Lung Cancer: causes, symptoms and the impact of delayed diagnoses

Leonie Millard
Leonie Millard

Published: November 7th, 2022

7 min

Lung cancer is one of the most common causes of death in the Western world. In the United Kingdom, as in many countries, carcinoma of the bronchus is the most common cause of cancer deaths in men and women.

The most common cause of lung cancer is smoking, with the instances of lung cancer being directly related to the number of cigarettes smoked. There are other risk factors for the future development of lung cancer, including exposure to asbestos and heavy metals such as nickel. Fibrotic disease of the lung can also be a cause of cancer.

Symptoms of Lung Cancer

Patients with lung cancer can present in numerous different ways, although lung cancer in its early stages does not always cause symptoms. Commonly though, patients will have a cough or haemoptysis, which is blood in the sputum. Chest symptoms are also common, such as an ache or pain, or getting out of breath easily. Persistent tiredness, losing appetite and weight, and repeat chest infections can all also be symptoms of lung cancer.

How to detect Lung Cancer

There are numerous different ways of diagnosing and detecting lung cancer.

  • Chest X-ray

    • This can also pick up whether the cancer has spread to the surrounding area.

  • CT scan

    • This can also show whether the cancer has spread.

  • MRI scan

  • Bronchoscopy - a test to look at the inside of the airways in your lungs.

  • Ultrasound scans

    • Endobronchial ultrasound or endoscopic ultrasound

  • Biopsies can also test the tissue to detect whether cancerous cells are present.

If a chest X-ray or CT scan suggests lung cancer, patients should be offered an urgent referral to a member of the lung cancer team, usually a chest physician. This is the same even if the scan is normal but shows a high suspicion of lung cancer.

Usually, a combination of a chest X-ray or CT scan will be used first, and then a follow up bronchoscopy to observe any abnormalities in the lungs.

Impact of delayed diagnosis

After lung cancer has been diagnosed, the next step will be to stage the cancer. This will help define the prognosis and treatment. Staging will usually involve using a radio isotope bone scan and liver ultrasound.

Studies have shown that delays in diagnosing lung cancers can have a very detrimental impact on the outcome for the patient. Typically in cases in which the cancer is detected promptly, the cancer is able to be operated on at stage 1 or 2 with a good prognosis. Those cases in which the diagnosis was delayed by only a few months resulted in the operation taking place usually when the cancer is at stage 3 or 4. These operations are much more complex as the cancer tends to grow quickly at this stage, and is more likely to have already spread. The prognoses for these patients was generally much poorer, with a significantly reduced five year survival rate.

Survival rates

The overall prospects for survival are poor, and around 10% of patients survive ten years from diagnosis.

Those diagnosed with non-small cell lung cancer that are able to be operated on have a five year survival rate of up to 75%-90%. Radiotherapy is recommended for patients who have inoperable lung cancers. The five year survival figures are 20%.

For patients with more advanced cancer, palliative radiotherapy is the only treatment available.

Chemotherapy is the main treatment for patients with small-cell lung cancer. Approximately 80% of patients have an initial response to chemotherapy, with a complete rate of up to 60% of patients. Untreated, the survival rate 3 months, but with treatment 10-20% of patients survive 2 years, with 5% surviving for 5 years.

The five-year survival rates for lung cancer

  • Cancer was diagnosed when it was Stage 1: 57% chance that the patient will live for a further five years.

  • Cancer was diagnosed when it was Stage 2: 34% chance that the patient will live for a further five years.

  • Cancer was diagnosed when it was Stage 3: 13% chance that the patient will live for a further five years.

  • Cancer was diagnosed when it was Stage 4: 3% chance that the patient will live for a further five years.

Lung Cancer Statistics

  • In the period 2016-2018 there was an average of 48,549 new cases of lung cancer annually and 35,137 deaths annually recorded in the UK.

  • More than 70% of lung cancer cases are caused by smoking.

  • There were on average 34,771 deaths from lung cancer a year between 2017 and 2019.

  • Up to 79% of lung cancer cases are preventable.

The British Lung Foundation and Macmillan Cancer Support can both provide support to those suffering with lung cancer. Click here to visit the British Lung Foundation website, and click here to visit Macmillan Cancer Support to see further information about the help that these organisations can provide.

In the news

On 1 October 2022, the BBC reported that a woman from Suffolk had been attending Long Covid sessions run by East Suffolk and North Essex NHS Foundation Trust, with symptoms of breathlessness and fatigue. She began attending these virtual sessions in early 2021, but her symptoms did not improve.

By early 2022 she had been referred for a lung test as she was still feeling unwell. In August 2022, she was sadly diagnosed with lung cancer. The Long Covid service at the NHS had been designed to be delivered virtually, and was not able to recognise that her symptoms could have been related to lung cancer. Unfortunately in this case, the cancer was inoperable when it was detected. This is another sad case of misdiagnosis, in which had the symptoms been recognised more quickly, the lung cancer could have possibly been detected at an earlier stage.

Lung Cancer Client Case Study

We have recently achieved £83,000 for the spouse and estate of a 79 year old male. The hospital Trust reported;

'the CT scan from September 2019 did show an irregular nodule, which could not have been identified as a malignant lesion at that time. However, both agreed that this should have been reported as a new finding with a recommendation for the patient to have a repeat CT scan in 3 months' time. With regards to the CT scan from 4th May 2020, both agreed that at this point the nodule showed characteristics of a primary lung malignancy, and that this reporting discrepancy would be classed as a significant failure of perception."

The Deceased suffered terribly with symptoms whilst he was undiagnosed. He sadly died in January 2021.

If you or a loved one have a lung cancer diagnosis that you believe could have been diagnosed at an earlier stage, you may have a claim for clinical negligence. Contact our specialist team of clinical negligence solicitors and we would be happy to talk through the treatment you received to determine whether you may have a case.

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