Lung Cancer

Lung cancers are one of the commonest cancers, mostly attributable to tobacco use, although a significant minority of our patients have never smoked.

They can be classified as adenocarcinomas, squamous carcinomas, small cell carcinomas and neuroendocrine tumours. The lung team also sees patients with thymic tumours and mesothelioma (a tumour of the lung lining due to asbestos inhalation).

The vast majority of lung cancers are not inherited. There may be genetic changes in the cancer, but these alterations cannot be passed on to other family members. Very uncommonly lung cancer can be due to an inherited mutation and this possibility can be discussed with your doctor.

The Lung cancer team is a specialist team formed of representatives of every part of the service a lung cancer patient might interact with during their diagnosis and treatment. This would include the following:

• The Doctors responsible for diagnosing the patient
• Specialist radiologists and histopathologists are responsible for analyzing any imagery and biological samples generated during the patient care
• Clinical Nurse Specialists and Macmillan Cancer Support Worker
• Specialist surgeons, medical oncologists and clinical oncologists responsible for the delivery of treatment
• Clinic staff and a multi-disciplinary team meeting coordinators to track and follow patients through the system and cover their pathway end to end.

Do I need any tests to confirm the diagnosis?

Lung cancers are assessed with biopsies to confirm the type and scan to evaluate the extent of the disease, known as staging – this determines prognosis and treatment.

St George’s offers a comprehensive diagnostic service, including lung function testing, a dedicated unit to perform bronchoscopies, and specialist lung ultrasound (EBUS) or Computed Tomography (CT) guided biopsy.

To further aid diagnosis, the Radiology Department at St George’s University Hospitals NHS Foundation Trust provides a comprehensive imaging service (including Magnetic resonance imaging (MRI), CT and ultrasound technologies). In contrast, the Pathology service provides expert blood, cells and tissues analysis, including rapid in-house testing for tumour molecular mutations that guides treatment with novel therapies.

We can also offer Positron Emission Tomography (PET) scanning as part of our diagnostic suite through a mobile scanner that attends the Tooting site.

What treatments are available?

Lung cancers are usually treated with either surgery, chemotherapy, targeted therapies, immunotherapy or radiotherapy (or a combination of treatments). The type of surgery needed and the particular combination of surgery and therapy will depend on the type and complexity of the cancer.

St George’s is the sole provider of thoracic surgery for the hospitals in the southwest London cancer network, meaning we have excellent and well-staffed facilities to handle this. Due to our role as a surgery centre, patients diagnosed with lung cancer at sites such as Epsom & St Helier, Croydon or Kingston, who are eligible for surgery, will have it here.

We can also provide chemotherapy, targeted therapies and immunotherapy onsite in both a day patient and inpatient setting.

genomics plays an important part in the diagnosis and management of lung cancer. Tumour samples are sent to our regional genomics hub for next generation sequencing to identify targets for treatment.

Due to our close links with the Royal Marsden for patients requiring radiotherapy, we are able to offer the initial consultations here, followed by treatment at one of the Royal Marsden’s sites, Sutton and Fulham. The Royal Marsden’s radiotherapists work closely with the St George’s team, ensuring that patients receive the highest standard of care.

What is Personalised Cancer Care?

 Personalised Cancer Care means your team will support you to take an active role in your cancer care by giving choices and control based on what matters most.

Together with your key workers’ team, like your Clinical Nurse Specialist and Macmillan Support worker, we will aim to help you access the care and support that meets your individual needs from the moment you receive your cancer diagnosis so that you can live as full, healthy and active a life as possible.

You will be invited to complete a Holistic Needs Assessment (HNA) to identify any concerns you may have when you have been diagnosed with cancer. These concerns may be physical, emotional, practical, financial and spiritual.

You will answer a simple set of questions or fill in a checklist about all areas of your life. It is to find out about the concerns you may have. You are often asked to rate how important these concerns are to you. It could help you decide what to discuss first during the assessment.

Once you have completed the assessment, your Clinical Nurse Specialist will discuss your needs, maybe face-to-face in a clinic or over the phone. During the discussion, you and your Clinical Nurse Specialist will agree on the best ways to manage your needs and concerns. They will write down what you have decided in a document called a care plan.  They may write it during the discussion. Or they may make notes and send them to you afterwards. Your care plan will record the following:

• The main concerns you talked about
• Suggestions and actions to help you manage your concerns
• Services that may be able to support you, and any referrals that are made
• What is already being done to help – for example, the services you are already using
• Information about who to contact if you need more help
• The details of other health or social care professionals with whom you have agreed to share the information.

You may not wish to complete the holistic needs assessment at this time. The care you receive will not be affected in any way, and we will be happy to discuss this again in the future

 Health and wellbeing information and support also include:

• Access to the Macmillan Information & Support Centre to find out what support is available in the community, e.g., practical, financial, and how to access it
• Help with understanding cancer and its treatment and how to manage its impact through videos and workshops run by healthcare professionals at St George’s and in the community.
• Attend wellbeing activities which are great opportunities for you and your carers to get together with others affected by cancer.