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Lung Cancer

Welcome to the Lung Cancer Web page

The Lung Cancer Team is Multi-disciplinary and made up of the below team members:

Dr M. Chaudri Lead Lung Cancer Clinician
Lucia Sabel Nurse Consultant Lung Cancer
Dr T. Woolmore Consultant Radiologist
Dr A Mahmood Consultant Radiologist
Matthew Potts MDT Co-ordinator
Jade Norton Lung Cancer Clinical Nurse Specialist Ext 2752
Gail Guy Lung Cancer Specialist Nurse Ext 2752
Lisa Matthews Lung Cancer Specialist Nurse Ext 2752
Dr Hafeez Medical Oncologist (RHH and New Cross)
Dr Ilyas Medical Oncologist (RHH and New Cross)
 Dr P. Koh Clinical Oncologist (RHH and New Cross)
 Mr Yui Thoracic Surgeon (New Cross)
 Mr Habib Thoracic Surgeon (New Cross)
 Mr Olimey Thoracic Surgeon (New Cross)

 

Investigations

You may have been referred to us by your GP using our Rapid Access Service. You will be seen by either our Lung Cancer Lead Clinician or our Lung Cancer Nurse Consultant. As part of this you may be required to have some investigations done. These may be carried out either here or New Cross Hospital.

These may include:

  • Blood tests
  • Electrocardiogram (ECG). This is a basic tracing of your heart; this gives the doctor an idea of your heartrate and rhythm.
  • Spirometry. This is a breathing test used to help diagnose and monitor certain lung conditions by measuring how much air you can breathe out in one forced breath. It’s carried out using a device called a spirometer, which is a small machine attached by a cable to a mouthpiece.
  • Chest X-ray. A chest x-ray is often the first type of lung cancer test. A simple x-ray of the chest which can sometimes show abnormalities such as inflammation, infection, scarring or growths.
  • CT scan
  • PET CT scan. A PET scan gives pictures showing where there is active cancer throughout the body. A PET scan should be used before lung cancer surgery and radical radiotherapy, to make sure that curative treatment is possible. A PET scan is more accurate than a CT scan for this purpose. A PET scan can also be used to investigate a suspected cancer, if diagnosis has not been possible using other tests. An injection containing a radiotracer is given to highlight any active cancer cells. The scan is painless and quiet and you will not be fully encased during the examination. Modern PET scans are usually combined with a CT scan which is performed at the same time. This is known as a PET-CT scan.
  • Pleural Aspirate. This is a procedure which involves passing a small needle through your chest wall, to remove fluid or air from the space between your lung and the inside of your chest wall (the pleural space). This sample will be sent for testing to the labs to identify a possible cause for the build-up of fluid.
  • CT guided biopsy. A local anesthetic is used to numb the skin. A doctor then uses a CT scanner to guide a needle through your skin into your lung to the site of a suspected tumour. The needle is used to remove a small amount of tissue from a suspected tumour so it can be tested at a laboratory.
  • Bronchoscopy. If a CT scan shows there might be cancer in the central part of your chest, you may be offered a bronchoscopy. A bronchoscopy is a procedure that allows a doctor to see the inside of your airways and remove a small sample of cells (biopsy).During a bronchoscopy, a thin tube with a camera at the end, called a bronchoscope, is passed through your mouth or nose, down your throat and into your airways. The procedure may be uncomfortable, so you’ll be offered a sedative before it starts, to help you relax, and a local anaesthetic to make your throat numb. The procedure takes around 30 to 40 minutes.
  • EBUS. A newer procedure is called an endobronchial ultrasound scan (EBUS), which combines a bronchoscopy with an ultrasound scan. Like a bronchoscopy, an EBUS allows a doctor to see the inside of your airways. However, the ultrasound probe on the end of the camera also allows the doctor to locate the lymph nodes in the centre of the chest so they can take a biopsy from them. The procedure takes around 90 minutes.
  • A Mediastinoscopy allows a doctor to examine the area between your lungs at the Centre of your chest (mediastinum). For this test, you’ll need to have a general anesthetic. The doctor will make a small cut at the bottom of your neck so they can pass a thin tube into your chest. The tube has a camera at the end, which enables a doctor to see inside your chest. They’ll also be able to take samples of cells from your lymph nodes during the procedure. This will take place at New cross hospital.

