CMedEd | Understanding Lung Cancer

Treatment

Treatment for lung cancer varies, depending largely on the type of lung cancer and the stage of the disease. Surgery (resection) is usually the main treatment option for early-stage non-small cell lung cancers, and occasionally early stage small cell carcinoma. In more advanced stages, treatments may also include chemotherapy, radiation therapy, and targeted therapy. Surgery is rarely an option for small-cell lung cancer because it is such an aggressive disease and usually isn't detected until it has reached an extensive stage. Here are some of the procedures your doctor may recommend as part of your treatment plan.

Surgery

Surgery is usually the main treatment option for early-stage non-small cell lung cancers. It offers the best chance of success for individuals healthy enough to undergo the operation. There are several different surgical procedures your doctor may recommend to treat your cancer:

Wedge Resection

The surgeon removes the entire tumor along with a wedge-shaped margin of healthy tissue.

Segmentectomy

The surgeon removes part of the lobe where the tumor is located.

Lobectomy

The surgeon removes the entire lobe where the tumor is located.

Pneumonectomy

The surgeon removes the entire lung where the cancer is located.

Sleeve Resection

The surgeon removes the lobe together with part of the bronchus where the cancer is located. Once the cancer is removed, the surgeon reattaches the two healthy parts of the lung.

In each of these procedures, the surgeon also removes nearby lymph nodes to have them checked for cancer spread. This helps your doctor determine whether or not you need adjuvant chemotherapy and/or radiation after surgery.

Chemotherapy

Radiation Therapy

Radiation therapy uses waves of high energy rays to target and kill cancer cells. There are two primary methods of radiation therapy: external beam radiation and internal radiation therapy. In external beam radiation, a large machine delivers radiation to your tumor from outside the body. This is the method most commonly used to treat lung cancer. In internal radiation therapy (brachytherapy), your doctor places radioactive pellets inside your body near the tumor. Doctors occasionally use internal radiation to shrink tumors blocking the airways in your lungs. There are several new external radiation techniques doctors use to target the tumor more accurately and administer higher amounts of radiation with fewer side effects.

Three-dimensional conformal radiation therapy (3D-CRT)

Your doctor uses a CT or MRI scan to find the exact location of your tumor. Your doctor then administers radiation to the tumor from several different angles. This technique allows your doctor to deliver the maximum amount of radiation to the tumor without harming normal tissue.

Proton beam radiation therapy

Proton beam radiation therapy uses protons rather than X-rays to kill cancer cells. Protons cause much less damage to normal tissue and causes fewer side effects than traditional radiation therapy. This allows doctors to deliver more radiation to the tumor with less damage to normal tissue.

Please see Understanding Proton Therapy to learn more.

Stereotactic radiation therapy

In stereotactic radiation therapy, your doctor will find the exact location of your tumor using a CT or MRI scan. Your doctor will then put you in a body frame to reduce movement and deliver radiation to the tumor from many different angles.

Intensity-modulated radiotherapy

IMRT changes the shape of the radiation beam to match the shape of the tumor. Your doctor can adjust the strength of the beam to limit the amount of radiation to healthy tissue. This allows your doctor to target the tumor more precisely and administer higher amounts of radiation with fewer side effects.

Additional Treatments

The doctor may also recommend any of the following treatments:

Targeted Therapy

Some types of lung cancer cells contain certain proteins that cause the cancer to grow more aggressively. Targeted therapy specifically targets these cells, preventing the proteins from fueling cell growth. For lung cancer, the doctor may recomend drugs that target the EGFR protein. Another form of targeted therapy attacks the process of angiogenesis, which tumors use to create new blood vessels to support their growth. This therapy may shrink the tumor or slow its growth.

Immunotherapy

Cancer immunotherapy is a type of treatment that harnesses the patient’s immune system to attack and destroy tumor cells. The immune system has checkpoints to keep it from attacking normal cells in the body and cancer cells can use these checkpoints to avoid being destroyed by the immune system. PD-1 is one such checkpoint, and a drug targeting this protein is now approved for the treatment of metastatic squamous cell cancer of the lung. As with targeted therapy, this treatment can shrink a tumor or slow its growth .

Clinical Trials

Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation. You may need to be referred to a University hospital or a dedicated cancer center as not all outpatient cancer clinics participate in all clinical trials.

Palliative Treatments

Doctors may perform procedures to relieve symptoms caused by the cancer, particularly in advanced stages. Supportive surgery includes putting a stent into the airways, and using photodynamic or laser therapy to relieve blockages.

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Understanding Lung Cancer