This website is for patients who have experienced, or continue to have, symptoms that might mean they have lung cancer. This does not mean you have lung cancer but the symptoms require further investigation to find out what the cause is.

All patients are different and the symptoms they have vary. For this reason each person has different tests to find out what is causing their symptoms.

Reasons why your GP has referred you:

You have been referred to the hospital to see a chest physician via a fast track referral because you may have experienced or continue to experience any of the following symptoms:

• A chest infection that doesn't get better.
• Coughing up blood.
• A cough that is changing or troubling you more.
• Feeling more breathless than normal.
• Chest or shoulder pain.
• Voice changes, for example hoarseness, that last for more than three weeks.

 The Team

Contacts

Listed below are the names, contact numbers and email addresses of the core members of the University Hospitals Bristol NHS

Foundation Trust Lung Cancer Multi-Disciplinary Team:

Should you require advice or have an urgent enquiry please contact:

Sophie Fox, lung cancer specialist nurse

Direct line/Voicemail: 0117 342 3489 Fax: 0117 342 4262 Email: Sophie.Fox@uhbristol.nhs.uk

Office hours: 8am - 4pm, Mon- Fri (except Bank holidays)

They are not routinely in the office, so please leave a message and they will return your call within 24 hours, or call between 9am -noon on Tuesdays.

Alternatively, you can call the switchboard on 0117 923 0000 during office hours and ask them to bleep the lung cancer nurses.

Department of Respiratory Medicine

Dr Abi Jeyabalan, lead clinician for lung cancer and consultant respiratory physician

- Tel: 0117 342 3485 Fax: 0117 342 4262

Dr Nabil Jarad, consultant respiratory physician

- Tel: 0117 342 2620Fax: 0117 342 4262

Dr Jim Catterall, consultant respiratory physician

- Tel: 0117 342 2619 Fax: 0117 342 4262

Dr Adam Whittle, consultant respiratory physician

- Tel: 0117 342 2966 Fax: 0117 342 4262

Dr Liz Gamble, consultant respiratory physician

- Tel: 0117 342 4259 Fax: 0117 342 4262

Dr Kathryn Bateman, consultant respiratory physician

- Tel: 0117 342 3842 Fax: 0117 342 4262

Dr Nick Bell, consultant respiratory physician

- Tel: 0117 342 3842 Fax: 0117 342 4262

Department of Clinical Radiology

Consultant radiologists

Dr John Hughes

- Tell: 0117 342 2690

Department of Thoracic Surgery

Mr Gianluca Casali, consultant thoracic surgeon

- Tel: 0117 342 3132 Fax: 0117 342 3522

Mr Doug West, consultant thoracic surgeon

- Tel: 0117 342 3132 Fax: 0117 342 3522

Thoracic cancer nurse specialist

- Tel: 0117 342 7648 Fax: 0117 342 3522

 

First appointment

Please note, you are more than welcome to bring someone with you to the appointment

Prior to your first appointment you may need to have a CT (Computerised Tomography) scan. This may have been organised by your GP or the hospital before your first appointment or you may be asked to have this done on the day of your appointment. This test is a special scan which enables your consultant to see in more detail any abnormal areas that may have been seen on a chest x-ray.

If a CT scan has been requested a hospital member of staff will contact you either by letter or telephone. If you do need a CT scan, please report to Reception x-ray department, level 2, BRI. Please ensure you have nothing to eat or drink two hours before to the scan.

  At your first appointment, the consultant will probably want to do the following:

• History- the consultant will take a detailed history and will want to know about any symptoms that you have been experiencing, any previous medical problems and what medication you are currently taking. It may be helpful to bring a list of medications with you. It is particularly important that you tell us if you are on any blood-thinning medications e.g. warfarin, clopidogrel or rivaroxaban
• Physical examination- the consultant will want to examine you.
• Blood tests- the consultant may ask you to have some blood tests.
• Chest X - ray- If you haven't had a chest x-ray you almost certainly need one but this will normally have been requested by your GP and completed before your hospital appointment.
• Simple breathing tests- you may be asked to breathe into a small machine which can help to show how effective your breathing is.
• If you have enlarged lymph glands in your neck or fluid in your chest, we may want to take a sample with a syringe and needle. This is a simple test that can be done in the clinic and can speed up the diagnosis

 You should be offered the opportunity to meet the lung specialist nurse during or after this appointment. Your lung specialist nurses will give you contact details and will ensure that all your questions are answered and that you and your family have support if you need it.