You will be informed at each stage of your investigations what you will need, the results when available and the next steps. You will be provided with written information for any procedures you may have and will being given the contact details for the lung cancer nursing team.

Once all of your results are available your case will be discussed at our multi-disciplinary team (MDT) meeting. This happens once a week usually on a Monday and the members of the MDT previously provided will look at all of your scans and investigation results as well as you as a person. The team will together devise a treatment plan for you and may refer you onto our treating teams. You may receive treatment both here at Russells Hall or at New Cross Hospital.

To get more information click on the hyperlinked investigations above or the links below and this will take you to the appropriate website or document.

Types of Lung Cancer

Non-small cell lung cancer

Adenocarcinoma

Adenocarcinoma is a type of non-small cell lung cancer (NSCLC). It is a little more common in women and is also the most common type of lung cancer amongst people under 45. More frequently seen in the outer parts of the lung, adenocarcinoma develops from a particular type of cell that produces mucus (phlegm) and can lead to a chronic cough. It accounts for approximately 50% of all cases of NSCLC.

Large Cell Carcinoma

This type of lung cancer tends to grow quite quickly and often arises in the larger air passages. It has a tendency to spread outside the lung at an earlier stage.

Squamous Carcinoma

This is the most common type of primary lung cancer in the UK and often forms in the larger, more central airways.

Small-cell lung cancer

Small-cell lung cancer is less common than non-small-cell lung cancer. The cancerous cells are smaller in size than the cells that cause non-small-cell lung cancer. Small-cell lung cancer only has 2 possible stages:


Mesothelioma

It is closely associated with a history of asbestos exposure either through work or contact with a person in the asbestos industry. It generally affects older males and may take 35-40 years from the date of first exposure for the cancer to develop. The cancer cells usually positioned in the lining of the lung and often produce fluid. This may require draining from time to time, but may improve breathing.

Mesothelioma can be difficult to treat as it is often found when it is at an advanced stage. Patients should therefore discuss treatment options with their cancer doctor or lung cancer nurse specialist. Treatment may include chemotherapy, radiotherapy or surgery. Please note that financial compensation from the government may be available if lung damage from exposure to asbestos is proven.

Pancoast Tumour

This rare tumour grows at the top of the lung. Treatment is usually the same as the NSCLC and will depend on where the tumour is, the size of it and whether it has spread to other parts of the body.

Carcinoid Tumour

This is a rare tumour disease of the lung which is generally less aggressive than other types. The tumour develops from a special type of cells in the lung called neuroendocrine cells.

Many carcinoid tumours can be cured by surgery but some are more aggressive and can spread to other parts of the body. In this case treatment with chemotherapy may be required.

Malignant Pleural Effusion

Pleural effusion is an excessive build-up of fluid between your lungs and chest cavity. There are many causes of a pleural effusion, but unfortunately cancer is one of the most common. This is called malignant pleural effusion and occurs when there is a build up of fluid and cancer cells that collect between the chest wall and the lung.

Treatments for Lung Cancer

Non-small-cell lung cancer

If you have non-small-cell lung cancer that’s in only 1 of your lungs and you’re in good general health, you could have surgery to remove the cancerous cells.

This could possibly be followed by a course of chemotherapy to destroy any cancer cells that may have remained in your body.

If the cancer has not spread far but surgery is not possible (for example, because your general health means you have an increased risk of complications), you may be offered radiotherapy to destroy the cancerous cells. In some cases, this may be combined with chemotherapy (known as chemo radiotherapy).

If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy and / or immunotherapy are usually recommended. If the cancer starts to grow again after you have had chemotherapy treatment, another course of treatment may be recommended.

