Secondary cancer in the lung

Sometimes, cancer cells spread from a cancer that started somewhere else in the body to the lungs. This is called secondary lung cancer. Some cancers are more likely to spread to the lungs than others, for example breast and bowel cancer.

Symptoms of secondary cancer in the lungs can include:

  • a cough
  • breathlessness
  • pain or discomfort in your chest
  • a build-up of fluid in the pleura (pleural effusion).

Tests to diagnose secondary cancer in the lung include a chest x-ray, CT or PET scan and removing a sample of tissue from the area (biopsy).

Sometimes secondary lung cancer is diagnosed first. Different tests are then done to find where the cancer first started (the primary cancer).

Your treatment will depend on the primary cancer and your general health. Treatment is usually to control the cancer. But with certain cancers treatment may aim to cure the cancer.

You can also have treatment to help with symptoms, such as breathlessness or fluid on the lung. Your doctor or nurse can tell you more.

What is secondary cancer in the lung?

Secondary cancer in the lung is when cancer cells have spread to the lungs from a cancer that started somewhere else in the body.

We have separate information about cancer that starts in the lung (primary lung cancer).

We hope this information answers your questions. If you have any more questions, you can ask your doctor or nurse at the hospital where you are having your treatment.


The lungs

The lungs are the parts of our body that we use to breathe. We have two lungs (right and left). They supply oxygen to the organs and tissues of the body. The lungs are divided into areas called lobes. The right lung has three lobes and the left lung has two lobes.

The lungs are covered by a lining called the pleura. This has two layers. The inner layer covers the lungs. The outer layer lines the ribcage and a sheet of muscle called the diaphragm.

Structure of the lungs and pleura
Structure of the lungs and pleura

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The lungs are part of our respiratory (breathing) system. This system includes the:

  • nose and mouth
  • windpipe (trachea)
  • two tubes (bronchi) that branch from the windpipe going into each lung
  • lungs.

When we breathe in, air passes from our nose or mouth through to the windpipe (trachea). The trachea divides into two tubes (airways) that go to each lung. These tubes are called the right and left bronchus.

Air passes through each bronchus into the lungs through smaller tubes called bronchioles. At the end of the bronchioles, there are tiny air sacs called alveoli. This is where oxygen from the air we have breathed in (inhaled) passes into the blood. Then oxygen is circulated through the blood around the body.

A waste gas called carbon dioxide passes from the blood into the air sacs (alveoli). We get rid of carbon dioxide when we breathe out (exhale).


Secondary cancer in the lung

Sometimes cancer cells break away from the part of the body where the cancer started (primary cancer). They can travel in the blood or the lymphatic system to another part of the body, such as the lungs. This is called secondary cancer or metastatic cancer.

Some cancers are more likely to spread to the lungs than others. These include:

Sometimes, people are diagnosed with a secondary cancer before the primary cancer has been diagnosed. In this case, you have tests to find where the cancer started. Occasionally, doctors may not be able to find the primary cancer. This is called cancer of unknown primary (CUP).


Symptoms of secondary lung cancer

Some people may not have any symptoms. Secondary lung cancer may be diagnosed after a routine scan, or during a chest x-ray for another condition.

Symptoms of secondary lung cancer can include:

  • a cough that does not clear up
  • feeling breathless
  • coughing up blood (haemoptysis)
  • pain or discomfort in your chest that does not go away
  • a build-up of fluid in the pleura (pleural effusion).

Some people may have general symptoms such as:

  • tiredness
  • weight loss
  • losing their appetite.

These symptoms can be caused by conditions other than cancer, for example a chest infection. Always see your doctor if you have any of these symptoms. If you do not feel better after treatment (such as antibiotics), your doctor should do more tests.


How secondary lung cancer is diagnosed

You may have different tests to diagnose secondary lung cancer, including one or more of the following tests.

Chest x-ray

This may be the first test you have. It is to check your lungs for anything that looks abnormal.

CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes about 10 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with.

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This can make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

PET (positron emission tomography) scan

This uses low-dose radiation to measure the activity of cells in different parts of the body. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. The scan is done after at least an hour’s wait. Areas of cancer are usually more active than surrounding tissue, so they show up on the scan.

Biopsy

Some people may need a biopsy. You usually have this done in the hospital x-ray department, during a CT scan. This helps your doctor find the exact area to take the biopsy from.

Your doctor gives you an injection of local anaesthetic into the skin to numb the area. Then they pass a thin needle through your skin into the lung and remove a sample of cells (biopsy). They will look at the sample under a microscope to check for cancer cells. You may feel a pushing sensation when they take the biopsy, but it only takes a few minutes.

Secondary lung cancer can make fluid collect in the space between the two membranes that surround the lungs (pleura). This is called a pleural effusion. If this happens, it may be possible for the doctor to remove some of the fluid and check it for cancer cells.

When the doctors look at the cancer cells, they can usually tell it is a secondary lung cancer. This is because the cells look like the cells from the primary cancer. For example, if a bowel cancer has spread to the lungs, the cells look like bowel cancer cells not lung cancer cells.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

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Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Treatment for secondary lung cancer

The treatment you have for secondary lung cancer depends on:

  • the primary cancer
  • your general health
  • your preferences.

