you can take to lower your risk of lung cancer is to live a smoke-free life. For those who do not smoke, it’s as simple as avoiding second-hand smoke and choosing not to start smoking or vaping.
For those who currently smoke, quitting can be a more complex journey – but we’re here to help. It’s never “too late” to quit smoking, even after a lung cancer diagnosis.
Radon is the second leading cause of lung cancer, and the first leading cause of lung cancer in non-smokers. Radon is a natural radioactive gas that comes from the breakdown of uranium in soil and rock. In enclosed spaces like homes or workplaces, radon can build to unsafe levels. Learn more about radon and how to test for it in your home.
Some workers have a higher risk of developing lung cancer. This most often impacts people who work with or around:
- Asbestos
- Diesel engine exhaust
- Crystalline silica
- Welding fumes
- Nickel
- Chromium
- Radon
- Second-hand tobacco smoke
People who work in the following industries have an increased risk for lung cancer:
- Rubber manufacturing
- Iron and steel founding
- Coal gasification
- Coke production
- Chimney sweeping
- Commercial painting
- Roofing and paving
- Industries that use the Acheson process to create silicon carbide
A family history of lung cancer may increase your risk of lung cancer, especially if any of your first-degree relatives – parents, siblings, or children – have been diagnosed.
With or without a history of smoking, we will be here for you.
The best action you can take to lower your risk of lung cancer is to live a smoke-free life. For those who do not smoke, it’s as simple as avoiding second-hand smoke and choosing not to start smoking or vaping.
For those who currently smoke, quitting can be a more complex journey – but we’re here to help. It’s never “too late” to quit smoking, even after a lung cancer diagnosis.
Radon
Radon is the second leading cause of lung cancer, and the first leading cause of lung cancer in non-smokers. Radon is a natural radioactive gas that comes from the breakdown of uranium in soil and rock. In enclosed spaces like homes or workplaces, radon can build to unsafe levels. Learn more about radon and how to test for it in your home.
Workplace exposures
Some workers have a higher risk of developing lung cancer. This most often impacts people who work with or around:
- Asbestos
- Diesel engine exhaust
- Crystalline silica
- Welding fumes
- Nickel
- Chromium
- Radon
- Second-hand tobacco smoke
People who work in the following industries have an increased risk for lung cancer:
- Rubber manufacturing
- Iron and steel founding
- Coal gasification
- Coke production
- Chimney sweeping
- Commercial painting
- Roofing and paving
- Industries that use the Acheson process to create silicon carbide
Genetics
A family history of lung cancer may increase your risk of lung cancer, especially if any of your first-degree relatives – parents, siblings, or children – have been diagnosed.
Symptoms of lung cancer
The most common early symptoms of lung cancer include:
- A stubborn cough that won’t go away (which could make it difficult to sleep)
- Coughing up blood or rust-coloured sputum (phlegm)
- Laboured breathing, shortness of breath, or wheezing
- Chest pain (deep in the lungs when lifting, coughing, or laughing)
- Chest infections like pneumonia that are frequent and hard to get rid of
- Fatigue
- Unexplained weight loss and appetite loss
These symptoms are not unique to lung cancer, but it’s important to get checked out if you experience them. Some could be signs of chronic obstructive pulmonary disease (COPD) or other conditions.
Once treatment begins, you may experience side effects of treatment along with symptoms of the disease.
The lung cancer journey
Screening
Screening for lung cancer is checking for lung cancer in people who do not have symptoms. Most of the time, routine screening for lung cancer is not recommended, except for people who have risk factors such as smoking, workplace or lifestyle exposures, or a family history of cancer.
In Ontario, lung cancer screening is offered to people at high risk of getting lung cancer. People aged 55-74 with a history of smoking may be referred for screening.
Screening involves a test called a low-dose CT scan – with lower radiation – which looks at the lungs to find lung cancer early. The test involves lying on a table that slides in and out of the machine. The machine takes many pictures of the lungs. A computer combines these images to create a more detailed picture of your lungs.
Finding lung cancer early means treatment has a better chance of working. If lung cancer is caught at stage I rather than stage IV, the likelihood of surviving 5 years or more is improved.
Screening for lung cancer is checking for lung cancer in people who do not have symptoms. Screening involves a test called a low-dose CT scan – with lower radiation – which looks at the lungs to find lung cancer early.
Testing is recommended when a person is experiencing symptoms that could indicate lung cancer. If you are experiencing some of the symptoms listed above, your doctor may want you to have certain tests done.
Staging cancer is determining the stage (extent) of the cancer. This will help guide decisions about the most appropriate treatment approach.
Your medical team will consider a number of factors when choosing treatments to fight your cancer most effectively. They will consider your age, your overall health, and other personal factors, like the unique features of your particular cancer.
Navigating the cancer care system can seem overwhelming at first, but we are here to help. Advocating for yourself can help you to feel more empowered as you go through cancer care.
