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DO NOT PUBLISH - Lung Cancer Test
What is Lung cancer?
Lung cancer affects the lungs. In healthy people, the lungs are responsible for the exchange of oxygen and carbon dioxide, which is essential for the body.
In lung cancer, abnormal cells in the lungs grow uncontrolled and lead to cancer development. Because lung cancer usually doesn't present symptoms until it has spread, detecting and treating it can be difficult. Lung cancer damages the lung tissues and causes the formation of tumours, which reduce the lung capacity to carry out normal breathing.
In people with lung cancer, the tumours can grow within the lungs or in the lining around the lungs, which can affect the respiratory system and disrupt the normal functioning of the lungs.
This is why people with lung cancer experience symptoms of shortness of breath, coughing, and chest pain. [1]
What are the symptoms of lung cancer?
Not everyone with these symptoms will have lung cancer. They may be caused by other, more common conditions. But if you have any symptoms, it is essential to get them checked by your doctor.
The most common symptoms of lung cancer include the following:[1]
- A new cough that is persistent or worsens, or a change in an existing chronic cough
- Pain in the chest, back, or shoulders that worsens during coughing, laughing, or deep breathing
- Shortness of breath that comes on suddenly and occurs during everyday activities
- Lung infections such as bronchitis or pneumonia that won't go away
- Unexplained or unintended weight loss
- Feeling that you are tired or weak
- Hoarseness or wheezing
- Coughing up blood
- Loss of appetite.
What are the different types of lung cancer?
There is more than one type of lung cancer. The type you have can be identified by looking at a sample of cells from the tumour under a microscope. The type of cancer will determine which treatment options are available to you. The different types of lung cancer can be divided into 2 main groups.
Small cell lung cancer (or SCLC) is a very fast-growing type of lung cancer and is typically caused by smoking. Around 1 out of every 10 lung cancers diagnosed are SCLC.[2]
Non-small cell lung cancer (or NSCLC) is the most common type of lung cancer. Around 9 out of every 10 lung cancers are diagnosed as NSCLC.[2] There are three main types of NSCLC, with differences seen by looking at a sample of cells under a microscope:[2]
- Adenocarcinoma starts in the gland cells that line the airways and produce mucus.
- Squamous-cell carcinoma develops in the flat cells that cover the airway surface.
- Large-cell carcinoma cells are large and round with big nuclei (the part of the cell that contains all of its genetic information) and it is not clear what kind of cells these start in.
Learn more about Lung Cancer
What causes lung cancer? Who is at risk of lung cancer?
Lung cancer is caused by an abnormal and uncontrolled growth of cells in the lungs. Factors that are known to increase the chance of a person developing a disease are called ‘risk factors’. Having a risk factor does not mean that you will definitely get the disease, but the more risk factors you have can make it more likely. Some risk factors for lung cancer are:[3]
- Cigarette smoking
- Breathing second-hand smoke
- Being exposed to substances such as asbestos or radon
- Infections such as tuberculosis or HIV
- Having a family history of lung cancer
- Previous radiation therapy to the lungs
- Air pollution.
How is lung cancer diagnosed?
If your doctor thinks you might have lung cancer, they will ask questions about symptoms, examine a certain part of the lungs, refer you to a pulmonologist, and run certain tests. These can include imaging tests such as X-rays, CT scans, biopsies or PET scans.
- X-ray: It is a quick and painless medical imaging tool that produces images of the structures inside your body using radiation technology.
- CT scan: A computerised tomography (CT) is an imaging test that uses X-rays and a computer to create detailed images of the inside of the body.
- PET scan: A positron emission tomography (PET) scan is a functional imaging method that uses safe chemical traces to help visualise and measure changes in the body.
- Lung biopsy: A lung biopsy is a medical procedure that involves removing a small sample of lung tissue for laboratory testing.[4]
What are the stages of lung cancer?
The stages of lung cancer describe where the cancer is and if it has spread into nearby tissues and/or around the body. This can help doctors decide how best to treat the disease and the likelihood of reaching a disease-free period (‘remission’). The staging system that is commonly used for lung cancer is:
- Stage 1: the cancer is small and contained in the lungs and has not spread
- Stage 2: the cancer is in the lungs, and the tumour is larger than in stage 1 and/or has spread into lymph nodes close to the tumour
- Stage 3: the cancer is larger; it may have spread into surrounding tissues such as the liver, brain, bones or adrenal glands and/or spread into the lymph nodes.
