Lung cancer:
early detection, treatment & follow-up care

1. What is lung cancer?

Lung cancer, medically known as lung or bronchial carcinoma, is a malignant tumour that arises from cells of the bronchi or the lung tissue. It grows into the surrounding tissue and can form secondary tumours (metastases) via the lymphatic and blood vessels, for example in the brain, bones, liver or adrenal glands.^¹

In Germany, around 58,000 people were newly diagnosed with lung cancer in 2023. It is by far the most common cause of cancer death in men and the second most common in women. While rates have been falling in men for years, they are rising in women — a reflection of smoking habits in earlier decades.^²

The treacherous part: in its early stages, lung cancer usually causes no symptoms. Many tumours are therefore only discovered once they have already spread. In early stages, a cure — usually through surgery — is quite possible; in advanced stages it is rare, but thanks to new treatments many people affected now live considerably longer and better than just a few years ago. This is exactly where the new early detection programme comes in.

2. Types, stages and tumour biology

Under the microscope, two large groups are distinguished that differ markedly in behaviour and treatment:^¹,³

• Non-small cell lung cancer (NSCLC): the vast majority. The most common subtype is adenocarcinoma — including in people who have never smoked. There is also squamous cell carcinoma, plus rarer forms.
• Small cell lung cancer (SCLC): less common, almost always in smokers. It grows quickly, spreads early and initially responds well to chemotherapy, but frequently comes back.

The stage (I to IV) uses the TNM system to describe how large the tumour is, whether lymph nodes are affected and whether there are distant metastases. Stages I and II count as early disease, stage III as locally advanced and stage IV as metastatic.

Tumour biology has a say

In non-small cell lung cancer, the laboratory now examines the tumour tissue for genetic changes (driver mutations), for example in the genes EGFR, ALK, ROS1, KRAS, BRAF, MET or RET, and for the protein PD-L1. If such a change is found, there is often a tablet that acts in a targeted way. Driver mutations are particularly common in people who have never smoked. This testing is standard and comes before every treatment decision in advanced stages, and increasingly in early stages too.^¹

3. Symptoms: often late and non-specific

The symptoms are not typical of cancer and usually have harmless causes. You should take them seriously if they last longer than three to four weeks — especially if you smoke or used to smoke.^³

• A new or changed cough — in smokers, above all a smoker's cough that feels different from usual.
• Blood in the phlegm — even small amounts should be checked by a doctor.
• Shortness of breath and chest pain — increasing, with no obvious reason.
• Persistent hoarseness — when the tumour irritates the nerve to the vocal cords.
• Unintentional weight loss, night sweats, exhaustion — known as B symptoms.
• Recurring pneumonia — in the same place, or a pneumonia that doesn't heal properly.
• Symptoms caused by metastases — bone pain, headaches, neurological deficits, swelling of the face and neck.

Small cell lung cancer in particular can produce hormone-like substances and so cause symptoms far from the lungs, such as a low sodium level in the blood (paraneoplastic syndromes).

4. Causes and risk factors

• Smoking: By far the most important risk factor. The risk rises with duration and amount — cigars, cigarillos and pipes are not harmless either. How risky e-cigarettes are in the long term cannot yet be said conclusively.^³
• Passive smoking: Increases the risk even in people who have never smoked themselves.
• Radon: A natural radioactive gas from the ground that can build up in cellars and on ground floors; after smoking, one of the most important causes.
• Occupational pollutants: Asbestos, quartz dust, diesel engine exhaust, chromium, nickel or arsenic compounds. Lung cancer after such exposure can be recognised as an occupational disease — this is worth looking into.
• Air pollution: Fine particulate matter measurably increases the risk, but much less than smoking.
• Previous illnesses and predisposition: COPD, pulmonary fibrosis, previous radiotherapy to the chest and lung cancer in close relatives.

5. Diagnosis: from findings to treatment plan

If lung cancer is suspected, a series of tests follows. It clarifies whether it really is cancer, which type, how far it has spread and whether you would cope with an operation.^¹

• CT scan of the chest: Shows location, size and lymph nodes much more precisely than an X-ray.
• Tissue sample: Usually taken during a bronchoscopy, often with ultrasound through the bronchial wall, or by CT-guided needle biopsy. Without tissue, there is no reliable diagnosis and no tumour biology.
• Extent of spread (staging): PET-CT for lymph nodes and metastases, MRI of the head for brain metastases.
• Molecular testing and PD-L1: In non-small cell lung cancer, the basis for targeted therapy and immunotherapy.
• Lung function and heart check: Help decide whether, and how much, lung can be removed.
• Tumour board: Specialists in respiratory medicine, surgery, oncology, radiotherapy, radiology and pathology agree on the recommendation together.

Blood tests such as tumour markers are not suitable for detecting or ruling out lung cancer. It makes sense to plan treatment at an experienced centre, such as a lung cancer centre certified by the German Cancer Society (Deutsche Krebsgesellschaft). It pays to prepare for the consultation about your results — see Prepare for a doctor's appointment.

6. Early detection with low-dose CT

Since 1 April 2026, lung cancer screening with low-dose computed tomography has been covered by statutory health insurance. It is based on the Lung Cancer Screening Ordinance, which has permitted the procedure under strict quality requirements since July 2024, and on a decision by the Federal Joint Committee (G-BA), which decides what statutory health insurance covers.^⁴,⁵

Who is eligible?