Tests you may need

The consultant may want to arrange some of the following tests listed below (this will be on a seperate day to your first appointment). You will be given written information about some of the tests that explains them in more detail when you are seen at the hospital.

• Breathing tests:You will be asked to blow into a machine that can accurately measure the effectiveness of your breathing.
• Bronchoscopy:This test allows us to to see inside your main breathing tubes. Usually samples or biopsies are taken. It is done as an outpatient and usually involves attending the hospital for a morning or afternoon. You will need someone to take you home and stay with you after the procedure.**link to Bronchoscopy leaflet**
• Endobronchial ultrasound - This is a procedure which is similar to a bronchoscopy, which allows your doctor to look into your breathing tubes but also allows the doctor to take samples of the glands in the centre of the chest using an ultrasound scanner. If you need to have this test, it will be carried out by a specialist at Southmead Hospital.** Link to EBUS leaflet**
• CT (Computed Tomography) guided biopsy:An investigation that allows an x-ray doctor to take samples of abnormal areas seen on the CT scan. This can help to establish what they are. This is usually done as an outpatient but you will need someone to take you home and stay with you after the procedure.
• CT/ PET scan:This is another detailed type of CT scan. If you need a PET scan you will need to travel to Cheltenham to have this done.
• Bone scan:A special type of x-ray scan that can show abnormal areas in the bones.
• Pleural tap: Sometimes there is fluid in the lung that we may remove for comfort or diagnostic reasons. This is usually done in the pleural clinic in the respiratory department, level 2, BRI
• MRI or Ultra Sound scan:In some patients these tests are also needed. They are done by the x-ray department and are done as well as,or sometimes instead of the CT scan.
• Mediastinoscopy:This is a minor operation carried out by the chest or thoracic surgeon under a general anaesthetic. They can look at the area in the centre of the chest (mediastinum) and take samples (biopsies) when appropriate. If you need this test, you will be referred to see a surgeon first.

The Multi-Disciplinary meeting

When the results of the tests that you have had are available, the consultant will discuss your case at a weekly Multi-disciplinary Team Meeting (MDT). At the meeting your symptoms and test results are discussed by the whole lung cancer team. This ensures that any treatment recommended to you is the best and most appropriate.

You don't attend this meeting.

The team includes respiratory physicians, oncologists (cancer treatment specialists) chest/ thoracic surgeons, x-ray specialists, the lung cancer nurse specialist and other specialists who are experienced in caring for people with suspected cancer.  

The meeting takes place once a week, every Friday 11:30am to 1pm and a member of the team may contact you after the meeting if they need to discuss any future tests or appointments.

Results will not be given over the phone.

Second appointment

At your second appointment your consultant or nurse specialist will tell you of the results of your tests. They will usually be able to tell you if you have a lung cancer or not and what is the best treatment for you if you do have lung cancer.  Occasionally extra tests may be needed before the diagnosis is certain.

If lung cancer is confirmed we will also give you an explanation of the cell type. This is important because different cell types need different treatments. You should also be told if the cancer seems to be confined to the lung or if it has moved anywhere else in your chest or body.

You will be told the likely treatment plan decided by the discussion at the Multi-Disciplinary Team Meeting. This will often mean you will be referred on to see another specialist  such as  a surgeon or oncologist (cancer specialist).

 

 

The two main types of lung cancer are:

• small cell lung cancer (SCLC)
• non-small cell lung cancer (NSCLC).

About 15% of lung cancers (less than 1 in 5) are small cell; the rest are non-small cell

Small Cell lung cancer

Small cell lung cancer is called this because when the cancer cells are looked at under a microscope they are very small. It is sometimes referred to as oat cell cancer.

Small cell lung cancer is usually caused by smoking, and it is rare for someone who has never smoked to develop this type of lung cancer. Small cell lung cancer is often fast-growing and can spread quickly.

Non-small cell lung cancer

There are three main types of non-small cell lung cancer. Sometimes it is not possible to tell which type someone has. This is because when the cells are looked at under a microscope, they are not developed enough or the biopsy doesn't contain enough cells to diagnose the different types of NSCLC. 

• Squamous cell carcinoma- This develops in the cells that line the airways. This type of lung cancer is often caused by smoking.
• Adenocarcinoma - This is the most common subtype. This develops from the cells that produce mucus in the lining of the airways. This type of cancer is becoming more common.
• Large cell carcinoma -This gets its name from the large, rounded cells that are seen when they are examined under a microscope. It is  sometimes known as undifferentiated carcinoma

Mesothelioma

This is a cancer of the membrane that covers the surface of the lungs and lines the inside of the chest. It often occurs in people who have been exposed to asbestos.

