Remembering George Harrison: Understanding Lung Cancer

A guitarist who named his own risk factor

George Harrison played lead guitar for the Beatles and wrote "Here Comes the Sun" and "Something." He was also unusually plain about his cancer. In 1998, after treatment for throat cancer, he told the public he knew the cause. CBS News quoted him saying, "I got it purely from smoking. I gave up cigarettes many years ago, but had started again for a while and then stopped in 1997."

In May 2001 his lawyers confirmed a second episode. They reported that surgeons at the Mayo Clinic had removed a cancerous growth from his lung, and that the operation was successful. Harrison died on November 29, 2001, in Los Angeles at the age of 58. Billboard reported his death after a long illness with cancer.

That is the public record, and it is where the story about him should stop. How his care actually unfolded stayed private. The part worth your attention is the disease itself.

Lung cancer is really two diseases

The National Cancer Institute separates lung cancer into two groups. They behave differently and are treated differently.

Non-small cell lung cancer is the larger group, and NCI's guidance for clinicians lists three main forms within it. Adenocarcinoma accounts for roughly 40 percent and usually begins in the outer lung. Squamous cell carcinoma accounts for about 25 percent and starts near the central airways, the large tubes that carry air. Large cell carcinoma accounts for another 10 percent. NCI notes that adenocarcinoma "is now the most common histological subtype in many countries."

Small cell lung cancer is the smaller group, and it tends to grow faster and spread sooner.

Telling the two apart is not a technicality. NCI states that before treatment begins, "an experienced lung cancer pathologist must review the pathological material." A pathologist is a physician who examines tissue under a microscope.

How it announces itself

NCI lists a worsening cough as a common first sign. Others include chest pain, coughing up blood, shortness of breath, hoarseness, weight loss, and a general sense of feeling unwell.

Some signs come from the tumor pressing on neighboring structures. Trouble swallowing can mean pressure on the esophagus, the tube running from throat to stomach. A hoarse voice can mean the nerve that supplies the voice box is involved. If the cancer has already traveled, the first hint may instead be bone pain or a change in thinking or balance.

When to get checked

CDC lists coughing that gets worse or does not go away, chest pain, shortness of breath, wheezing, coughing up blood, feeling very tired all the time, and weight loss with no known cause, and says to talk to your doctor for help finding the cause. Repeated bouts of pneumonia and swollen lymph nodes inside the chest can also occur. Any of the following is worth raising, and sooner if you smoke or used to smoke:

• A cough that is new, or an older cough that changes or worsens
• Blood in what you cough up, even once, even a streak
• Chest pain, especially with a deep breath or a cough
• Getting winded doing something that was comfortable last year
• Wheezing that was not there before
• Pneumonia twice in a year, or pneumonia that will not clear
• Unplanned weight loss, or hoarseness lasting several weeks

Screening is a separate question

Screening looks for cancer before symptoms start. CDC says the U.S. Preventive Services Task Force recommends a yearly low dose CT scan for people who meet all three conditions: age 50 to 80, a smoking history of 20 pack years or more, and either current smoking or quitting within the past 15 years. CDC defines a pack year as smoking an average of one pack a day for one year. Two packs a day for ten years also reaches 20.

NCI describes what the underlying evidence showed. Yearly low dose CT for three years found more early lung cancer than chest x-rays did. It also reduced the risk of dying from lung cancer among current and former heavy smokers.

NCI is equally direct about the costs. Scans flag findings that turn out to be harmless, which can lead to invasive procedures nobody needed. Some cancers that screening uncovers might never have caused harm. Repeated radiation carries a small risk of its own.

What a workup involves

NCI's clinician guidance maps the sequence. It opens with history, physical examination, laboratory work, and a chest x-ray. Next comes a CT scan of the chest with contrast dye. A biopsy confirms the diagnosis, meaning tissue is removed and examined.

Staging then asks how far the cancer has traveled. PET scanning with a radioactive sugar tracer is used, along with brain imaging in selected patients. The lymph nodes in the mediastinum, the space between the lungs, matter enormously. NCI states that "surgical staging of the mediastinum is considered standard if accurate evaluation of the nodal status is needed." Imaging alone is often not sufficient.

Why the tissue also gets gene tests

This is the largest change since 2001, because tumor samples are now routinely tested for specific gene changes. NCI notes that EGFR variants "strongly predict the improved response rate and progression-free survival in patients who receive EGFR inhibitors." ALK gene fusions appear in 3 to 7 percent of cases and respond to ALK inhibitors. NCI lists further targets including BRAF, ROS1, RET, NTRK, MET, KRAS, and HER2.

NCI also describes immunotherapy, which "helps a person's immune system fight cancer." Biomarker tests can help predict who is likely to respond to those drugs.

Treatment by stage

For early stage disease, NCI states that patients "may be cured by surgery or surgery followed by chemotherapy." Chemotherapy after an operation may benefit some people with stage II or IIIA disease.

For stage IIIA, selected patients receive surgery combined with chemotherapy or chemoradiation, delivered either before or after the operation. When stage III disease cannot be removed, NCI says the treatment is radiation therapy combined with chemotherapy.

Stage IV means the cancer has spread beyond the lung, which is what metastatic means. NCI states that these patients "may achieve improved survival and palliation of symptoms with chemotherapy, targeted agents, and other supportive measures."

What the numbers describe

SEER, NCI's cancer surveillance program, tracks outcomes across very large groups. For lung and bronchus cancer diagnosed in the years 2016 through 2022, five year relative survival is 65.5 percent when the cancer is still localized, 38.2 percent once nearby lymph nodes are involved, and 10.5 percent once it has reached distant sites.

Timing is the difficult part. SEER records 51 percent of cases as already distant when they are found, and only 24 percent as localized. For 2026 the American Cancer Society projects 229,410 new cases and 124,990 deaths, and SEER carries those estimates.

These figures are group averages drawn from thousands of earlier patients. They do not describe any individual reader, any individual tumor, or any medication approved since the data closed.

Sources

• https://www.cbsnews.com/news/george-harrison-has-lung-cancer/
• https://www.billboard.com/music/music-news/world-mourns-george-harrison-77575
• https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq
• https://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq
• https://www.cancer.gov/types/lung/patient/lung-screening-pdq
• https://seer.cancer.gov/statfacts/html/lungb.html
• https://www.cdc.gov/lung-cancer/screening/index.html
• https://www.cdc.gov/lung-cancer/symptoms/index.html