How is lung cancer treated?

All relevant information about the patient, including his or her health status, the kind of tumor and how far it has spread are brought together to design the most appropriate therapy for that individual’s cancer.

Lung cancer is a very challenging cancer to treat. Cell type and stage are the most critical factors in determining the survival rate is the stage at the time of diagnosis. Those that are diagnosed at a localized stage may be curable. Unfortunately, most people are diagnosed when the disease has spread outside the chest (advanced or distant) or involves the nodes in the chest (regional). Also, the lungs are very sensitive organs and may not handle some forms of treatment easily. This combination explains why lung cancer has one of the poorest survival rates of all cancers. The overall two-year survival rate of those diagnosed with lung cancer is 25%. At five years, survival rate drops to 15%.

It is important to discuss the goals of lung cancer treatment with your doctor. Some treatments may be used to control the cancer. Others are used to improve quality of life and/or reduce symptoms. These treatments may be used alone or in combination.

Chemotherapy and targeted therapies

Chemotherapy is the use of drugs that are designed to kill rapidly growing cells, such as cancer cells. Chemotherapy may be injected directly into a vein (by IV, or intravenously) or given through a catheter, which is a thin tube placed into a large vein and kept there until it is no longer needed. Some chemotherapy drugs are taken orally in pill form.

Targeted agents are a newer class of drugs that are designed to act against specific weaknesses in cancer cells or surrounding supportive tissues, such as blood vessels. These drugs can also be taken orally or by IV. They are most effective in cancers with specific changes in their genes or cell receptors.

In early stages of non-small cell cancer, chemotherapy may be used in conjunction with surgery to improve survival rates. In more advanced stages of non-small cell cancer and in all stages of small cell cancer, chemotherapy and targeted therapies may be used to relieve symptoms and extend life.

Chemotherapy affects both normal cells and cancer cells. Your doctors will try to prevent side effects as much as possible while treating the cancer appropriately. Side effects depend largely on the specific type of drug and the amount given. They can be different for each person and may be only temporary. Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores and/ or fatigue. Your healthcare providers can suggest ways to make any side effects manageable and to help improve symptoms that may occur during and after procedures.

Radiation therapy

Radiation therapy is a form of high energy X-ray that kills cancer cells. It can be used as a primary treatment, or in combination with chemotherapy (with or without surgery). It often can play an important role in advanced cancer patients by providing relief from pain, blockage of the airways, shortness of breath or coughing.

Radiation therapy is a “focused” treatment, meaning it is designed to maximize its effect on the cancer cells while minimizing injury to normal cells. Radiation to treat lung cancer most often comes from a machine (external radiation). Occasionally, the radiation may be delivered internally using tubes that place a radioactive seed directly near the tumor (internal radiation or brachytherapy).

Side effects of radiation therapy depend mainly on the part of the body that is treated and the treatment dose. Common side effects of radiation therapy to the chest are a dry, sore throat; difficulty swallowing; fatigue; skin changes at the site of treatment; and/or loss of appetite.

An area of particular innovation in radiation therapy is a high-technology approach, sometimes termed “radiosurgery.” In very select patients who have small tumors but for whom surgery is not desired or is unsafe, radiosurgery using very high doses of precisely focused radiation aimed only at the small tumor in the lung, is an effective alternative.

Surgery

Surgery is still considered the “gold standard” for treating early-stage lung cancer. Removing the tumor and surrounding lung tissue gives the best chance for cure for patients whose disease is localized. Surgery should be performed by specialized thoracic surgeons with particular expertise in treatment of lung cancer and other chest malignancies. Your surgeon will determine whether a tumor is resectable (removable). Not all tumors are resectable due to their location near, or if they have invaded, vital structures.

In patients with multiple medical problems or poor lung function, surgery may not be the best option. This is carefully determined by our multidisciplinary team including pulmonologists, medical oncologists, and radiation oncologists who work collaboratively daily.

What types of surgery are used to treat lung cancer?

How much lung tissue will be removed and what type of surgical approach will be used depends on where the tumor is located in the lung, its size, patient’s body type/weight and any previous chest surgeries. When resection is needed, minimally invasive approaches are considered. Trained thoracic surgeons may perform video-assisted thoracic surgery (VATS) and VATS lobectomy routinely as well as robotic surgery. Surgical resection of lung cancer is generally performed as:

  • Limited resection: An operation to remove only a small portion of the lung is called a segmental or wedge resection.
  • Lobectomy: Removal of a defined section of the lung, (there are three lobes of the lung on the right and two on the left), is a lobectomy. This is the most common surgery performed for lung cancer.
  • Pneumonectomy: The removal of an entire lung is called a pneumonectomy.

Recovery after thoracic surgery depends on the extent of the surgery, whether or not it is performed minimally invasively, as well as the age and overall fitness of the patient. Many patients return home within three to four days after surgery. Patients who undergo minimally invasive surgery can generally return to work three weeks after surgery.

What other services are offered to people with lung cancer?

Pulmonary rehabilitation

Chronic diseases and disorders of the lungs and airways, as well as some of the invasive treatments for them, can take their toll on health and quality of life. Pulmonary rehabilitation programs use an array of tactics – from education and exercise to encouraging lifestyle changes – to help our patients manage their conditions.

Pain management

Pain can be a significant issue for people undergoing cancer treatment. Various cancer interventions, as well as the cancer itself, can cause pain. Effective pain management can help maintain or improve quality of life and reduce the risk of depression associated with pain.

Smoking cessation

Smoking is a major cause of lung cancer, but quitting can be a challenging proposition for some chronic smokers. As smoking patterns vary from person to person, there is no “best” method for quitting. The most successful smoking cessation programs offer smokers a range of strategies.

Last reviewed by a Cleveland Clinic medical professional on 07/10/2019.

References

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  • American Lung Association. Lung Cancer. Accessed 9/9/2019.
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  • Mazzone, PJ, Silvestri GA, Patel S, et al. Screening for lung cancer: CHEST guideline and expert panel report. [Published online ahead of print January 25, 2018]. CHEST. Doi:10.1016/j.chest.20189.01.016.
  • World Health Organization. Cancer. Accessed 9/9/2019.

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