Ask The Expert: Lung cancer

Thomas Routledge is a cardiothoracic surgeon at London Bridge Hospital (part of HCA UK) and at Guy’s and St Thomas’ NHS Hospitals

How did you become a lung cancer specialist? I’ve been a consultant lung cancer surgeon for 15 years. I was drawn to this patient group because it is historically underserved. Lung cancer is often seen as self-inflicted. The surgery is technically demanding and high risk, and so it’s technically satisfying.

What are the causes and risk factors? Smoking and genetics. At least 75 per cent of cases are caused by smoking. Asbestos exposure is also a significant risk factor. This has been cleared as a hazard for some decades but there are still people around getting asbestos-related cancers. Traditionally we’ve said that ten per cent of lung cancers are people with very little smoking history, and this is probably a genetic phenomenon.

What are the symptoms to watch out for? Lung cancer can cause people to cough, cough up blood or be breathless. But early stage cancer (cancer that hasn’t spread outside the lung) is normally asymptomatic.

This is why there is increasing emphasis on screening. There have been local pilots and a programme called Targeted Lung Health Check—a lowdose CT scan for over 50s—is being rolled out across the UK. Lung cancer is eminently treatable in the early stages.

What are the most common misconceptions about the disease? Firstly, that it’s a death sentence. Early stage lung cancer can be very effectively treated by surgery or targeted radiotherapy. Surgery is getting gentler all the time. Even frail people can weather robotic keyhole surgery. 70 to 80 per cent of people who have surgery for lung cancers that have not spread are cured. Advanced lung cancer survival scores are vastly better now than even ten years ago, thanks to personalised drug treatments.

How can you help protect yourself against developing lung cancer? Stopping smoking, even later in life, always improves health outcomes. Engage with the screening programme where available. ■

For more information go to finder.hcahealthcare.co.uk/hca/ specialist/mr_thomas_routledge_1