Lung Cancer

Lung cancer often has no early symptoms, which is why it is frequently detected late. ¹ When symptoms do appear, they may include:

• A persistent cough lasting more than a few weeks, or a cough that worsens ³
• Coughing up blood (haemoptysis) ³
• Persistent breathlessness or wheezing ³
• Chest or shoulder pain, especially with breathing or coughing ³
• Unintended weight loss, fatigue or loss of appetite ³
• Less common: hoarse voice, swelling of the face or neck, clubbing of fingers (changes in shape of the finger tips) or of the toes.³

See a doctor if you notice any of these signs, especially if they persist

Several factors increase the risk of developing lung cancer. While smoking is the most significant, non-smokers may also develop the disease. Key risk factors include:

• Tobacco smoking, including cigarettes, cigars, or pipes. ⁴
• Secondhand (passive) smoke, which also significantly raises risk. ⁵
• Radon exposure: In South Africa, radon—especially in homes in mining or granite-rich areas—is a known risk factor. ⁶
• Occupational exposures: Jobs in mining, construction or manufacturing (e.g., exposure to soot, metals like nickel or chromium) have been linked to higher lung cancer risk. ⁷
• Previous lung disease, such as tuberculosis or COPD, and even alcohol consumption, have been associated with increased risk. ⁸

In a study from KwaZulu-Natal, compared to those with no smoke exposure, tobacco was associated with a 2.9 times increase in lung cancer, and those exposed to passive smoking had a 3.3 times increase. ⁸

Diagnosing lung cancer typically involves a series of tests:

1. Medical history & physical exam – Your doctor will review symptoms, risk factors (like smoking or work exposures), and listen to your lungs as part of the physical examination.
2. Imaging:
   • Chest X-ray is often the first test. ³
   • CT scan (sometimes with contrast) provides detailed images. ³
3. PET-CT: If a CT scan shows abnormalities, a PET-CT may help locate active cancer cells. ³ A PET (positron emission tomography) scan uses a small amount of radioactive substance, injected into the body, which is taken up more by the active cancer cells than other normal cells.
4. Biopsy:
   • Bronchoscopy: a flexible tube with a camera can collect airway tissue. ³
   • Endobronchial ultrasound (EBUS): allows sampling of lymph nodes. ³
   • Other biopsies (e.g., CT-guided or surgical) may be done if needed. ³
5. Staging: Pathologists and oncologists determine the “stage” of cancer often using a TNM (Tumor size, lymph Nodal involvement, Metastases to other tissues in the body / organs) system. ³

Treatment depends on cancer type small cell (SCLC) vs non-small cell lung cancer (NSCLC), its stage, and your overall health. Options may include:

• Surgery: For early-stage NSCLC, removal of part of the lung (lobectomy, segmentectomy) or the entire lung (pneumonectomy) may be offered. ³
• Radiotherapy:
  • Radical radiotherapy: to try to cure NSCLC when surgery is not possible. ³
  • Stereotactic radiotherapy: very focused, high-dose beams, useful for small tumours. ³
  • Palliative radiotherapy: to relieve symptoms such as pain or bleeding. ³
  • Prophylactic cranial irradiation (PCI) may be used in SCLC to reduce the risk of brain metastases. ³
• Chemotherapy: Often used if cancer has spread, or before/after surgery to improve outcomes. ³
• Immunotherapy: Drugs such as pembrolizumab or atezolizumab may boost the immune system to attack cancer cells. ³
• Targeted drug therapy: Some tumours have genetic mutations (e.g., EGFR, ALK) that can be treated more precisely. ³
• Other treatments:
  • Radiofrequency ablation: heat-based therapy for small NSCLC tumours. ³
  • Cryotherapy: freezing therapy, especially if tumour blocks an airway. ³
  • Photodynamic therapy: uses light-sensitive drugs + lasers to target tumour cells. ³

Because access to some of these advanced therapies in South Africa can be limited, treatment may depend on what is available in your healthcare setting. ⁹

A diagnosis of lung cancer affects not just your physical health but also your emotional, social, and practical life. Here are some ways to cope:

• Support team: Ask to meet a lung cancer nurse specialist or care coordinator to help with info and support.
• Breathlessness: Breathing exercises, using a fan, pacing activity, and small, frequent meals can help. ³
• Pain: If you have pain, let your medical team know — palliative care can help manage it.
• Emotional health: It’s normal to feel anxious, sad or overwhelmed. Talking with family, counsellors or support groups can help.
• Nutrition: A dietitian can guide you on foods that support your recovery and energy.
• Follow-up: Work with your care team on treatment plans, appointments, and monitoring.

There are effective steps to lower your risk of lung cancer:

1. Quit smoking — This is the most important action. Stopping smoking reduces risk significantly; over 15 years, risk can approach that of a non-smoker. ¹
2. Avoid secondhand smoke — Encourage smoke-free environments at home and work.
3. Minimise radon exposure — Test your home; reduce radon if needed, especially in high-risk areas. ⁶
4. Protect yourself at work — Use protective gear, follow safety measures if exposed to dust, metals or other carcinogens.
5. Healthy lifestyle: Eat a balanced diet (see below), stay physically active, and avoid excessive alcohol.

Nutrition plays a supportive role both in reducing risk and managing symptoms:

• Fruits & vegetables: Aim for a variety — rich in fibre, antioxidants and vitamins.
• Whole grains: Choose wholewheat bread, oats, brown rice — supports overall health.
• Lean protein: Include fish, poultry, beans, legumes — helps maintain strength.
• Healthy fats: Use olive or canola oil; eat nuts, seeds — supports healing and reduces inflammation.
• Limit salt & processed foods: Helps control blood pressure and supports general wellness.
• Hydration: Drink enough water, herbal teas, or soups — helps with energy and breathing.
• Frequent small meals: If breathless or tired while eating, try smaller, more regular meals.

• Lung cancer often goes undetected until it has progressed; if you develop persistent respiratory symptoms, see a healthcare provider.
• Smoking (both active and passive) is the biggest modifiable risk; quitting is vital.
• Diagnosis requires imaging and biopsy; early detection can improve treatment options.
• Treatment may involve surgery, radiation, chemotherapy, immunotherapy, targeted therapy — depending on cancer type and stage.
• Supportive care (breathing exercises, pain management, nutrition) helps you live better with lung cancer.
• Prevention through lifestyle change, occupational safety and radon control is key.

This brochure is for educational purposes only and is not intended to provide a diagnosis or treatment or replace the advice of your doctor, pharmacist, primary health care nurse or other health care provider. You are advised to discuss any questions or concerns you have with your health care provider.