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Lung Cancer

Lung cancer is one of the most common forms of cancer and has the highest mortality rate worldwide. In Italy, in 2024, approximately 44,831 new diagnoses were estimated, placing this neoplasm second among men and third among women in terms of incidence (source: The numbers of cancer in Italy 2024, AIOM-AIRTUM).

Despite advancements in prevention, early diagnosis, and therapies, lung cancer remains one of the major challenges for healthcare. Catching it in its early stages and gaining access to targeted treatments can make a significant difference in terms of survival and quality of life.

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What Is Lung Cancer?

Lung cancer develops when the cells of the lung tissue begin to grow abnormally and uncontrollably. Depending on the type of cell involved, the cancer may present different clinical features and prognoses.

The lungs, located in the thoracic cavity, perform a vital function: they enable the exchange of oxygen and carbon dioxide between the blood and the air. When you breathe, the air enters the trachea, which divides into two main bronchi (one for each lung). The bronchi branch into smaller tubes, the bronchioles, which carry air to the alveoli, tiny sacs where gas exchange takes place.

Lung cancer most frequently originates in the cells lining the bronchi, but it can develop in various areas of the respiratory system.

Types of lung cancer

There are various types of lung cancer, which differ in cellular origin, growth rate, and response to treatments:

  • Small Cell Lung Cancer (SCLC): An aggressive and fast-growing cancer, often located in the central airways. It is strongly associated with tobacco use and accounts for approximately 15% of cases. It is often diagnosed in an advanced stage.
  • Non-Small Cell Lung Cancer (NSCLC): Represents about 85% of all lung cancers. Includes several subtypes:
    • Adenocarcinoma.
    • Squamous cell carcinoma.
    • Large cell carcinoma.
  • Pleural mesothelioma: A rare and aggressive cancer that develops in the mesothelium, the tissue lining the lungs (pleura) and other organs. It is often linked to exposure to asbestos fibers.

How can you lower your risk of lung cancer?

Not all lung cancers are preventable, but you can significantly reduce the risk by adopting protective behaviors. The most important is to quit smoking, even if you've been smoking for many years.

Other helpful tips for prevention include:

  • Undergoing regular check-ups if you belong to at-risk groups (smokers, former smokers, people exposed to toxic substances).
  • Avoiding secondhand smoke.
  • Limiting exposure to carcinogenic substances (e.g. asbestos, radon, industrial pollutants).
  • Engaging in regular physical activity.
  • Following a balanced diet rich in antioxidants.

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What Are the Symptoms of Lung Cancer?

In the early stages, lung cancer is often asymptomatic. In many cases, the disease is discovered accidentally during radiological exams performed for other reasons.

When symptoms do appear, they may be mild or nonspecific, but they tend to worsen as the disease progresses. The most common ones are related to respiratory function, such as shortness of breath (dyspnea) and persistent or worsening cough.

Other warning signs not to underestimate include:

  • Coughing up blood (hemoptysis).
  • Hoarseness or altered voice.
  • Persistent chest pain.
  • Chronic fatigue.
  • Loss of appetite and weight loss.
  • Recurring respiratory infections (bronchitis or pneumonia).

Lung cancer risk factors

Cigarette smoking is the main risk factor for lung cancer: it is responsible for about 80% of cases, including both active and passive smokers.

Other risk factors include:

  • Exposure to radiation, such as cancer treatments or frequent diagnostic procedures.
  • Exposure to asbestos and other toxic substances in the workplace (e.g. arsenic, beryllium, chromium, nickel).
  • Exposure to radon, a naturally occurring radioactive gas that can accumulate in enclosed spaces, basements, or mines.
  • Advanced age: the risk increases after age 65.
  • Family history: having close relatives diagnosed with lung cancer.
  • Previous diagnosis of lung cancer.

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How Do You Diagnose Lung Cancer?

The diagnosis of lung cancer is based on an initial clinical evaluation, which includes:

  • Analysis of present symptoms
  • Personal and family medical history

If a neoplasm is suspected, the specialist may prescribe imaging tests and specific procedures to confirm the diagnosis and determine the type and stage of the cancer. The main ones are:

  • Lung biopsy: A needle is inserted into the lung (guided by CT or ultrasound) to collect a sample for microscopic analysis.
  • Bronchoscopy: A thin tube (bronchoscope) is inserted through the nose or mouth to visualize the airways. The device can be equipped with ultrasound (EBUS) to locate nodules and collect samples (bronchial biopsy).

Imaging tests:

  • Chest X-ray.
  • PET (Positron Emission Tomography).
  • MRI (Magnetic Resonance Imaging).
  • CT scan (Computed Tomography).

Lung cancer screenings and tests

Detecting lung cancer at an early stage can significantly improve treatment and survival prospects. For this reason, a screening program has been introduced for high-risk individuals.

Main criteria for access to screening include:

  • Age between 50 and 80 years.
  • Exposure to harmful substances (asbestos, arsenic, radon).
  • Active smoking or having quit less than 15 years ago, with a smoking intensity of at least 20 pack-years (e.g. one pack a day for 20 years).
  • Presence of chronic respiratory diseases, such as COPD.
  • Family history of lung cancer.

The recommended examination is low-dose chest CT (LDCT): It is fast, non-invasive, and far more sensitive than a standard X-ray in detecting early-stage cancerous nodules.

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How Do You Treat Lung Cancer?

Lung cancer treatment depends on several factors, including:

  • The type of cancer (small cell or non-small cell).
  • The patient's overall health condition.
  • The stage of the disease at the time of diagnosis.

Specialists may recommend a single therapeutic approach or a combination of treatments, including:

Chemotherapy

Chemotherapy Frequently used in the treatment of lung cancer, it can have different purposes:

  • Neoadjuvant: before surgery, to reduce tumor size.
  • Adjuvant: after surgery, to lower the risk of recurrence.
  • Palliative: to slow disease progression when the tumor is inoperable.

Surgery

The main option when the tumor is localized and the patient is operable. The procedure may involve:

  • Removal of a segment or an entire lung lobe
  • In some cases, pneumonectomy (removal of the entire affected lung).

Radiotherapy

Uses high-energy radiation to destroy cancer cells. It can be used:

  • In combination with surgery or chemotherapy.
  • For palliative purposes, to relieve symptoms such as pain or breathing difficulty.
  • To prevent brain metastases in small cell lung cancer.

Other Therapeutic Options Include:

  • Immunotherapy: stimulates the immune system to recognize and attack cancer cells.
  • Targeted therapies (molecular targeting): specific drugs that target genetic alterations in cancer cells.
  • Clinical trials: offer access to new drugs or treatment combinations still under investigation, often with promising results.

Prognosis varies based on numerous factors: cancer type, stage at diagnosis, response to treatment, and the patient’s overall condition.

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Reviewed June 2025.