• Age: 50 to 75.
• Smoking duration: smoked for at least 25 years.
• Amount: at least 15 pack-years.
• Former smokers: stopped smoking less than ten years ago.

How it works

1. A participating GP or internal medicine practice checks whether you meet the requirements, explains the benefits and risks and refers you. If you still smoke, you receive information about stopping.
2. A radiology practice approved for this purpose carries out the low-dose CT.
3. If the findings are abnormal, a second radiologist from a lung cancer centre also assesses the images.
4. If everything is normal, the next scan follows after twelve months; findings that need monitoring are checked sooner, and suspicious ones are investigated further.

Benefits and risks — honestly weighed up

Studies show that an annual low-dose CT in heavy smokers can reduce deaths from lung cancer, because more tumours are discovered at a curable stage.^⁴ This has to be weighed against disadvantages:

• False-positive results: Small round nodules often show up that later turn out to be harmless — bringing worry, follow-up CT scans and sometimes unnecessary procedures.
• Overdiagnosis: Some of the tumours detected would never have become dangerous but are treated anyway.
• Radiation: The dose is low, but not zero — and it is repeated every year.
• Incidental findings: Abnormalities in other organs can lead to further investigations.

7. Treatment by stage

Treatment depends on the type, stage, tumour biology, lung function and your general health. It is planned at the tumour board; you make the decision together with your treatment team. With lung cancer there are no promises of a cure — but there are effective options at every stage.^¹

In small cell lung cancer, surgery is rarely possible. If it is confined to the chest, chemoradiotherapy is usually used, often followed by immunotherapy; in the extensive stage, chemotherapy combined with immunotherapy. Because of the risk of brain metastases, regular MRI scans of the head or preventive radiotherapy to the skull are part of the plan.

8. Medicines in cancer treatment

Lung cancer treatment rarely means just one medicine: alongside the cancer treatment come medicines for nausea, pain, thrombosis or side effects — on top of your existing long-term medication. This makes interactions and dosing errors a real risk.^⁶

Chemotherapy

Usually given as an infusion in cycles. Typical effects are nausea, for which effective prevention is available today, for example with ondansetron; tiredness, changes in the blood count with a risk of infection and, depending on the drug, hair loss or nerve damage in the hands and feet. The preventive anti-sickness medicines work best if you take them exactly as planned — not only once you feel sick.

Immunotherapy with checkpoint inhibitors

These antibodies release the immune system's brake on attacking the tumour. The downside: the immune system can also attack healthy organs. Inflammation of the lungs, bowel, liver and skin is possible, as are disorders of the hormone glands, such as an underactive thyroid or, rarely, new-onset diabetes. Such side effects can appear weeks to months after starting treatment, sometimes even after it has ended. Caught early, they can usually be treated well, often with cortisone.^⁶

Targeted tablets

You take tyrosine kinase inhibitors and related drugs at home, often daily for months or years. That puts a large part of the responsibility on you — and on the question of what else you are taking:

• Acid blockers: Proton pump inhibitors such as pantoprazole reduce the absorption of some of these tablets into the blood.
• Herbal products and grapefruit: St John's wort can weaken the effect considerably, grapefruit can strengthen it, see Herbal medicines.
• Smoking: Speeds up the breakdown of individual drugs.
• Rules for taking them: Some tablets are taken on an empty stomach, others with food — the instructions apply to your specific product.
• Typical side effects: Skin rash, diarrhoea, inflammation of the nail beds; depending on the drug, also changes in liver values or heart rhythm.

Cancer also increases the risk of thrombosis or a pulmonary embolism; anticoagulants in turn have their own interactions with cancer medicines. An overview of typical combination problems is given in the guide Drug interactions.

9. Follow-up care and life afterwards

Treatment aimed at a cure is followed by structured follow-up care. It is meant to detect relapses and second tumours early, treat the after-effects of therapy and help you back into everyday life.^¹

• Regular check-ups — more frequent in the first few years, usually with CT scans, later at longer intervals.
• Rehabilitation — a rehabilitation programme directly after surgery or chemoradiotherapy (Anschlussheilbehandlung), with breathing therapy and exercise, helps you regain strength and stamina.
• Staying smoke-free — the best protection against a second tumour.
• Vaccinations — against flu, pneumococci and other respiratory pathogens, coordinated with your treatment team, see Vaccinations for adults.
• Emotional support — psycho-oncology services and cancer counselling centres help with fear of relapse and with questions about work, pensions and the severe disability pass (Schwerbehindertenausweis).

With long-term treatment in the metastatic stage, “follow-up care” is really about monitoring progress: regular imaging to see whether the treatment is still working, and a switch if it is not.

10. Everyday life with lung cancer

• Keep a complete medication plan — cancer medicines, supportive medicines, long-term medication and anything you buy yourself on one list that every practice sees. Instructions under Create a medication plan.
• Note down side effects — with the date and severity. This helps the practice to take action early.
• Maintain your weight — unintentional weight loss weakens you; nutritional advice is worthwhile early on, not only once malnutrition has set in.
• Keep moving — adapted exercise, lung exercise groups (Lungensport) and breathing techniques such as pursed-lip breathing improve stamina and breathlessness, even during treatment.
• Involve your loved ones — take them to appointments, share the centre's emergency number, divide up tasks.

Treatment today is more varied and often better tolerated than its reputation suggests — but it demands organisation. If you have your medicines, appointments and symptoms under control, you gain strength for what matters.

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