- Stage 4: the cancer has spread from where it started to brain, bones, liver, or widely around your body.[5]
What treatment options are available for lung cancer?
Your doctor may test a sample of cancer cells taken from the tumour (a biopsy). Different types of lung cancer can be treated using different types of drugs and approaches, so the more your healthcare team knows about your type of lung cancer, the easier it is for them to select the right treatment for you.
If you have been diagnosed with lung cancer, several treatments can help treat the condition and support recovery.
Treatment of lung cancer depends on the type and stage of the disease. Other things to consider when deciding on treatment are the age, overall health, medical history of the patient, type, stage and whether the cancer cells produce high amounts of certain proteins.[6]
The main treatments for lung cancer are listed below, the choice of which depends on how advanced your lung cancer is.[6]
- Surgery: removal of cancer tissue; this may be followed by chemotherapy to destroy any remaining cancer cells.
- Adjuvant/neoadjuvant therapy: neoadjuvant therapy is given before surgery to shrink a tumour. Adjuvant treatment is often given after surgery to kill any remaining cancer cells and lower the risk that the cancer will come back. Adjuvant/neoadjuvant treatment may include chemotherapy, radiotherapy or biological therapy.
- Chemotherapy: chemotherapy uses drugs that stop cancer growing, either by killing the cancer cells or by stopping them from dividing. In some cases, chemotherapy is combined with radiotherapy (known as chemoradiotherapy).
- Radiotherapy: the body is exposed to radiation to damage cancer cells and ultimately kill them. This may be used as the only treatment for your tumour, or before/after surgery or chemotherapy to remove any remaining cancer cells.
- Anti-angiogenesis therapy: angiogenesis means the growth of blood vessels. Tumour angiogenesis is the growth of new blood vessels that a cancer needs in order to survive. Some cancer cells make a protein called vascular endothelial growth factor (or VEGF). The VEGF protein attaches to cells in blood vessels in the tumour. This triggers the blood vessels to grow so that the cancer can grow. Anti-angiogenesis therapy aims to stop tumours from growing new blood vessels. This might slow the growth of a cancer or sometimes shrink the tumour.
- Targeted therapy: targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells with less harm to normal cells. Examples of types of lung cancer that can be treated with a targeted therapy are:
- EGFR-positive NSCLC – during diagnosis, your doctor may order a test to find out whether your lung cancer is positive for an EGFR gene mutation (change); this is also known as EGFR+ NSCLC. Around 1 out of every 7 patients with NSCLC will have EGFR-positive NSCLC. [7] EGFR (or epidermal growth factor receptor) is a protein that is found on the surface of cells, including in the lungs. EGFR helps the cells grow and divide normally. When the EGFR gene is mutated it is constantly activated and sends increased survival signals meaning that cells can grow too quickly. [8]
- ALK-positive NSCLC – your doctor may also order a test to find out whether your lung cancer is ALK-positive or ALK+. [9] Around 1 out of every 20 patients with NSCLC will have ALK-positive NSCLC. [9,10] ALK (or anaplastic lymphoma kinase) is a protein that is not normally present in healthy lung cells. In ALK+ NSCLC, the ALK gene is mutated (changed) and these changes result in the production of the ALK protein, which increases the growth of cancer cells. Knowing that a tumour is ALK-positive helps doctors plan cancer treatment by using medicines that specifically target ALK. [9,10]
- It is rare for tumours to be both EGFR and ALK positive. [11]
- Cancer immunotherapy: this helps the body’s own immune system to fight cancer and can be used as an alternative to chemotherapy. It is also used in combination with, or after, chemotherapy. While immune cells are able to find and kill abnormal cells, cancer cells are able to protect themselves from immune attacks. Cancer immunotherapy aims to beat this protection so that immune cells can find and destroy cancer cells.[12] Some types of cancer immunotherapy used in NSCLC work by targeting proteins called PD-L1 and PD-1.[13, 14] ] PD-L1 (programmed death ligand 1) is a protein that interferes with the body’s immune responses and can stop the immune system from fighting cancer. Cancer immunotherapies can be used to block PD-L1 activity, allowing the body’s immune system to destroy the cancer cells. [12, 14]
Your doctor will be able to advise what treatment options are available to you, based on your individual type of lung cancer. It is important to remember that some of these lung cancer drugs only work on tumours that have a particular genetic mutation (EGFR+ or ALK+ NSCLC), so some of the therapies that you hear about might not be suitable for you.