In some cases, if the cancer has a specific mutation, biological or targeted therapy may be recommended instead of chemotherapy, or after chemotherapy. Biological therapies are medicines that control or stop the growth of cancer cells.

Small-cell lung cancer

Small-cell lung cancer is usually treated with chemotherapy, either on its own or in combination with radiotherapy. This can help to prolong life and relieve symptoms.

Surgery isn’t usually used to treat this type of lung cancer. This is because the cancer has often already spread to other areas of the body by the time it’s diagnosed. However, if the cancer is found very early, surgery may be used. In these cases, chemotherapy or radiotherapy may be given after surgery to help reduce the risk of the cancer returning.

Radiotherapy

Radiotherapy is a type of cancer treatment which uses high energy x-rays (radiation) to destroy cancer cells while avoiding normal cells. It is given in small individual doses (fractions) aimed precisely at the tumour over a specified period. This can range from a few days to as many as six and half weeks (up to 33 treatments).

Small cell lung cancer can also be treated with radiotherapy when chemotherapy is not suitable. Radiotherapy can be particularly helpful for treating lung cancer that has spread outside of the lung.

Radiotherapy is usually given from outside the chest (external radiotherapy) by directing x-rays at the area needing treatment. The machines that are most commonly used for this are called linear accelerators.

Radiotherapy doctors (radiotherapists) will know which treatment is best for the patient. The following information in this section is referring to external radiotherapy. Radiotherapy is only given in specialist cancer centres our nearest centre is New cross hospital.

Radiotherapy can be used to treat lung cancer in several ways:

Chemotherapy

Chemotherapy uses powerful cancer-killing medicine to treat cancer. There are several ways that chemotherapy can be used to treat lung cancer. For example, it can be:

  • Given after surgery to prevent the cancer returning.
  • Given to relieve symptoms and slow the spread of cancer when a cure isn’t possible.
  • Given in combination with radiotherapy.

Chemotherapy treatments are usually given in cycles. A cycle involves taking chemotherapy medicine for several days, then having a break for a few weeks to let the therapy work and for your body to recover from the effects of the treatment. The number of cycles you need will depend on the type and grade of lung cancer.

Most people need 4 to 6 cycles of treatment over 3 to 6 months. You will see your doctor both during after these cycles have finished.

If the cancer has not improved after these cycles, your doctor will tell you if you need a different type of chemotherapy.

Alternatively, you may need maintenance chemotherapy to keep the cancer under control.

Chemotherapy for lung cancer involves taking a combination of different medicines. The medicines are usually given through a drip into a vein (intravenously), or into a tube connected to one of the blood vessels in your chest. Some people may be given capsules or tablets to swallow instead.

Before you start chemotherapy, your doctor might prescribe you some vitamins and/or give you a vitamin injection. These help to reduce some the side effects.

Immunotherapy

Immunotherapy, or immune-oncology (IO) as it is sometimes referred, is a type of treatment for non-small cell lung cancer (NSCLC). It works by helping the body’s immune system to recognise and destroy cancer cells.

Cancer cells can sometimes find ways to trick the immune system into thinking they are normal cells and should not be attacked. This allows them to grow and spread. One way this happens is through proteins called checkpoint proteins. PD-L1 and PD-1 are types of checkpoint proteins.

Immunotherapy treatments reactivate the immune system, helping it to recognise and attack the abnormal cancer cells.

At present, there are four immunotherapies licensed and approved for use in the UK to treat people diagnosed with advanced non-small cell lung cancer, either squamous or non-squamous. These are called:

  • Atezolizumab
  • Durvalumab
  • Nivolumab
  • Pembrolizumab.

Immunotherapy is an effective treatment for some people with lung cancer, but not for others. This is because the immune system can only recognise cancer cells that have particular genetic mutations.

Targeted therapies

Targeted therapy drugs for non-small cell lung cancer come as a tablet, which you take by mouth, every day, at home

You can keep taking a targeted therapy for as long as it keeps working for you.

