Lung Cancer

At a glance

Lung cancer is a malignant tumor that starts in the lungs.
In Korea it is the second most common cancer after thyroid cancer.

Lung cancer is split into two kinds by how the cells look under a microscope.
The names are hard, but they always come up because this split completely changes the treatment.

• Non-small cell lung cancer — about 85% of lung cancers. Most cases are this kind. Surgery plays an important role.
• Small cell lung cancer — about 15%. It grows fast and spreads early, so chemotherapy and radiation therapy matter more than surgery.

So the words "it is lung cancer" alone do not set the treatment plan.
The direction is decided after a biopsy shows which kind it is.

Why screening matters

Lung cancer, too, causes no particular symptoms early on.
It starts with common symptoms such as a cough or phlegm,
so it is often passed off as a cold or bronchitis.

If you have smoked for a long time, the state supports screening even without symptoms.
The exact conditions are set out in 'What tests are done' below.

This page is reference information summarising official sources.
Always talk to a medical professional about diagnosis and treatment.

If changes like the ones below continue, please see a doctor.
These are the main symptoms of lung cancer listed by the National Cancer Information Center.

• Cough — the most common one. The National Cancer Information Center says 75% of lung cancer patients report a frequent cough.
• Coughing up blood — phlegm with blood in it, or spitting blood
• Breathlessness — being short of breath. About half of patients have this.
• Chest pain — pain in the chest. About 1 in 3 patients report it.
• Hoarse voice — the voice changes
• Weight loss, poor appetite, tiredness

Signs that need to be checked quickly

• Blood mixed in with phlegm
• A cough that has not cleared up in over 3 weeks
• A cough that clearly feels or sounds different from before
• Shortness of breath that keeps getting worse

These symptoms are also common with other causes, such as a cold, bronchitis or tuberculosis.
Having symptoms does not mean cancer, and having none is not a reason to feel safe either.
Tests are what decide.

You can get it even if you do not smoke

Smoking is the biggest cause, but it is not the only one.
The National Cancer Information Center lists these as risk factors too.

• Second-hand smoke
• Exposure to harmful substances at work
• Air pollution
• Genetic predisposition

If the symptoms above continue even though you have never smoked, get checked.

Where to go first

For breathing-related symptoms such as cough, phlegm or coughing up blood, start at pulmonology (respiratory medicine).
It is also pulmonology when a chest X-ray or CT at a health check-up shows something unusual.

A local clinic can take a chest X-ray, but
CT scans and biopsies are usually done at a large hospital with the equipment and staff.

After diagnosis

• Pulmonology — performs the test that takes tissue through a bronchoscope
• Thoracic surgery — if an operation is needed
• Hematology and oncology — if you have chemotherapy, targeted therapy or immunotherapy
• Radiation oncology — if you have radiation therapy
• Radiology — sometimes takes tissue with a needle while watching a CT scan

With lung cancer, several departments often meet together to set the direction of treatment.
At the hospital you may hear the words "joint care" or "multidisciplinary care"; this is what they mean.

Do I need a large hospital

If lung cancer is confirmed or strongly suspected, you will go to a general hospital or a tertiary hospital.
A tertiary hospital needs a referral letter (진료의뢰서) for national health insurance (건강보험) to apply,
so it is best to get the letter from the hospital that did your tests.

Also ask for your CT images on a CD and take them with you.
Sometimes the same scan does not have to be repeated, and it lowers radiation exposure too.

You can look for local clinics and large hospitals together on the map.

Screening stage

In the national cancer screening program (국가암검진), lung cancer is checked with low dose chest CT.
It uses less radiation than an X-ray and can still show small lesions.

Unlike other cancer screenings, there are conditions for who is covered.

• Age — 54 to 74 years old
• Condition — being in the high risk group for lung cancer
• Interval — every 2 years

The high risk group here means people such as
current smokers with a smoking history of 30 pack-years or more.