Treatment is usually with drugs or treatments that are used for the primary cancer.

Usually the aim of treatment is to:

  • control the cancer
  • treat the symptoms.

With certain cancers, the aim may be to try to cure the cancer. Your cancer doctor and specialist nurse will talk to you about treatment options. You can ask them any questions you may have. You and your doctor can decide together on the best treatment plan for you.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is often given to:

  • shrink and control secondary cancers in the lung
  • reduce symptoms.

Chemotherapy can be given into a vein (intravenously) or as tablets. The chemotherapy drug you have depends on whether you have had chemotherapy before and how long ago. You usually have your treatment in a chemotherapy day unit.

Hormonal therapy

If you have a cancer that relies on hormones to grow, such as breast or prostate cancer, you may have hormonal therapy. The type of hormonal therapy you have depends on which hormonal treatments you have already had. There are several different types of hormonal therapy. They are usually given as tablets or injections.

Targeted therapy or immunotherapy drugs

Targeted therapy drugs interfere with the way cancer cells signal or interact with each other. This stops them growing and dividing. You may have a targeted therapy drug as an injection into a vein (intravenously) or as tablets.

Immunotherapy drugs help stimulate your immune system to recognise and destroy cancer cells. Depending on the type of tumour you have, you might have an immunotherapy drug.

Radiotherapy

Radiotherapy treats cancer by using high-energy x-rays. You might have a short course of radiotherapy to relieve symptoms of secondary lung cancer, such as breathlessness or coughing up blood.

Surgery

Occasionally, surgery to remove the secondary lung cancer may be possible. It is usually only done if the secondary cancer:

  • is small
  • is in one area of the lung
  • has not spread anywhere else in the body.

Tumour ablation

Tumour ablation uses heat or cold to destroy cancer cells. Doctors sometimes use it instead of surgery for secondary lung cancer.

Radiofrequency ablation (RFA) uses heat to destroy cancer cells. It may be done under a general anaesthetic or using a local anaesthetic.

The doctor puts a needle into the tumour, usually using a CT scan to make sure it is in the right place. An electrical current (radio-waves or microwaves) is passed through the needle into the tumour. The current heats the cancer cells to a high temperature. This destroys (ablates) them.

Cryoablation (cryotherapy) is when extreme cold is used to destroy cancer cells.

Clinical trials

You may be asked to take part in a clinical trial. Your doctor will talk to you about the treatment, so you fully understand the trial. You may decide not to take part, or to withdraw from a trial at any stage. You will then receive the best standard treatment.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Managing the symptoms of secondary lung cancer

There are different ways your symptoms can be managed or treated.

Breathlessness

Breathlessness can be difficult to cope with, but there are treatments and drugs that can be used to help.

A blocked airway

Sometimes a secondary cancer in the lung can block one of the airways. This can make breathing difficult. The following treatments can help.

Laser treatment

This uses heat to destroy cancer cells. This can help relieve the symptoms. You usually have this done under a general anaesthetic.

Stents

If the secondary cancer is causing pressure on the windpipe, a surgeon can insert a small tube (stent) to hold the windpipe open. You usually have this done under a general anaesthetic.

You can breathe more easily with the stent in place. It does not generally cause any problems.

Internal radiotherapy

If the cancer is blocking one of the airways, you may have a type of internal radiotherapy (brachytherapy).

Most people have only one session of treatment. It is usually done in an operating theatre. The doctor passes a thin tube (catheter) down the nose or throat into the lung, using a bronchoscope. They put a small piece of radioactive material inside the catheter, next to the cancer. They leave it in place for a few minutes to give a dose of radiation to the cancer. Then they remove it together with the catheter.

Fluid on the lung (pleural effusion)

A secondary lung cancer can cause a build-up of fluid between the two membranes (pleura) that cover the lungs. This is called a pleural effusion. The fluid puts pressure on the lung. It may cause:

  • breathlessness
  • a cough
  • a dull, aching pain.

These symptoms can be relieved by carefully draining the fluid through a tube.

A cough

A cough is a common symptom. There are different treatments that can help a cough, including:

  • some types of painkiller that are given by mouth
  • drugs given as a vapour that you inhale
  • a short course of radiotherapy.

Pain

It is important to tell your doctor or nurse if you have any pain. There are different drugs that can be used to control pain. You can take painkillers in different ways, including:

  • tablets
  • capsules
  • a liquid
  • skin patches
  • injections, usually under the skin.

Let your doctor or nurse know if your painkillers are not controlling the pain. They can increase the dose or give you a different drug.

Coughing up blood

You may notice some streaks of blood in your phlegm (sputum), but this does not usually cause a problem. If you notice larger amounts of blood, let your doctor know. You can have treatment to help control it, such as radiotherapy.


Your feelings

Finding out your cancer has spread or come back may be even more upsetting than hearing for the first time that you have cancer. You may have many different feelings, including:

  • anxiety
  • uncertainty
  • fear
  • anger.

These are all normal reactions.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends. Others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it.

Our cancer support specialists can give you details of counselling services in your area.

Living with advanced cancer

Amanda talks about her experiences of living with advanced breast cancer.

About our cancer information videos

Living with advanced cancer

Amanda talks about her experiences of living with advanced breast cancer.

About our cancer information videos

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