What is the outlook for a person with lung cancer?
The outlook for a person with lung cancer depends on various factors, including the type and stage of cancer, the overall health of the patient and the treatment options available. Unfortunately, lung cancer is often not diagnosed until it has reached an advanced stage, which can make treatment difficult.
Clinical research is looking into new treatments for people living with lung cancer who do not respond or who stop responding to chemotherapy or radiotherapy or biological therapy.
Clinical trials (which can also be called ‘research studies’) are designed to look at how safe these experimental drugs or procedures (such as a new type of surgery) are and how well they work and may compare them with treatments that are already available. If you would like to know more about Roche-sponsored clinical trials or are interested in taking part in a clinical trial, speak to your doctor or visit the Roche ForPatients clinical trials page link.
General Nutrition
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Using Nutrition to better manage side effects
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Benefits of doing workouts
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Managing emotions after diagnosis
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Retaining Fertility
Cancer and male fertility
If you have been diagnosed with cancer, your doctor will suggest a cancer treatment that is tailored to your situation. Your doctor will also explain what the treatment involves and tell you about the possible side effects. A possible risk to your fertility may be one of the side effects mentioned.
Please discuss this with anyone who may be affected by this risk, such as your partner and family, as soon as possible. Fertility problems after treatment will not definitely occur. However, it is best to keep this risk in mind from the start and take the necessary precautions.
Cancer and male fertility treatments
A decrease in sperm count, or even a complete absence of sperm, may occur in men being treated for cancer.
We talk about subfertility when there are difficulties having a child and sterility or infertility when it is impossible to conceive.
Infertility may be related to treatment side effects or to surgery on reproductive organs. It may also be linked to sexual problems but has nothing to do with a lack of sexual desire or inability to get an erection.
Infertility can be temporary or permanent and depends on several factors such as:
- Age at the time of treatment
- Fertility status before starting treatment
- The area being treated
- The type of procedure
- The doses administered
- The time elapsed since the end of treatment
Consequences of treatment in possible pregnancies
It is not recommended to conceive a child while undergoing cancer treatment or in the weeks or months followingtreatment. If this happens, the consequences have to be assessed by the medical team.
In order to avoid this situation, contraception (condoms, contraceptive pill, IUD etc.) is offered. It is recommendedthat you use contraception when you start treatment and that you continue to use it throughout your treatment in order to avoid any pregnancy where the mother or child may be at risk. For chemotherapy, it may be advisable to use condoms during sexual intercourse as there's a possibility that the drugs may be excreted into the semen.
At the end of cancer treatment, it is recommended that you wait for at least one year before thinking about getting pregnant and to monitor your sperm. After this time, the sperm production quality can be assessed.
Male fertility in cancer treatments
How to preserve male fertility before cancer treatment
Some of the side effects that cancer treatments may cause include those related to male fertility.
Before introducing any treatments, the medical team must evaluate the risk-benefit balance by assessing the possible toxic effects that the treatments could have on the male reproductive function.
There is a regulatory framework that specifies health safety rules and consent. The latter must comply with the law on patient rights, as well as with the guidelines established by the decree on good practice.
In addition to the information provided by the medical team about treatments and how they would affect your reproductive function, it is advised that you contact a reproductive and sexual health clinic. Here you will also receive information on fertility preservation purposes and methods.
There are several factors to consider when choosing the most appropriate fertility preservation method:
- Your age
- The type of cancer
- Testicular toxicity from treatments that you have already received or will receive in the future
- If you need to start treatment urgently
Fertility preservation methods for men before cancer treatment
Your medical team may recommend that you collect a semen or sperm sample before you start any chemotherapy or radiotherapy. If possible, it is recommended that you collect several semen samples so that you have a sufficient amount for storage.
