Introduction
Upon diagnosis of non-small cell lung cancer (NSCLC), a variety of treatment choices are offered, depending on the stage (extent) of the disease. Other elements, such as a patient’s overall health and lung function, as well as certain features of cancer itself, are also important. In many situations, more than one form of therapy is utilized.
It’s critical to talk about all of your treatment choices and any potential negative effects with your family and treatment team so that you can make the best decision for yourself. If you have any questions, please ask your doctor or treatment team.
It is sometimes a good idea to seek a second opinion if time permits. A second opinion can provide you with additional knowledge and confidence in your treatment choice.
Before deciding on a treatment, gather all of your options and discuss them with your doctors. Your treatment will most likely be overseen by a group of specialists that may include:
- a thoracic surgeon, specializing in the chest and lungs;
- a pulmonologist (lung specialist);
- a medical oncologist;
- a radiation oncologist.
Treatment for Non-small Cell Lung Cancer (NSCLC)
Stage I: Depending on the extent of the tumor, you might only require surgery to remove a portion of the lung. If you’re at high risk of recurring, chemotherapy may also be suggested.
Stage II: You might require surgery to remove part of or the entire lung. Chemotherapy is usually advised.
Stage III: Your treatment will most likely include chemotherapy, surgery, and radiation therapy.
Stage IV is one of the most difficult to treat. Surgical excision, radiation therapy, chemotherapy, targeted therapy, and immunotherapy are all viable alternatives.
Treatment for Small Cell Lung Cancer (SCLC)
There are also several treatment options for Small Cell Lung Cancer (SCLC). Chemotherapy and radiation therapy are all viable choices. In most circumstances, the disease will be too advanced for surgery.
Learn more about treatment options and what to expect during them down below.
Surgery
These are the 3 types of lung cancer surgery:
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A lobectomy is a type of surgical lung excision in which one or more major portions of the lungs (called lobes) are removed. If the malignancy is only present in a single section of 1 lung, your physicians will advise you to have this procedure.
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Pneumectomy – where the entire lung is removed – is another surgical procedure. It’s used when a tumor has grown in the center of the lung or has spread throughout it.
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Wedge resection or segmentectomy is a procedure only suitable for a small number of patients because it entails removing a small piece of the lung. It’s only used if your doctors determine that your cancer is limited to one area of the lung and is minor in terms of severity. This usually happens in very early-stage NSCLC.
Although people may be concerned about not being able to breathe if some or all of a lung is removed, it is feasible to breathe normally with only one lung. If you have breathing issues before the procedure, however, these symptoms are likely to persist after it.
Surgery entails cutting (incision) into your chest or side and removing a portion or all of the afflicted lung, depending on the type of cancer. If it’s believed that cancer has spread to nearby lymph nodes, they may also be removed.
After the Operation
You’ll probably be able to return home 5 to 10 days after your surgery. You’ll be encouraged to get up and walk as soon as possible after your operation. Even if you have to stay in bed, you’ll need to keep performing routine leg exercises to help circulation and prevent blood clots from developing. To minimize the risk of complications, breathing exercises to help with relaxation and circulation are also recommended.
When you return home, you’ll need to exercise with care to increase your strength and fitness. Walking and swimming are excellent forms of exercise that most individuals can do following treatment for lung cancer. Choose which types of activity are best for you according to the advice of your care team.
Complications
There is a chance of complications with every surgical procedure. Complications are thought to occur in around 1 out of 5 lung cancer operations. These issues may generally be treated using medicine or additional surgery, which means you’ll need to remain in the hospital for a longer time.
The following are some of the possible complications that may occur after lung surgery:
- inflammation or infection of the lungs (pneumonia);
- excessive bleeding;
- a blood clot in the calf (deep vein thrombosis), which has the potential to travel to the lung and cause a pulmonary embolism.
Radiotherapy
Radiotherapy is a treatment that uses radiation to destroy cancer cells. It may be used in several ways to treat lung cancer.
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If you are not healthy enough for surgery, a special form of radiation therapy, called radical radiotherapy, might be used to treat non-small-cell lung cancer. Stereotactic radiotherapy may be used instead of surgery in certain cases where the tumor is very small.
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Treatment with radiation therapy can be used to prevent or treat the symptoms, such as pain and bleeding, as well as slow the growth of cancer when a cure isn’t possible (known as palliative radiotherapy).
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Prophylactic cranial irradiation (PCI) is a type of radiotherapy that, in some cases, is given to patients with small-cell lung cancer before they receive their intended therapy. PCI entails delivering a low dose of radiation to the whole brain. It’s recommended as a preventative therapy because small-cell lung cancer has the potential to spread to the brain.
The 3 main ways that radiotherapy can be given are:
- External radiation therapy – beams of radiation are aimed at the affected areas of your body.
- Stereotactic radiosurgery is a specialized form of external beam radiotherapy that delivers greater doses of radiation to the tumor while minimizing damage to surrounding healthy tissue.
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Internal radiation therapy – a tiny tube (catheter) is inserted into the lung, through which a small piece of radioactive material travels and is placed against the tumor for a few minutes before being extracted.
External beam radiotherapy is used more frequently than internal radiation therapy for lung cancer, especially if a cure is thought to be possible. Stereotactic radiotherapy may be utilized to treat tumors that are small enough to undergo stereotactic therapy rather than standard radiotherapy alone. When the cancer is obstructing or only partly blocking your airway, internal radiotherapy is usually given as palliative therapy.