Living with lung cancer means changing the way you approach your daily activities to accommodate your symptoms and treatment. Don't worry — we can help.
Diagnosis
Testing is recommended when a person is experiencing symptoms that could indicate lung cancer. If you are experiencing some of the symptoms listed above, your doctor may want you to have certain tests done. These may include:
- A chest x-ray
- A biopsy (taking a small sample of lung tissue with a thin needle so it can be looked at under a microscope)
- A bronchoscopy (looking in the lungs for tumours with a camera on a tube)
- An analysis of phlegm that is coughed up
- A CT scan
Staging lung cancer
Staging cancer is determining the stage (extent) of the cancer. This will help guide decisions about the most appropriate treatment approach.
The stages of non-small cell lung cancer:
- Stage 0: Abnormal cells are found, but they are precancerous (not considered cancer yet).
- Stage I: The cancer is found only in the lung and has not spread to any lymph nodes. The tumor is quite small – generally smaller than 2 inches (5 centimetres) across.
- Stage II: The tumor is larger than 2 inches (5 centimetres) across, or it may be a smaller tumor that involves nearby structures such as the chest wall, the diaphragm, or the lining around the lungs (pleura). Stage II cancer may also have spread to nearby lymph nodes.
- Stage III: The tumor has grown very large and has invaded other organs near the lungs, or a smaller tumor is accompanied by cancer cells in lymph nodes farther away from the lungs.
- Stage IV: Cancer has spread beyond the affected lung to the other lung, or to distant areas of the body. Almost half of all lung cancers are diagnosed at this stage.
Small cell lung cancer is staged a little differently:
- Limited stage: The cancer is only on one side of the chest. It is found in one lung and maybe in nearby lymph nodes on the same side of the chest.
- Extensive stage: The cancer is in both lungs or in distant lymph nodes and organs of the body.
Treatment
Your medical team will consider a number of factors when choosing treatments to fight your cancer most effectively. They will consider your age, your overall health, and other personal factors. They will also consider the unique features of your particular cancer including the type of cancer, location of the tumour, and whether it has spread to other parts of the body.
There are two main forms of treatment. Local treatments are directed at one part of the body, such as the lungs. Radiation and surgery are examples of local treatments.
Systemic treatments are treatments that affect the whole body. They tend to be used when cancer is found in several parts of the body, or to reduce the chance of cancer coming back. Chemotherapy is a systemic treatment. Targeted therapy is another form of systemic treatment.
Targeted therapies are treatments that are based on molecular testing and are personalized to the specific biomarkers for your cancer. These treatments can be more effective because they target the specific type of cancer you have.
Navigating your lung cancer care
The cancer care system can seem overwhelming at first, but we are here to help you navigate it so that you feel supported and empowered.
It can be helpful to familiarize yourself with the different members of the lung cancer care team. These may include oncologists, respirologists, nurses, social workers, pharmacists, dieticians, and palliative care.
Advocating for yourself can help you to feel more empowered as you go through the cancer care process. Asking questions, taking notes, and reporting your symptoms are simple ways you can stay actively involved. Including family, friends, and other loved ones in the process of navigating the healthcare system is also very helpful.
You may want to ask a loved one to come with you to appointments if you are concerned about remembering everything or finding your way through the healthcare system on your own, and having someone there can help you to feel more supported too. Know that you have the right to view and access your medical records.
Learn more on our navigating your lung cancer care page.
Living with lung cancer
Living with lung cancer means changing the way you approach your daily activities to accommodate your symptoms and treatment. Some symptoms can make daily life more challenging, from getting dressed, to managing the household, to being productive at work. Shortness of breath and fatigue are two of the most commonly reported challenges of people living with lung cancer.
Other common challenges reported by people with lung cancer include the need for support in the community, the need for support for loved ones, sex and intimacy, and concerns about work.
For more information on living with lung cancer, and for solutions and support for many of these common concerns, see our coping with lung cancer page.
Lung Cancer Screening
“Screening” means checking for cancer before symptoms develop, even if you feel healthy. Screening can help detect cancer in its earliest stages.
Diagnosis and Staging
Being diagnosed with lung cancer is often life-changing, and emotional distress is common. Understanding the steps and procedures can help you feel more in control, prepare you to advocate for yourself during your treatment.
Navigating Your Lung Cancer Care
The cancer care system can seem overwhelming at first, but we’re here to help you navigate it in a way that makes you feel empowered and supported.
Treatment
Your treatment team will consider a number of factors when choosing treatments that will fight your cancer most effectively. They will consider your overall health, age, and personal situation.
Questions and Answers About Coping with Lung Cancer
The questions we list here are the top coping questions reported by people with lung cancer. Our answers provide some basic information, but we encourage you to discuss any concerns or questions with your oncologist and other members of your cancer care team.