Lung cancer

Creating a world without fear of cancer 

Lung cancer results from the development of a tumor inside the lung, referred to as primary lung cancer. However, the lungs can also be a site for metastases originating from another tumor, such as breast cancer. In the latter case, it is not strictly lung cancer, and the choice of treatment depends on the type of cancer causing the metastases.

The figures below concern primary lung cancers in Belgium in 20211:

  • 9,192 patients  diagnosed with lung cancer
  • 3rd most common cancer in Belgium
  • 76.4% mortality within 5 years in men and 67.9% in women.

The symptoms of lung cancer typically manifest late, with the initial stages showing no discernible signs. As the disease progresses, affected individuals may develop general symptoms such as persistent cough, presence of blood in sputum, recurrent inflammation of the respiratory pathways, and shortness of breath. Unfortunately, late diagnoses are common as many people overlook these general symptoms, thus delaying medical intervention. Consequently, lung cancer diagnosis often occurs when metastases are already present, as is the case in about half of situations.

As depicted in the table below, early detection of tumors would allow for intervention at an earlier stage, thereby increasing the chances of survival.



You can be symptom-free and yet seriously ill: Globally, lung cancer is the second most common cancer and the deadliest. The lack of clear symptoms in the early stages means it is often detected too late. Early detection strategies are key, but this is a type of cancer that challenges medicine and health policy alike.

The high mortality rate shows that even with all the therapeutic advances it is still crucial to detect lung cancer as early as possible. Except for small-cell lung cancer, tumors can be surgically removed at an early stage and there is a high probability of the cancer being cured. In many cases, however, the malignant cell change is detected early only by chance, for example during examinations of the spine. Uniform screening could close this gap in care.

Technically, CT is very well suited to screening. Compared to the X-ray image, the computed tomogram enables a precise visualization of smaller tumors. Since CT images are created layer by layer, physicians can also use the fine sectional images to assess the spatial extent of the tumor and obtain important information for a possible surgery.

For a long time, there was a discussion about radiation exposure from CT screening. The risk of possibly causing radiation-induced damage to health is unacceptable, especially where people undergo screening examinations repeatedly over many years. Current CT technology offers the possibility of examinations with very low radiation doses. The resulting average radiation dose is just 0.6 to 0.8 millisievert (mSv), with doses even going below 0.1 mSv (the cosmic radiation on a flight from Germany to Japan2) thanks to Siemens Healthineers’ unique Tin Filter Technology.


Accurate staging is vitally important for appropriate therapy decision and prognostic assessment. Lung cancer initially spreads locally to adjacent mediastinal lymph nodes and subsequently to distant organs with bone, brain, and adrenal metastases common.

This is the moment when one may choose to refer the patient to nuclear medicine to determine the cancer stage. Depending on the stage, we can either perform a PET/CT or SPECT/CT image. Nuclear medicine, providing molecular-level information, can offer a significant complement of information to the CT scan conducted during the screening phase.

Depending on the type of examination conducted and the chosen radioisotope, we can obtain various results to better guide therapy and assess the patient's prognosis.

The clinical application of AI in molecular imaging is one of great potential. For example, AI could help physicians identify uptake patterns of glucose-analog tracers in examinations for non-small cell lung cancer. In this type of disease the presence of tracer uptake is a potential indicator of a metastasis, but sometimes there’s also distinct uptake in small lymph nodes. Even with standard uptake value (SUV) thresholds, how do we confidently resolve the uncertainty around lymph node uptake? The use of AI could help differentiate a metastasis from other potential causes of uptake.

  • For PET images, the Lesion Scout with AutoID application is avaiblable. Within 10 seconds and with 92% accuracy, it automatically assesses an entire patient dataset, segments all uptake, identifies the foci of interest, and processes a selection of foci to be excluded and included in the findings creation.
  • For SPECT/CT images, there's the Auto Lung 3D application. In just 45 seconds, it automatically locates and contours the lungs in 3D, segments right/left lung lobes, quantifies ventilation/perfusion, and generates a report containing the percentage of total perfusion and volumes.


Edge ® and Truebeam ® machines deliver precise doses to tumors of the lungs, and other areas of the body where radiation is indicated. Treatment of lung tumors is particularly challenging because the target is moving. To tackle this challenge, these machines can track tumor position in real time, it precisely calculates patient movement in all six degrees of freedom and monitors respiratory motion.

Dose rate until 2400 UM/minute for X10FFF et 1400 UM/min for X6FFF to deliver dose, it allows treatment with a daily high dose without increasing significantly the treatment time.

Unique imaging techniques include:

  • Blended MV/kV radiographs
  • Respiration-synchronized fluoroscopy and cine MV
  • Respiration-synchronized MV and kV radiographs
  • kV image acquisition during treatment delivery
  • Extended length Cone Beam CT
  • Short-Arc and Gated CBCT
  • Iterative CBCT reconstruction

Triggered Imaging (with Auto Beam Hold): The system acquires kV images during treatment delivery. Called “triggered images”, these images are acquired at user-defined intervals using different trigger criteria: Time, MU, Gantry angle or Respiratory gating. When used for patients with fiducial markers, TrueBeam can automatically track the fiducial markers against the planned position and warn if these fiducials move outside the user-defined threshold. In addition to this. the Auto-Beam hold functionality can hold the beam automatically if thresholds are exceeded. Papers have been published on this functionality, allowing users to implement margin reduction strategies.

4D CBCT: Allows the user to visualize and assess the extent of anatomical motion and to ensure the target motion is consistent with the plan. The online 4D CBCT acquisition utilizes the (Advanced) Respiratory Motion Management component integrated in the TrueBeam® and Edge®system architecture to acquire and bin 10 CBCT volumes. It allows the user to analyze Maximum Intensity Projection, an Average Intensity Projection or even individual phases.


Lung cancer

Squamous Cell Carcinoma Antigen (SCCA) is a cytoplasmic glycoprotein found in normal squamous epithelia and in elevated concentrations in serum from patients with Squamous Cell Carcinomas (SSC). More than 90% of cancers of the head and neck, 30% of non-small cell lung cancers (NSCLC),3 and 80% of cervical cancers are SCCs.4 SCCA has been studied in squamous cell malignancies of the lung, esophagus, head and neck, anal canal, and skin, indicating it is a reliable biomarker to monitor residual disease post-treatment, response to therapy, and recurrence.5

The Siemens Healthineers SCC assay can accurately detect SCCA concentrations, which, in conjunction with other clinical and laboratory findings, aids clinicians in treating their patients with squamous cell carcinomas.

In lung cancer typically two main types can be distinguished: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC accounts for approximately 85% of all patients with lung cancer, 35% of the NSCLC are squamous cell carcinoma.