Care pathway for lung cancer

The main types of lung cancer are small cell lung cancer and non-small cell lung cancers, of which the latter group has several different subtypes. Different subtypes of lung cancer are very different biologically, some are types that only progress slowly and some are very aggressive.

There are no typical symptoms of lung cancer, as many other conditions also have similar symptoms. Common initial symptoms of lung cancer include coughing or blood in sputum, shortness of breath, and pain in the chest or the area of a metastasis. Lung cancer can also be asymptomatic.

Lung cancer examinations are usually started in primary health care. A suspicion of lung cancer may also occur in connection with other examinations conducted due to other illnesses, such as pneumonia or heart disease. Most often, an X-ray finding in the lungs raises suspicion of lung cancer.

If lung cancer is suspected, the physician will refer you to the HUS Pulmonary Outpatient Clinic.

When your referral arrives at HUS, a physician will review the information, plan the required additional examinations, and plan follow-up visits.

You will receive an invitation letter by mail. The invitation will indicate when and in which hospital you will need to register, the procedure for which you have been booked, and instructions on how to prepare for coming to the hospital. You can reschedule or cancel your appointment by calling the number indicated in the invitation letter.

Information on the patient’s smoking habits is the most important background information when lung cancer is suspected. When lung cancer is suspected, a contrast-enhanced CT scan will be performed to determine the location, size and possible spread of the tumor.

In some cases, additional information may be obtained on the spread of the lung cancer by performing a PET scan to determine the metabolism of the tumor.

Lung function tests are performed with spirometric tests in the laboratory.

A tissue sample is needed from the tumor tissue at an appropriate site, usually taken as a needle sample.

For the treatment plan, information is needed on the scope and extent of the cancer changes and the tissue type of the cancer. At the first outpatient clinic visit, all examination results needed for diagnostics and treatment decisions may not be available yet. Additional testing may be required. Condition, functional performance, self-sufficiency  and assessment of other diseases are central and have a significant impact on treatment opportunities.

A nurse will also meet the patient at the first appointment. If necessary, guidance and counseling will be provided at the nurse’s appointment during the clinic visits, and follow-up on medical treatments for cancer will also be carried out.

If necessary, we will assess the situation of the cancer and provide a treatment recommendation in HUS’s multidisciplinary team of specialists who are experienced in the diagnostics and treatment of lung cancer.

Surgery is the primary treatment for local lung cancer unless the patient’s physical condition, other conditions, or pulmonary function prevents this. We will proceed to surgery either directly based on the oncology meeting or after the surgeon’s assessment in outpatient care.

If surgery is not possible, high-dose, or so-called targeted radiation therapy may be an alternative treatment form in some cases.

If the lung cancer has spread to regional lymph nodes in the chest area, but does no wider spread is observed, various combinations of radiation therapy and drug therapy may be considered.

After surgery or radiotherapy to treat the local lung cancer, your follow-up at HUS will normally end after five years if the disease has not recurred.

In addition to the tumor in the lung, the majority of lung cancers have spread or progress during the disease as metastases to other parts of the body, such as to the other lung, the pleura, the lymph nodes, the liver, the bones, or the brain.

The goal of the treatments is then to slow down the progress of the disease and relieve cancer-related symptoms and to promote the best possible quality of life for the patient’s remaining time.

When cancer treatments no longer provide benefit or because of the adverse effects caused by the treatment, it is not justified to continue with the treatment, a switch will be made to symptomatic, i.e. palliative, treatment.

Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the cancer treatments, assistance in treating the difficult symptoms, and, if needed, also conversational support.   

After surgery or radiotherapy to treat the local lung cancer, your follow-up at HUS will normally end after five years if the disease has not recurred.

In advanced lung cancers, follow-up is determined individually based on the situation of the illness and the cancer treatments provided.