Lung Cancer
Lung cancer carries a heavy reputation — much of it earned a generation ago. The reality today is different. Targeted drugs and immunotherapy have, for many patients, turned what was once a brief illness into a manageable one. The earlier we find it, the more options we have.
What lung cancer is — in plain words
Lung cancer begins when cells lining the airways start to grow uncontrollably. Most cases are linked to smoking — but a significant minority occur in people who never smoked, especially women in our region. Second-hand smoke, indoor air pollution, occupational exposures (asbestos, silica) and family history all play a role.
The first distinction we make is between the two big families: non-small-cell lung cancer (about 85% of cases) and small-cell lung cancer (about 15%). They behave differently and are treated differently.
Signs and symptoms to take seriously
A cough that won't settle
A cough lasting more than three weeks, or a familiar smoker's cough that has clearly changed in character.
Coughing up blood
Even a single episode of blood-streaked sputum is worth a chest X-ray and a clinic visit.
Breathlessness or chest pain
New shortness of breath on exertion, or a dull ache that doesn't go away with rest.
Unexplained weight loss
Losing weight without trying, ongoing fatigue, or repeated chest infections in the same area.
None of these symptoms alone proves cancer. But in anyone who smokes (or used to), or who has been around heavy smoke, they deserve quick investigation.
"When a patient walks in with a stage I lung cancer found by chance on a scan, my heart lifts. That patient has a real shot at cure. Find it early, change the story."
How lung cancer is diagnosed
- Chest X-ray — the first step, but it can miss small tumours. A normal X-ray with persistent symptoms still warrants further imaging.
- CT scan of the chest — the workhorse. Shows the tumour, the lymph nodes, and gives a guide for biopsy.
- Biopsy — done through a bronchoscope (a camera passed into the airways) or by a needle through the chest wall under CT guidance. EBUS (endobronchial ultrasound) lets us sample lymph nodes at the same time.
- PET-CT — to look for spread beyond the chest before deciding on surgery or radiation.
- Brain MRI — lung cancers can spread to the brain silently; an MRI checks before treatment is finalised.
- Molecular and PD-L1 testing — on the biopsy sample. This is no longer optional for non-small-cell cancer.
Why molecular testing matters so much
For non-small-cell lung cancer (especially adenocarcinoma, the kind most common in non-smokers), the tumour's molecular profile changes everything. We look for:
- EGFR mutations — treatable with daily tablets (osimertinib and others) that often work for years.
- ALK and ROS1 rearrangements — also targetable with tablets that frequently produce dramatic responses.
- KRAS, BRAF, MET, RET, NTRK — each has its own targeted therapy in selected cases.
- PD-L1 expression — guides the use of checkpoint inhibitors (immunotherapy).
If your biopsy report doesn't mention these tests, ask. A patient with an EGFR mutation should generally be on an EGFR tablet, not on standard chemotherapy.
Stages — what the numbers mean
Stage I
Small tumour, no lymph nodes involved. Surgery alone often cures. Five-year survival around 70–90%.
Stage II
Larger tumour or nearby lymph nodes involved. Surgery followed by chemotherapy, sometimes immunotherapy.
Stage III
Spread to mediastinal lymph nodes. Treated with a combination of chemotherapy, radiation and immunotherapy — still with curative intent in many cases.
Stage IV (metastatic)
Spread beyond the chest. Not currently curable, but modern targeted therapy and immunotherapy give many patients years of good-quality life.
How we treat lung cancer
Surgery
For early-stage non-small-cell cancer, removing the lobe of the lung containing the tumour (a lobectomy) is the gold standard. Minimally invasive techniques mean most patients are out of hospital within a few days.
Radiation therapy
An alternative to surgery for very early tumours (stereotactic body radiotherapy, or SBRT), and a key part of treatment for stage III disease combined with chemotherapy.
Chemotherapy
Platinum-based combinations remain a backbone — given before or after surgery, combined with radiation for stage III, and combined with immunotherapy for stage IV. Read more about chemotherapy →
Targeted therapy
Daily tablets for EGFR, ALK and similar mutations. For the right patient, these can shrink a cancer dramatically within weeks, with side effects much milder than chemotherapy.
Immunotherapy
Checkpoint inhibitors (pembrolizumab, nivolumab, atezolizumab, durvalumab) have transformed lung cancer outcomes. They are now standard either alone or combined with chemotherapy for most stage IV non-small-cell cancers without a targetable mutation. Read more about immunotherapy →
Small-cell lung cancer
Treated primarily with chemotherapy plus immunotherapy, and often radiation to the chest. Responds quickly but tends to relapse, so close follow-up matters.
What the outlook honestly looks like
Lung cancer survival depends almost entirely on stage at diagnosis. A stage I cancer found on a screening scan has a 70–90% chance of cure. A stage IV cancer with an EGFR mutation may give five or more years of good life on a daily tablet. A stage IV cancer without a targetable mutation but with high PD-L1 may respond beautifully to immunotherapy.
The averages from a decade ago no longer apply. We treat every patient as an individual, and we are honest about both the hopes and the limits.
Screening — for those at high risk
- Age 50–80, with a heavy smoking history (20+ pack-years) and currently smoking or quit within the last 15 years.
- Low-dose CT scan once a year — proven to reduce lung cancer deaths by detecting tumours when they are still curable.
- Even outside formal screening criteria, anyone with persistent symptoms and a smoking history should have a CT, not just a chest X-ray.
Life during treatment
Many lung-cancer patients keep working through targeted therapy. Chemotherapy and immunotherapy cycles allow rest periods between treatments. Breathlessness can be helped with pulmonary rehabilitation, breathing techniques and, where needed, oxygen. Mental health support is part of standard care — a lung-cancer diagnosis is heavy, and you do not have to carry it alone.
Recently diagnosed with lung cancer? Let's review the molecular report.
The single most important question after diagnosis is: what is the molecular profile? Bring your biopsy report and we'll go through it together.
Medically reviewed by
Dr. Rehan Abdullah
Dr. Rehan Abdullah is a dual-trained clinical and radiation oncologist with over a decade of experience treating both solid tumours and hematologic malignancies. He serves as Consultant Oncologist at INMOL Hospital and sees patients at Farooq Hospital and Healthnox Medical Center, Lahore. Read full profile →
This page is patient education, not a substitute for an in-person consultation. Cancer care must be individualised. Read our medical disclaimer →