• Overall survival (OS): Overall survival (OS) is how long patients live, full stop.
• Progression-free survival (PFS): Progression-free survival (PFS) is how long patients live without their cancer growing.
• Lung cancer drugs in England: what NICE has recommended: Which lung cancer drugs the NHS in England funds, and which it does not.
• Lung cancer: the failed and stopped programmes, and why: The list of lung cancer treatments that looked right and did not work: more radiotherapy, radiotherapy after surgery for involved nodes, immunotherapy at the wrong PD-L1 threshold, immunotherapy added to chemoradiotherapy, and several drugs whose confirmatory trials failed.
• Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain: What is done when a lung cancer makes breathing hard, fills the chest with fluid, blocks an airway, spreads to bone or reaches the brain.
• Limited-stage vs extensive-stage (small-cell lung cancer): Small-cell lung cancer uses a two-way split instead of the usual four stages: limited (confined to one side of the chest and treatable within one radiation field, about a third of patients) or extensive (everything else).
• Targeted lung health check: The NHS appointment that decides whether you are offered a lung scan.
• Pack-year: The unit used to measure how much someone has smoked over a lifetime: one pack-year is twenty cigarettes a day for one year.
• Small-cell lung cancer transcription-factor subtypes (SCLC-A, SCLC-N, SCLC-P, SCLC-I) and SLFN11: Small-cell lung cancer has looked like one disease for fifty years; RNA profiling now splits it by the master transcription factor in charge (ASCL1, NEUROD1, POU2F3, or none with an inflamed signature), and these groups, plus the DNA-damage protein SLFN11, are the first leads for matching drugs to a cancer that has had almost no biomarkers.
• Radon: A radioactive gas that seeps out of the ground into buildings, with no smell and no taste.

Screening and diagnosis: Low-dose CT screening in heavy smokers finds some SCLC but stage shift is limited; diagnosis by bronchoscopic or CT-guided biopsy; staging with PET/CT and brain MRI.

Biomarker results to ask for: DLL3 (not required for tarlatamab), B7-H3, SCLC-A/N/P/I subtypes (research), Stage (limited vs extensive) is the dominant decision, B7-H3 (I-DXd trials), SSTR2 (RYZ101), Transcription-factor subtype (ASCL1/NEUROD1/POU2F3/YAP1, research), PD-L1 and TMB (not predictive in SCLC), SLFN11 (chemotherapy/PARP sensitivity, research), ctDNA (research).