Here are some methods for preserving male fertility:
- Obtaining sperm through masturbation (the most common method)
- Collecting sperm from the urine
- Taking a testicular tissue sample (anaesthesia required)
In all of these cases, sperm is collected either via ejaculation or testicular sample. The sperm is frozen so it can be used at a later date in assisted reproduction techniques. As long as sperm parameters are not altered, sperm can be stored for a long time without losing its fertilising capacity.
Once a sample has been collected, a decision must be made about which assisted reproduction technique will be used (insemination or in vitro fertilisation). This decision is linked to various factors such as the number of available samples, the origin of sperm and the number of motile sperm after thawing.
The chances of getting pregnant depend on the quality of the sperm after thawing, the woman's fertility and the assisted reproduction technique chosen. In the event of a positive assessment and compliance with other non-medical criteria, the couple may decide to use assisted reproduction techniques.
In any case, the medical team will be available to answer any questions or concerns that you may have. Psychology or sexology specialists will also be available to help guide you. Please do not hesitate to contact them during this process.
Cancer and female fertility
Some of the side effects that cancer treatments may cause include those related to fertility.
If you have already undergone one of these treatments, your doctor probably mentioned this before administering chemotherapy or another treatment. Cancer and infertility is a topic that cancer patients of reproductive age should be aware of when making decisions.
That's why it is always important to discuss cancer, sterility and assisted reproduction techniques with your medical team and your family.
Cancer and female fertility treatments
We talk about hypofertility when there are difficulties having a child and sterility or infertility when it is impossible to conceive.
A decrease in egg count, or even a complete absence of eggs, causing onset of menopause, may occur in women being treated for cancer.
In addition to being related to the side effects of cancer treatments, infertility may also be associated with sexual disorders, but this has nothing to do with a lack of desire or inability to have sex.
Infertility can be temporary or permanent and depends on several factors such as:
- Age at the time of treatment
- Fertility status before starting treatment
- The area being treated
- The type of procedure
- The doses administered
- The time elapsed since the end of treatment
Consequences of treatment in possible pregnancies
In women who have been treated for cancer, doctors advise considering postponing pregnancy plans. This is related to the disease prognosis and the associated risk period for relapse.
To avoid a pregnancy where the mother or child may be at risk, the medical team may recommend preventive contraception measures such as condoms, the pill or an IUD. This may happen at the start of or during cancer treatment, depending on the type of therapy administered and other factors.
In any case, we recommend that you consult with your medical team to make the decision that is most appropriate for your situation.
Female fertility in cancer treatments
How to preserve female fertility before cancer treatment
Some of the side effects that cancer treatments may cause include those related to female fertility.
The medical team must evaluate the risk-benefit balance of these therapies by assessing the possible toxic risks that the treatments could have on the female reproductive function.
Each situation must be carefully assessed by that team, and you can demand the appropriate explanations. There is a regulatory framework that specifies health safety rules and consent. The latter must comply with the law on patient rights, as well as with the guidelines established by the decree on good practice.
In addition to the information provided by the medical team about treatments and how they would affect your reproductive function, it is advised that you contact a reproductive and sexual health clinic. Here you will also receive information on fertility preservation purposes and methods.
There are several factors to consider when choosing the most appropriate fertility preservation method:
- Your age
- The type of cancer
- Ovarian toxicity from treatments that you have already received or will receive in the future
- If you need to start treatment urgently
Fertility preservation methods for women before cancer treatment
Here are some methods for preserving female fertility:
- Hormone stimulation or superovulation
This involves administering hormones via subcutaneous injections in order to stimulate the ovaries to produce the maximum number of oocytes and freeze them, obtaining several eggs in the same cycle.
After patient recovery, in vitro fertilisation is used.
For some breast cancers, this technique is not used because hormonal changes would exacerbate the disease.
- In vitro fertilisation
This involves the extraction via puncture of oocytes obtained after hormone stimulation. It can be performed under local or general anaesthesia.
This technique is limited to certain types of cancer and is only possible if you have at least one month to complete it.
There are two types of in vitro fertilisation:
- Embryo freezing
This involves fertilising the eggs with the partner's semen. The obtained embryos are then frozen.
