There are two main types of lung cancer:

• Non small cell lung cancer (NSCLC), which accounts for up to 85% of all lung cancers
• Small cell lung cancer (SCLC)

Once a lung cancer is confirmed, the next step is to determine the stage (extent of the cancer in the body). This is done with CT scans, PET scans and brain scans.

SCLC accounts for approx. 15% of all diagnoses and has two main stages

• Limited stage (LS-SCLC) with the cancer limited to one lung and possibly some lymph nodes
• Extensive stage (ES-SCLC) where the cancer has spread to the other lung, the fluid around the lungs, and potentially to other organs

NSCLC may be further classified as adenocarcinoma, squamous cell carcinoma, or large undifferentiated carcinoma depending on the cell type where the cancer is identified.

Following diagnostic tests, NSCLC will be staged to assist in determination of best treatment options. These can be broadly classified into:

• Stage I and II (early)
• Stage III (locally advanced)
• Stage IV (advanced)

In recent years, adenocarcinoma (sometimes referred to as non-squamous NSCLC) has been characterised on the basis of mutations or alterations in genes in the tumour (“oncogenes”), determined by specific testing. When these abnormalities are thought to be driving the cancer they may be targeted by drugs to block their action and control the cancer, as opposed to “passenger” mutations, where more generic therapy is used. A small gene panel to test for common “driver” mutations is reimbursed by the Australian government and many targeted therapies are also reimbursed by the government as part of the Pharmaceutical Benefits Scheme (PBS)

Treatment for lung cancer will depend on the type of lung cancer you have, the stage of the cancer, how well you can breathe (your lung function) and your general health. Ideally your case will be reviewed and treatment options determined in a multidisciplinary team meeting (MDT) comprising the various specialities involved in lung cancer care. Generally, treatments comprise the following, although not all options will be offered to all patients based on the lung cancer diagnosis, and some options may be offered in combination.

• Surgery including removal of a lobe (lobectomy), wedge resection (part of the lobe is removed) and pneumonectomy (a whole lung is removed). Video-assisted thoracoscopic surgery (VATS) is increasingly being offered rather than open lobectomy.
• Radiotherapy or radiation therapy is the use of targeted radiation to kill or damage cancer cells. Radiotherapy may also be given as part of palliative care to reduce the symptoms of lung cancer and improve quality of life. Stereotactic ablative body radiation (SABR) or stereotactic body radiation therapy (SBRT) is a type of radiation therapy designed to give a very precise high dose of radiation therapy to small NSCLCs.
• Chemotherapy is the use of drugs to destroy cancer cells. It usually works by blocking the cancer cells from growing, dividing, and making more cells. Because cancer cells usually grow and divide faster than normal cells, chemotherapy has more of an effect on cancer cells. In lung cancer chemotherapy may be given:
  • before surgery to try to shrink the cancer and make it easier to remove the cancer (neoadjuvant chemotherapy);
  • before or in combination with radiation therapy to make radiation therapy more effective (chemoradiation);
  • after surgery to reduce the risk of the cancer returning (adjuvant chemotherapy), or;
  • when cancer is advanced – to reduce symptoms and improve quality of life (palliative chemotherapy).
• Immunotherapy, which refers mainly to modern immune checkpoint inhibitors, restores and recruits the patient’s own immune system to fight the lung cancer by releasing the ‘brakes’ that the tumour microenvironment can place on the immune response and restoring visibility of the tumour cell to attack by cells of the immune system.
• Targeted therapies (most often referring to oral tyrosine kinase inhibitors) are used in non-squamous NSCLC to target ‘driver’ mutations that are responsible for driving tumour growth. Patients on these treatments can live for many years, with milder and very manageable side effects.
• Resistance to therapy may still emerge but most targeted therapies have developed newer generation drugs that may overcome drug resistance.

Smoking cessation (‘quitting’), where relevant, is an integral component of any lung cancer treatment plan. People with lung cancer who quit smoking tolerate and respond to treatment better, and may live longer. Best support for smoking cessation includes pharmacotherapy (e.g nicotine patches) and behavioural support (eg QUITLine 13 78 48)

NSCLC and SCLC are treated in different ways.

Generally, early stage SCLC is treated with chemotherapy and radiotherapy, whereas in extensive SCLC, palliative chemotherapy is the mainstay, with radiation therapy offered to control specific areas and to relieve symptoms. Immunotherapy has recently been included in treatment of extensive SCLC to improve disease control when added to standard upfront chemotherapy.

Early-stage NSCLC is considered curable and treatment options include surgery, and possibly chemotherapy after surgery to reduce recurrence. In patients that are not able to undergo surgery, radiotherapy has been shown to be an effective alternative.

Locally advanced NSCLC is usually treated with the intention to eliminate the cancer (referred to as ‘curative intent’), either with the combination of radiotherapy and chemotherapy, followed by immunotherapy, or chemotherapy followed by surgery, depending on the practice at the treating centre.

Advanced NSCLC is generally considered incurable, but treatment is used to control symptoms and quality of life (‘palliative treatment’) and to prolong life. The optimal treatment for a given patient is usually ‘personalised medicine’ taking into consideration the patient’s general health condition and fitness, the impact of the tumour on their symptoms and the biologic characteristics of the tumour, identified from the biopsy. Treatment options include chemotherapy alone or combined with immunotherapy, immunotherapy alone, radiotherapy, or targeted therapy for patients with ‘driver’ mutations in their tumour. When treatment is tailored to the molecular status of the tumour, it may also be called ‘precision medicine’.

In all diagnoses of lung cancer, clinical trials may offer expanded treatment options. Read more about clinical trials.

Read more information on common lung cancer treatments.

For an overview of what to expect during all stages of lung cancer care, visit Optimal Care Pathway for People with Lung Cancer Second Edition or the Cancer Council website.

For patient support services visit Lung Foundation Australia or Rare Cancers Australia.

The observed 5 year survival for lung cancer (the rate of survival at 5 years compared to all those diagnosed with lung cancer) in 2013-2017 was 17.8%, slightly higher for females, and slightly lower for males. In 2008-2012, the observed 5 year survival was just 13.2%, with the higher figures in 2013-2017 presumably reflecting the discovery of targeted treatments and immunotherapy (1).

Outcomes are better when lung cancer is diagnosed at an early stage, but more than 40% of lung cancers are diagnosed at Stage IV when the cancer has already metastasised (spread). Furthermore, this percentage of Stage IV lung cancer diagnoses is likely to be much higher, as almost 30% of lung cancer incidence in 2011 was unstaged (1). 

In contrast approx. 12% of lung cancers are diagnosed at Stage I, where median 5 year survival is 68% (1).

Following the delivery of a comprehensive lung cancer screening enquiry report by Cancer Australia in 2020, and various scoping reviews, the Australian Government has agreed to fund lung cancer screening in Australia. More information on lung cancer screening can be found on the Cancer Australia website.