The Chest Clinic
Lung cancer
Symptoms, diagnosis, staging and treatment options
A suspected lung cancer diagnosis can bring uncertainty and worry. This guide explains the steps from an abnormal scan to an individual treatment plan, and the questions you can ask along the way. An abnormal scan does not necessarily mean cancer.
Arrange an appointment | Investigations and CPEX
1. Symptoms and when to seek help
Get a cough lasting more than three weeks, or a change in a longstanding cough, checked. Other symptoms include unexplained breathlessness, recurrent or persistent chest infections, chest or shoulder pain, loss of appetite, weight loss and persistent fatigue. Hoarseness, difficulty swallowing, finger clubbing or swelling of the face or neck also warrant assessment. These symptoms commonly have other causes, but should not be ignored.
Coughing up blood needs an urgent GP appointment or NHS 111 advice. Call 999 for more than a few spots or streaks of blood, blood with breathing difficulty or chest pain, or severe breathing difficulty, collapse or severe sudden chest pain. Do not wait for a private outpatient appointment in an emergency.
Early lung cancer may cause no symptoms. It can occur in people who have never smoked. A normal chest X-ray does not always exclude lung cancer: persistent or worsening symptoms need review.
NHS: symptoms and seeking help
2. What type of lung cancer is it?
Non-small-cell lung cancer (NSCLC) includes adenocarcinoma and squamous-cell carcinoma. Small-cell lung cancer (SCLC) behaves differently and usually needs a different treatment approach. A pathologist examines a tissue or cell sample to identify the type. Cancer that has spread to the lung from another organ is a secondary cancer, rather than a new primary lung cancer. Mesothelioma arises from the lining around the lung and has its own investigation and treatment pathway.
Cancer Research UK: types and stages | Our mesothelioma guide
3. The diagnostic pathway
Your respiratory consultant reviews symptoms, previous scans, smoking and exposure history, medicines and general health. A contrast-enhanced CT scan provides detail about the lungs, lymph nodes and other structures and helps choose the next test. Small lung nodules are often benign; some need interval scans rather than immediate biopsy.
Tests are chosen to obtain useful information with the least reasonable risk. A bronchoscopy looks inside the airways and can obtain samples. EBUS uses an ultrasound bronchoscope to sample chest lymph nodes; EUS approaches selected nodes from the food pipe. CT-guided needle biopsy may suit an abnormality near the edge of the lung. Pleural fluid sampling, a pleural biopsy or occasionally surgical biopsy may be appropriate. Sometimes a safely accessible abnormality outside the lung provides the most useful sample.
A single procedure may establish both the diagnosis and the stage. Bleeding, infection and, with some biopsies, a collapsed lung are among the risks discussed before consent. A negative or insufficient sample may require further investigation. Your clinician will explain the expected result times and who to contact while waiting.
NICE: diagnosis and staging | NHS: tests and next steps
4. Staging: how far has it spread?
Staging describes the extent of cancer, rather than how unwell you feel. TNM describes the primary tumour (T), involvement of regional lymph nodes (N) and spread to distant sites (M). These findings are grouped into numbered stages. Clinical staging uses scans and samples; pathological staging after surgery can add information and sometimes change the stage.
In broad terms, stage I NSCLC is localised without lymph-node spread. Stage II involves a larger or locally extending tumour and/or certain nearby nodes. Stage III is locally advanced disease involving particular chest structures or lymph-node groups. Stage IV includes distant spread, which may involve another organ, the opposite lung or malignant pleural disease. These are simplified descriptions; the exact TNM combination matters.
Small-cell cancer may also be described as limited-stage or extensive-stage. Limited-stage disease can generally be encompassed within a suitable chest radiotherapy field; extensive-stage disease is more widespread. Your team will explain the classification used in your case.
Macmillan: understanding lung cancer staging
PET-CT can help identify active areas requiring further assessment, especially when treatment with curative intent is being considered. Infection and inflammation can also light up, so PET findings sometimes need a biopsy. Brain MRI or other targeted imaging is arranged according to cancer type, stage and symptoms. Not everyone needs every scan.
5. Biomarkers and personalised treatment
For suitable cancers, particularly non-squamous NSCLC, the laboratory looks for changes that may guide treatment. Examples include EGFR, ALK, ROS1, BRAF, KRAS, MET, RET, NTRK and HER2 alterations. PD-L1 is a separate marker that can help inform immunotherapy decisions. The relevant test panel and available treatments depend on the cancer type and current guidance.
