Symptoms and the early diagnosis of lung cancer

Lung cancer is the leading cause of cancer death in the western world, resulting in nearly 30 000 deaths in England and Wales in 2002.¹ Advances in the management of breast, cervical, and prostate cancer have led to improved survival rates, whereas mortality from lung cancer has remained largely unchanged.² Even the best reported 5 year survival rates for lung cancer are only 10–15%^3,4 and, in England, in patients diagnosed between 1993 and 1995 the survival rate was only 5.5% at 5 years and 22% at 1 year.⁵

This high mortality is very largely a consequence of patients presenting late when the cancer is already locally advanced or has disseminated. Around 80% of patients with lung cancer have stage III or IV disease at presentation, therefore excluding them from potentially curative surgical resection.⁶ Detection of the tumour at an earlier stage leads to an improved prognosis, patients presenting with stage IA non-small cell lung cancer and undergoing surgical resection having a 5 year survival of around 60%.⁷

Patients can (and usually do) live with lung cancer for many years before it becomes apparent. Early lung cancer is largely asymptomatic and internalisation of tumours means patients are not alerted by obvious physical changes. It takes around 8 years for a squamous cell carcinoma, for example, to reach a size of 30 mm when it is most commonly diagnosed so, by the time symptoms arise, the risk of metastasis is considerable.^8,9 Once symptoms appear they are often ignored by patients, delaying the diagnosis and treatment even further. The reasons for patient delay in diagnosis are poorly understood.

Lung cancer can present with a wide range of symptoms, the most common being cough, haemoptysis, chest …