Side Effects
The most common side effects of radiotherapy to the chest are chest pain, tiredness (at rest), persistent cough that may bring up blood-stained mucus, difficulties swallowing (dysphagia), and redness and soreness of the skin, which looks and feels like sunburn. These side effects should disappear once the radiation therapy has stopped.
Chemotherapy
Chemotherapy is a form of cancer treatment that employs strong cancer-killing drugs to treat the disease. There are several different ways chemo can be used to treat lung cancer:
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Can be administered ahead of time to shrink a tumor, increasing the chance of a successful operation (this is usually only done as part of a clinical trial).
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After surgery, chemotherapeutic agents can be given to keep cancer from recurring.
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Can be administered to alleviate symptoms and help stop the progression of the disease when a cure isn’t available.
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Can be used in conjunction with radiation therapy.
Chemotherapy is usually administered in cycles. A cycle entails undergoing chemotherapy for some days, after which taking a rest for a few weeks to allow the treatment to work and your body to recover from the therapy’s side effects. The number of cycles you’ll require will depend on the sort and grade of lung cancer. The majority of individuals require 4 to 6 treatments over 3 to 6 months.
If cancer has improved after the treatment, no more chemotherapy may be needed. If cancer has not shrunk after a few cycles of chemotherapy, your doctor will determine whether you need a different type of treatment. To keep the disease in check, you may require maintenance chemotherapy.
A variety of medications are used in chemotherapy for lung cancer. The medicines are generally administered via a drip into a vein (intravenously), or through a tube connected to one of the chest’s blood vessels. Instead, some individuals might be given capsules or tablets to consume.
Side Effects
Chemotherapy may induce tiredness, nausea, sickness, and hair loss. You may feel better during chemotherapy if you take some medicines to lessen these side effects, although they are common and should lessen after therapy is completed.
Your immune system will become weakened by chemotherapy, making you more susceptible to illness. If you have indications of an infection, such as a high fever or feel generally sick, tell your health team or doctor as soon as possible.
Immunotherapy
Immunotherapy is a type of therapy that boosts your immune system’s ability to identify and destroy cancer cells. It may be used alone or in combination with chemotherapy.
Your doctor may administer immunotherapy via a plastic tube (central line) that goes into your chest or an intravenous drip into your arm. It takes approximately 30 to 60 minutes to receive a dose, and you will require one every 2 to 4 weeks.
If the adverse effects are manageable and the treatment is effective, immunotherapy can be administered for up to two years.
Side Effects
Side effects are common when taking immunotherapy, such as tiredness or weakness, sickness, diarrhea, loss of appetite, aching joints or muscles, shortness of breath, skin changes such as dry or itchy skin.
For more information about side effects and how to manage them, see your doctor or nurse.
Targeted Therapies
Targeted therapies (also known as biological therapies) are drugs developed to limit the spread of advanced non-small-cell lung cancer. Targeted treatments are only suitable for people with specific proteins in their malignant cells. To determine whether these medicines are appropriate for you, your doctor may need biopsies of cells taken from your lung.
Side Effects
Flu-like symptoms such as chills, a high temperature, and muscular pain can all be caused by targeted therapies, as well as fatigue, diarrhea, loss of appetite, mouth ulcers, and feeling sick. Other side effects of skin problems, which usually develop slowly over time after the start of the treatment, are high blood pressure, bleeding or clotting problems, swelling in hands, feet, and legs, as well as in your face.
Other Treatment Options
Other therapies are sometimes used to treat lung cancer. These are:
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Radiofrequency ablation: At an early stage, radiofrequency ablation may be utilized to treat non-small-cell lung cancer. The doctor uses a CT scanner to guide a needle to the tumor’s location. The needle is inserted into the tumor and radio waves are applied through it. These radiations cause heat, which kills tumor cells.
The most typical radiofrequency ablation complication is a pocket of air that may form between the inner and outer layers of your lung (pneumothorax). To release the trapped air, a tube might be inserted into the lungs.
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Cryotherapy: Cryotherapy can be used to treat endobronchial obstruction, which occurs when cancer begins to obstruct your airways. Breathing difficulties, a cough, and bleeding from the lungs are all possible signs of endobronchial obstruction.
Cryotherapy is similar to internal radiation therapy in that it uses a cryoprobe, which is an instrument that applies very cold temperatures against the tumor.
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Photodynamic therapy: Early-stage lung cancer can be treated with photodynamic therapy (PDT) if a person is unable or unwilling to undergo surgery. It may also be utilized to remove a tumor that’s obstructing the airways.
Photodynamic therapy is performed in two steps. First, you’ll be given an injection of a drug, which will make the cells in your body extremely sensitive to light. The second stage, which takes place 24 to 72 hours later, is as follows: A thin tube is directed to the tumor site and a laser is directed through it. The laser beam destroys the cancerous cells that have become more sensitive to light. Side effects of PDT include airway inflammation and lung fluid accumulation. Both these side effects can induce breathlessness and chest tightness. However, as your lungs recover from the therapy’s influence, these symptoms should gradually lessen.
Clinical Trials
Clinical trials offer the opportunity to try out new medicines. Check with your doctor to see whether you’re qualified for a clinical trial.
Palliative Care
Some people with advanced lung cancer choose to cease treatment. Palliative care therapies, which are intended to alleviate symptoms rather than the actual illness, are still available to you.