These usually describe changes within the tumour; they do not automatically mean an inherited condition. Tissue is often needed, although a blood-based liquid biopsy can help in selected situations. A negative blood result may still require tissue testing. Molecular results may take longer than the initial diagnosis and can change the best treatment choice. Ask which results are pending before the treatment plan is finalised.
Cancer Research UK: personalised medicine
6. Assessing fitness and discussing options
The multidisciplinary team brings together respiratory medicine, radiology, pathology, thoracic surgery, oncology and specialist nursing. The team considers the cancer alongside your lung and heart health, day-to-day function and preferences.
Lung function tests, including gas transfer, assess breathing reserve. Selected patients have walking tests, cardiac assessment or cardiopulmonary exercise testing (CPEX/CPET) to help judge treatment risk. Fitness is individual: age alone does not decide whether treatment is suitable. Smoking cessation, nutrition, activity and rehabilitation can support preparation and recovery.
Our wider specialist team includes radiologist Dr Harmeet Chana, thoracic surgeon Mr Nizar Asadi and oncologist Dr Andreas Polychronis. Your respiratory consultant coordinates the appropriate specialist input and hospital pathway.
Meet the respiratory consultants | Dr Polychronis
7. Treatment for non-small-cell lung cancer
For suitable early-stage cancers, surgery aims to remove the cancer with nearby lymph-node assessment. The operation may remove a segment, lobe or, less commonly, a whole lung. For people who cannot have surgery or choose not to, stereotactic ablative radiotherapy (SABR) can offer focused treatment with curative intent in selected early cancers.
Some patients benefit from medicines before surgery (neoadjuvant treatment), after surgery (adjuvant treatment), or both. Depending on stage and biomarkers, these may include chemotherapy, immunotherapy or targeted treatment. The aim is to reduce the risk of cancer returning; eligibility is specific to each treatment.
For locally advanced disease, options include combined chemotherapy and radiotherapy, sometimes followed by further systemic treatment. Selected patients may have surgery as part of a combined approach. These decisions need specialist discussion.
NICE: treatment pathways and medicine appraisals
For metastatic NSCLC, treatment usually aims to control the cancer, improve symptoms and prolong life. A matching tumour alteration may allow targeted tablets or other targeted medicines. Immunotherapy, alone or with chemotherapy, is another option for suitable patients. Treatment choice depends on molecular results, PD-L1, cancer type, other illnesses and your priorities. Some people with a small number of metastatic sites may also be considered for local treatment.
8. Treatment for small-cell lung cancer
Small-cell cancer is often treated promptly with chemotherapy. Limited-stage disease may receive chemotherapy with chest radiotherapy; surgery is reserved for uncommon, carefully selected very early cases. Extensive-stage disease may be treated with chemotherapy plus immunotherapy when suitable. Further treatment after initial therapy depends on response, fitness and current guidance.
The team may discuss preventive brain radiotherapy or brain imaging surveillance, depending on the situation. If cancer returns, further drug treatment, radiotherapy, a clinical trial or supportive care may be appropriate. Ask about the likely benefit and burden of each option.
Cancer Research UK: treatment options
9. Side effects, symptom control and follow-up
Side effects differ between treatments. Surgery and radiotherapy can affect breathing and recovery; chemotherapy may cause fatigue, nausea and increased infection risk. Targeted medicines have drug-specific effects. Immunotherapy can cause inflammation in organs such as the lungs, bowel, liver or hormone glands. Your oncology team provides written information and an urgent contact number. Report new or worsening symptoms promptly.
Supportive and palliative care can accompany active cancer treatment from an early stage. It helps with breathlessness, cough, pain, fatigue, appetite, anxiety and family support. Procedures to drain pleural fluid or relieve an airway blockage may help selected patients. Follow-up checks recovery, treatment response and possible recurrence, using a plan tailored to you.
NHS: treatment and supportive care | Macmillan: lung cancer support
10. Screening and useful questions
NHS lung cancer screening is being rolled out in England for eligible people aged 55–74 who currently smoke or have smoked. An initial risk assessment determines whether a low-dose CT is appropriate. Screening is for people without symptoms: do not wait for an invitation if you develop symptoms.
Ask your team: What type and stage is my cancer? Are biomarker results complete? Is treatment intended to cure or control it? What are the expected benefits and side effects? Are there alternatives or clinical trials? Who is my specialist nurse and whom should I call if I become unwell?
NHS: lung cancer screening | Cancer Research UK: clinical trials
Information checked September 2026. This guide supports discussion with your clinical team; your investigation and treatment plan is individual.