Scans and tests linked to this cancer: Comprehensive genomic profiling, CT (computed tomography), Histopathology & immunohistochemistry, Low-dose CT lung screening, MRI, Multidisciplinary tumour boards.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• Very limited stage (T1-2 N0, ~5%): Lobectomy with mediastinal node dissection or SBRT, followed by adjuvant platinum-etoposide; PCI or MRI surveillance. (SBRT / SABR (stereotactic radiotherapy), Platinum + etoposide (EP / CE), Prophylactic cranial irradiation vs MRI surveillance)
• Limited stage: Concurrent cisplatin-etoposide with thoracic radiotherapy (45 Gy twice daily or 60-70 Gy once daily), then durvalumab consolidation up to 2 years (ADRIATIC); PCI or MRI surveillance. (Platinum + etoposide (EP / CE), IMRT / IGRT (modern external beam), Durvalumab, ADRIATIC, CONVERT, Prophylactic cranial irradiation vs MRI surveillance)
• Extensive stage, first line: Carboplatin-etoposide plus atezolizumab or durvalumab (4 cycles), then maintenance immunotherapy; lurbinectedin added to atezolizumab maintenance since 2025 (IMforte). Serplulimab-chemotherapy where approved. Consolidative thoracic radiotherapy for residual thoracic disease in good responders. (Platinum + etoposide (EP / CE), Atezolizumab, Durvalumab, Lurbinectedin, IMpower133, CASPIAN, IMforte, Serplulimab)
• Brain metastases: Whole-brain radiotherapy or, increasingly, stereotactic radiosurgery for limited numbers of lesions; PCI decisions individualised. (SBRT / SABR (stereotactic radiotherapy), Prophylactic cranial irradiation vs MRI surveillance, MRI)
• Transformed SCLC (from EGFR-mutant NSCLC): Platinum-etoposide, often with continued EGFR TKI; immunotherapy benefit uncertain; trials. (Platinum + etoposide (EP / CE), Osimertinib)
• Small-cell lung cancer: why the timeline is faster, and what that means for your decisions: Small-cell lung cancer moves faster than non-small-cell lung cancer, in both directions: it grows quickly and it shrinks quickly with treatment. NICE NG122 builds that into the standard. It says (1.8.1) to arrange for people with small-cell lung cancer to have an assessment by a thoracic oncologist within 1 week of deciding to recommend treatment, which is a far shorter interval than anything in the non-small-cell pathway, and (1.10.2) to start radiotherapy during the first or second cycle of chemotherapy for limited-stage disease rather than after the chemotherapy is finished. What that means for you is that the decisions arrive close together and the waiting-for-results pattern that suits advanced non-small-cell disease does not apply here. The treatment divides at limited against extensive stage. Limited stage: 4 to 6 cycles of cisplatin-based combination chemotherapy, with carboplatin substituted where kidney function, performance status or other illnesses make that safer (1.10.1); twice-daily radiotherapy given with the chemotherapy for people with a performance status of 0 or 1 whose disease fits in a radical radiotherapy volume, or once daily if they decline or cannot manage twice (1.10.2 and 1.10.3); sequential radiotherapy for people who are not well enough for concurrent treatment but respond to chemotherapy (1.10.4); preventive radiotherapy to the brain at 25 Gy in 10 fractions for performance status 0 to 2 where the disease has not progressed (1.10.5); and durvalumab afterwards where the disease has not progressed after chemoradiotherapy (1.10.6). Extensive stage: platinum-based combination chemotherapy if you are fit enough, to a maximum of 6 cycles depending on response and toxicity (1.11.1 and 1.11.2), with durvalumab or atezolizumab added (1.11.3), and thoracic radiotherapy with preventive brain radiotherapy considered for people who responded (1.11.4 and 1.11.5). NICE is unusually frank about the cost of preventive brain radiotherapy, saying it can adversely affect quality of life and that the survival benefits are limited, and has an open research question about replacing it with regular MRI scans. At relapse it says to offer assessment by a thoracic oncologist (1.12.1), to tell people whose disease did not respond to first-line treatment that there is very limited evidence that second-line chemotherapy will benefit them (1.12.2), to offer an anthracycline-containing or a further platinum-based regimen to a maximum of 6 cycles where chemotherapy is suitable (1.12.3), and to offer radiotherapy for palliation of local symptoms (1.12.5). Because the decisions arrive close together, three things are worth doing in the first weeks rather than later: the palliative care referral alongside treatment, for symptom control and not instead of it; the conversation with your team about what matters to you; and the practical paperwork Roy Castle's getting organised material covers. (Cisplatin, Carboplatin, Etoposide, Durvalumab, Atezolizumab, ADRIATIC, CASPIAN, IMpower133, Early integrated palliative care, Performance status (ECOG, Karnofsky))
• Relapsed, platinum-sensitive (≥90 days): Tarlatamab (preferred, OS benefit); platinum-etoposide rechallenge; lurbinectedin; topotecan. (Tarlatamab, DeLLphi-304, Lurbinectedin, Topotecan)
• Relapsed, platinum-resistant (<90 days): Tarlatamab; lurbinectedin; topotecan; clinical trials (I-DXd, RYZ101, DLL3 bispecifics). (Tarlatamab, Lurbinectedin, Topotecan, Ifinatamab deruxtecan, IDeate-Lung02, Actinium-225 DOTATATE)

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.