The aim after recovery is to implant the embryos in the woman's uterus. In this situation, a consultation with a psychologist is necessary to assess the couple's stability.
- Fertility preservation using oocyte storage is aimed at women of fertile age, with or without a partner, who do not want or are unable to preserve their fertility.
If they wish to get pregnant after recovery, the oocytes are thawed and fertilised in vitro with the partner's sperm. The resulting embryos are then reimplanted into the woman's uterus.
- Ovarian tissue cryopreservation
This technique is used for women whose treatment will involve a very high probability of loss of fertility.
Such treatments include chemotherapy with high doses of ovarian toxicity, treatment prior to bone marrow transplantation or high-dose abdominal radiotherapy.
The age limit is around 35 years.
- Ovarian transposition, in the case of radiotherapy, is a surgery that moves the ovaries out of the field of radiation.
In any case, the medical team will be available to answer any questions or concerns that you may have. Psychology or sexology specialists will also be available to help guide you. Please do not hesitate to contact them during this process.
Managing Sexuality
Cancer and male sexuality
If you are a cancer patient, you may notice changes in your sexual life that could affect your quality of life and that of your partner. These changes may make you feel uncomfortable, guilty or embarrassed when talking about them with your partner or a healthcare professional.
Although it's not easy to take that first step to deal with this issue, it is necessary and advisable to do so in order to find a solution from the start.
How do cancer treatments affect male sexuality?
It is normal for you to be unsure about how cancer treatments will affect you. That is why it is necessary to express your emotions and ask your doctor any questions that you might have about sexuality. This way, you will feel more informed and at ease, which will improve your quality of life and that of your partner.
Every cancer patient and situation is different. For this reason, several factors must be taken into account when diagnosing sexual problems and subsequently treating them, such as:
- The location of the cancer
- Whether it directly affects a sexual organ
- The planned treatment
- The cancer's current stage
- The assessment of the patient's sexual life prior to diagnosis
The effects during and after treatment may be functional and/or psychological. Each patient and situation may also be very different and require a specific diagnosis and care.
Here are some general considerations for you to consider:
- Talking with other patients may help, but remember that each person requires special care and attention.
- Communication with your partner is very important. If you find it difficult to talk about, try writing to them instead. The aim is to communicate how you feel and what concerns you have about your sexuality. Encourage the other person to do the same!
- The power of communication and mutual understanding can be felt through kisses, caresses etc.… Enjoy a moment of tenderness with your partner.
- Unleash your imagination with your partner. There is more to sex than penetration, and there are forms of stimulation that can bring sexual satisfaction to both you and your partner.
- Talk to healthcare professionals and only use the treatments that they prescribe. Don't self-diagnose and treat yourself.
Cancer and female sexuality
Cancer treatments may affect the sex life of women undergoing these therapies and their partners. That is why it is essential to identify these sexual difficulties in order to be able to tackle them in the right way and to consult a specialist.
It is important that you are honest about this subject and that you communicate properly with your healthcare professional and your partner.
It's important to learn to distinguish between sexual difficulties and emotional difficulties. It is common for women to worry that they are no longer desirable and that their partner may leave them. Being able to talk about this with your partner—and sometimes with the help of an expert—will allow you to regain self-confidence and to recreate an environment that promotes intimacy and sexual intercourse.
What physical sexual difficulties may women experience during or after cancer treatment?
The difficulties that women may experience as a result of cancer treatments include:
- Vaginal dryness and mucosal irritation
Vaginal dryness can also be caused by decreased sexual desire.
Using a lubricant prescribed by your doctor can easily resolve this issue, but remember that foreplay should be of an appropriate duration and quality.
- Loss of vaginal elasticity
While you should allow an appropriate amount of healing time, you should also resume regular sex gradually.
You may need to adopt new, more comfortable positions or even use a vaginal dilator as a preventative measure.
- Vaginal infections
These are due to hormonal changes, chemotherapy or radiotherapy, which cause an imbalance in the vaginal flora.
Advice on hygiene, wearing cotton knickers and using appropriate medical treatment for you and your partner may solve this problem.
- Urinary disorders and incontinence
These can cause discomfort or inhibition during sex. They are usually temporary.