How pack-years are counted
packs of cigarettes a day × years of smoking
e.g. one pack a day for 30 years = 30 pack-years / two packs a day for 15 years = 30 pack-years

When you are screened, you also get stop-smoking counselling along with a talk about your result.

The criteria above follow the official national cancer screening notice (last updated 2023-02-14).
To find out whether you are eligible this year,
check with the National Health Insurance Service.

Diagnosis stage

• Chest X-ray — the first, basic test.
• Chest CT — shows the size and position of the tumor in detail.
• Bronchoscopy — looks inside the airways and takes tissue from the suspicious area.
• Biopsy — the tissue taken is checked under a microscope. This is the test that finally decides whether it is cancer, and whether it is non-small cell or small cell lung cancer.
• PET-CT — checks whether it has spread elsewhere.
• Blood test — looks at tumor markers and other values.

Depending on where the tumor is, a bronchoscope may not reach it.
In that case doctors may take tissue with a needle while watching a CT scan.
It can feel like many repeated tests, but it is how they make sure they get the tissue.

Treatment for lung cancer differs a lot by type (non-small cell or small cell) and stage.
The National Cancer Information Center lists the treatments below.

Surgery

The part of the lung with the cancer is removed along with the nearby lymph nodes.
It is the main treatment for non-small cell lung cancer at an early stage.

Chemotherapy

This is a whole-body treatment that kills cancer cells with drugs.
It is used before or after surgery, and it can be the main treatment when surgery is difficult.
Small cell lung cancer grows fast and spreads early,
so chemotherapy and radiation therapy matter more than surgery.

Radiation therapy

This is a local treatment that destroys cancer cells with radiation.
It is often given together with chemotherapy.

Targeted therapy

These are drugs aimed at specific gene mutations found only in cancer cells.
They are not for everyone. The tissue taken at the biopsy is checked
for that mutation first, and the decision follows.

Immunotherapy

This treatment helps your body's immune system attack cancer cells.
Here too, test results decide who it is for.

Which treatments you have, and in what order, differs from person to person.
Talk it through fully with your medical team before you decide.

It differs by hospital and by the patient's condition, but the flow is usually like this.

Testing stage

A bronchoscopy, or taking tissue with a needle,
sometimes finishes the same day, and sometimes means a night or two in hospital for observation.

If you have surgery

1. Tests before surgery — blood tests and an electrocardiogram, along with a lung function test. This checks that you can still breathe well enough if part of a lung is removed.
2. Stopping smoking — stopping before surgery matters for recovery. The hospital will always tell you about this.
3. Surgery
4. Recovery — there is a period with a tube in the chest to drain air and fluid. You also do breathing exercises (respiratory rehabilitation).
5. After discharge — the biopsy result decides whether more treatment is needed.

Good things to bring

• Your referral letter, ID, national health insurance card
• The CD of CT images from your previous hospital, with the report and the biopsy result
• A list of the medicines you take (blood thinners in particular must be mentioned in advance)

The length of stay and the procedure differ from hospital to hospital.
Ask the hospital where you will be treated for the exact details.

Special cost-sharing for serious illness

If you are diagnosed with lung cancer, you can apply for the special cost-sharing program for serious illness (산정특례).
Once you are registered, your out-of-pocket cost for care related to that cancer drops a lot,
and this applies for a set period.

The hospital that issued your diagnosis certificate usually applies on your behalf.
If you do it yourself, submit the registration form to the National Health Insurance Service (국민건강보험공단).

Other help

• If it was found through the national cancer screening program (low dose chest CT), you can get support for the screening cost.
• Depending on your income, you may qualify for the medical cost support program for cancer patients.
• For targeted therapy drugs and immunotherapy drugs, the conditions for national health insurance cover differ from drug to drug. Be sure to ask your medical team "is this drug covered".

Programmes and out-of-pocket rates change.
What follows is a summary as of the reference date, so before you apply, always
check the latest rules at the National Health Insurance Service.