There are various types of targeted therapies used to treat lung cancer. However, targeted therapies only work for some people with non-small cell lung cancer (NSCLC). You will have to have had a biopsy to find out if a targeted therapy may be suitable for you.

The doctors are looking for specific characteristics that are different in some NSCLC cancer cells, and show up in the genes within the cells. These are called mutations, and the test is called a mutation test or molecular analysis.

Patients whose tumours test positive for these mutations, and who have been given matched targeted treatments, gain more benefit than from standard chemotherapy, a treatment they may also get at a later date.

Surgery

Our patients for surgery are referred to New cross hospital.

There are 3 types of lung cancer surgery:

  • Lobectomy – where one or more large parts of the lung (called lobes) are removed. Your doctors will suggest this operation if the cancer is just in 1 section of 1 lung.
  • Pneumonectomy – where the entire lung is removed. This is used when the cancer is located in the middle of the lung or has spread throughout the lung.
  • Wedge resection– where a small piece of the lung is removed. This procedure is only suitable for a small number of patients. It is only used if your doctors think your cancer is small and limited to one area of the lung. This is usually very early-stage non-small-cell lung cancer.

People may be concerned about being able to breathe if some or all of a lung is removed, but it’s possible to breathe normally with 1 lung. However, if you have breathing problems before the operation, it’s likely these symptoms will continue after surgery.

There are three primary methods for lung cancer surgery:

Thoracotomy / Open surgery

An incision is made around the side of your body, below your shoulder blade and between your ribs. The ribs are spread to get access to the lungs.

Video Assisted Thoracoscopy Surgery (VATS) / Keyhole Surgery

Your surgeon will use a video camera and make one to three small cuts to perform the operation. Incisions are generally made under the arm and/or just below the shoulder blade. The ribs are not spread.

Median sternotomy

This is a cut made vertically down the chest over the breastbone, which allows the surgeon to see both the left and right side of the chest. It is occasionally used for some lung operations.

https://www.roycastle.org/about-lung-cancer/treatments/surgery/

Our Specialist nursing teams also run some nurse led clinics they include:

Holistic Needs Assessments (HNA) clinic

If you have received a diagnosis of Lung Cancer you will be offered a HNA with one of our Lung Cancer Specialist Nurses. The HNA is a tool used by healthcare professionals to highlight any needs or concerns that are individual to you. If any are identified we will create a care plan in which we can offer advice and support with these. This could include referring you on to external agencies that may be able to assist. This could include Macmillan citizens advice Bureau.

Best Supportive care (Palliative care) Clinic

If you have been told you are unable to receive of the above treatment types. You may be told that you are for best supportive care. If this does happen you will be contacted by the nursing team at regular intervals to monitor your symptoms and general condition. By doing this the Specialist nurses can ensure your symptoms are being well controlled and any support you may require in community this may mean the nurses refer you to the district nursing team or even the specialist palliative care nurses.

Admission

You may have to be admitted to the hospital during your treatments or due to symptoms of Lung Cancer. If this does occur the Specialist Nursing team will be notified, they may visit you on the ward and if you feel you need to see one of the specialist nurses please ask your ward nurses to contact us.

If at any point you should have any concerns or issues please contact our Lung Cancer Nurse Specialists on: 01384 45611 ext. 2752 Monday-Friday 9-5 this is an answerphone, if there is an emergency do not leave a message call 111 or 999.

Support Contacts:

Macmillan Citizens Advice Bureau Benefits Team – 01384 817721

Action Heart – 01384 456111 ext. 1470

The White House Cancer Support – 01384 231 232

Link to NHS England 111
Link to NHS Blood Donation
Link to Care Quality Commission
Link to NHS Organ Donation
Link to Dudley Group directors' blog
Link to Dudley Group Facebook
Link to Dudley Group Twitter
Link to Autism West Midlands virtual tour
Link to Dudley Group CQC rating
Link to UK Foundation Programme