These issues may be linked to a general weakening of the area or decreased perineal muscle tone, or may occur after treatment affecting the urinary tract.
Remember that it is important to empty your bladder before sex. Your doctor may prescribe pelvic floor exercises for help with bladder control, and these also improve sensation during sex. You may also be prescribed a specific treatment, depending on the type of incontinence.
- Fatigue
This is related to the disease, the treatment and a condition called anaemia.
It can often remain after treatment, despite long nights of sleep.
Make sure that you take the time to look after yourself by adapting all activities—including your sexual activity—to your new routine.
You should also keep in mind that:
- Every woman is different and unique and requires special care in order to re-establish her sex life after cancer. Don't compare yourself to anyone else!
- Communication with your partner is very important. If you find it difficult to talk about, try writing to them instead. The aim is to communicate how you feel and what concerns you have about your sexuality. Encourage the other person to do the same!
- Maintain dialogue and communication with your partner. Say what you need, want and like, as well as what makes you feel uncomfortable and what you don't like.
- Let your imagination run wild and experience different things with your partner. You can achieve sexual satisfaction without penetration.
- If you are concerned about wanting to get pregnant or preserving your fertility, discuss this with your doctor before treatment. Your doctor will be able to help answer these questions.
- Follow recommendations from expert healthcare professionals.
References and further resources
1. Mary E Cooley. Symptoms in adults with lung cancer: a systematic research review, journal of pain and symptom management. J Pain Symptom Manage. 2000; 19 (2): 137–153. doi: 10.1016/s0885-3924(99)00150-5.
2. Cancer Research UK. Types of lung cancer. Accessed 30 December 2022. Available from: Link
3. Thandra CK, Barsouk A, Saginala K et al. Epidemiology of lung cancer. Contemp Oncol (Pozn). 2021; 25 (1): 45–52. doi:10.5114/wo.2021.103829.
4. NHS. Lung cancer - Diagnosis. Accessed 01 November 2022. Available from: Link
5. Naruke T, Tsuchiya R, Kondo H et al. Implications of staging in lung cancer. Chest. 1997; 112 (4): 242S–248S. Available from: doi: 10.1378/chest.112.4_supplement.242s.
6. NHS. Lung cancer - Treatment. Accessed 01 November 2022. Available from: Link
7. Zhang YL, Yuan JQ, Wang KF et al. The prevalence of EGFR mutation in patients with non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2016; 7 (48): 78985-78993. doi: 10.18632/oncotarget.12587.
8. Russo A, Franchina T, Ricciardi GR et al. A decade of EGFR inhibition in EGFR-mutated non small cell lung cancer (NSCLC): Old successes and future perspectives. Oncotarget. 2015; 6 (29): 26814-26825. doi: 10.18632/oncotarget.4254.
9. Shackelford RE, Vora M, Mayhall K et al. ALK-rearrangements and testing methods in non-small cell lung cancer: a review. Genes Cancer. 2014; 5 (1-2): 1–14. doi: 10.18632/genesandcancer.3.
10. Zhao Z, Verma V, Zhang M. Anaplastic lymphoma kinase: role in cancer and therapy perspective. Cancer Biol Ther. 2015; 16 (12): 1691–1701. doi: 10.1080/15384047.2015.1095407.
11. Sahnane N, Frattini M, Bernasconi B et al. EGFR and KRAS mutations in ALK-positive lung adenocarcinomas: biological and clinical effect. Clin Lung Cancer. 2016; 17 (1): 56–61. doi: 10.1016/j.cllc.2015.08.001.
12. Cancer Research UK. What is immunotherapy? Accessed 30 December 2022. Available from: Link
13. Teixidó C, Vilariño N, Reyes R et al. PD-L1 expression testing in non-small cell lung cancer. Ther Adv Med Oncol. 2018; 10: 1758835918763493. doi: 10.1177/1758835918763493.
14. Phillips T, Simmons P, Inzunza HD, et al. Development of an automated PD-L1 immunohistochemistry (IHC) assay for non-small cell lung cancer. Appl Immunohistochem Mol Morphol. 2015;23(8):541-549. doi:10.1097/PAI.0000000000000256
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