Carcinoid

Carcinoids are rare tumours which tend to be slow growing. They may not cause any symptoms for several years. Most of these tumours occur in people over the age of 60.Carcinoid tumours are also sometimes just called carcinoid. They are one type of tumour of the neuroendocrine system. 

Important links: Macmillan, Roy Castle, MESO UK, BBAFS.

Information about treatments

All patients with lung cancer can be helped and some can be cured. The treatment recommended to you will depend on the type of lung cancer you have and whether it is confined to the lung or has spread elsewhere in the body.

Whatever treatment is discussed with you it is important that you, your family or friends have all the information you require and the opportunity to ask questions about it.

Please ask questions about other treatments if you want to. Your consultant and nurse will be happy to discuss them with you.

The three main treatments for lung cancer are:

• Surgery- Some tumours are best treated by an operation to remove them. Surgery is obviously a major undertaking and your doctor will not advise this unless they feel that it is likely to result in you being cured of your lung cancer. Unfortunately some patients will not be fit enough for surgery or it may not be possible to remove all of the cancer with an operation.

If surgery is possible it may be necessary to remove just part of the lung or a whole lung. Even after removal of a whole lung patients can have a good quality of life and are still able to do many of the activities that they did before the surgery. However, you should expect to get breathless more easily.

Please see here for more information on lung cancer care.

• Radiotherapy- This is a type of x-ray treatment and is the most commonly used treatment for lung cancer. The treatment is targeted at where the cancer is. The number of treatments depends on your individual case and your oncologist (cancer specialist) will discuss this with you.

You should be offered the opportunity to meet the lung specialist radiographer, who offers information and support to patients having radiotherapy to their chest. They can also co-ordinate courses of intensive radiotherapy.

• Chemotherapy- This is drug treatment and is given in injection or tablet form. There are many different types and combinations of chemotherapy. Your oncologist will advise you which is best for you. Chemotherapy is a systemic treatment. This means it travels all-round the body and if the cancer cells are sensitive to it, it kills them wherever they are.

After treatment you will be seen regularly by the team who gave it, lung oncologist. They will assess how effective it has been and ensure any side effects have resolved. You will be supported by your GP and other members of the community team. You can also contact the lung cancer nurse specialist at any time. We will not routinely call you but please call if you have questions or concerns.

We may sometimes decide to observe you and treat you when you have symptoms. This will be discussed with you at your appointments with the team. 

Palliative care

You may be referred to palliative care in the hospital or in the community. Many patients have symptoms which can be difficult to manage and advice from specialists who can help with symptom control can be of benefit. 

 

 

 

New treatments are being developed all time. You may be offered entry into aclinical trial. Participation is entirely voluntary. Usually the current standard treatment is being compared with a new treatment. You can decline the offer and have what is considered the standard treatment instead. Your care and treatment will not be affected if you decline entry into a trial.

A healthy balanced diet is a vital part of a healthy lifestyle. For most people a healthy balanced diet includes:

• Fruit and vegetables - at least five portions per day
• Limited food high in fat
• Protein rich foods such as meat, fish, nuts and lentils
• Milk and dairy food each day
• Limited alcohol - not exceeding the national recommendations which are currently 14 units for women and 21 units for men per week.

 Some people may struggle with their diet/food on a day to day basis due to breathlessness or loss of appetite for example.  Please read leaflets, link. You do need to be at your best physical health as you can be for your treatment. If your BMI (body mass index) is low you may need to have extra support. So if you need specialist advice your clinical nurse specialist can refer you to a dietician. This will be discussed at your hospital appointment.

If you are overweight you can greatly improve the speed of recovery after your operation and your long term health by losing weight.

Your clinical Nurse specialist will be able to provide further support and information regarding diet and healthy eating please ask if this hasn't been discussed with you

Please remember every individual is different so information will be tailored to your needs.

• Alcohol

It is important that you are aware of your drinking and how it can affect your body. Drinking too much alcohol can damage you heart and your overall health by increasing your blood pressure.

The current guidelines for safe drinking suggest up to 14 units of alcohol for women and 21 units of alcohol per week for men.

One unit of alcohol is equivalent to:

• Half a pint of normal strength beer or lager
• One small glass of wine
• A single pub measure of spirits (25ml)

Your clinical nurse specialist will be able to talk through this with you and provide any information or support you may need.

Please see here for a leaflet on healthy eating.

Smoking Cessation

Please see here and here for information and guidance on stopping smoking.