Lung cancer can be treated by these modalities: Surgery, Radiation Therapy, Chemotherapy and Targeted Therapy. Each treatment option is well explained below, followed by a brief of common treatment plans according to the type and stage of cancer. Treatment options and recommendations depend on several factors which include the type and stage of cancer, the patient’s preferences and overall healthand possible side effects. At the time of charting out the final treatment plan, treatment team may decide to include treatment for symptoms and side effects, which plays an important role in cancer care. As with other cancers, therapy may be prescribed that is intended to be curative (removal or eradication of a cancer) or palliative (measures that are unable to cure a cancer but can reduce pain and suffering). More than one type of therapy may be prescribed.
A surgical oncologist is a surgeon who specializes in treating cancer with surgery. For lung cancer, a thoracic surgeon is specially trained to perform lung cancer surgery. The goal of surgery is the complete removal of the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surrounding border or margin of normal lung tissue. A “negative margin” means that when the pathologist examines the lung, or piece of lung that has been removed by the surgeon, no cancer was found in the healthy tissue surrounding the tumor.
Lobectomy. The lungs have five lobes, three in the right lung and two in the left lung. For NSCLC, the removal of an entire lobe of the lung in a procedure called a lobectomy is often the most effective type of surgery, even when the lung tumor is very small.
A wedge. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of normal lung.
Segmentectomy. This is another way to remove the cancer when an entire lobe of the lung cannot be removed. In a segmentectomy, the surgeon removes the portion of the lung where the cancer developed.
Pneumonectomy. If the tumor is close to the centre of the chest, the surgeon may have to remove the entire lung.
Radiofrequency ablation. Radiofrequency ablation (RFA) is the use of a needle inserted into the tumor to destroy the cancer with an electrical current. It is sometimes used for a lung tumor that cannot be removed with the other types of surgery listed above.
The time it takes to recover from lung surgery depends on how much of the lung is removed and the health of the patient before surgery.
Adjuvant therapy is treatment that is given after surgery to lower the risk of recurrence of lung cancer. Adjuvant therapy may include radiation therapy, chemotherapy etc. (possibly targeted therapy). Each therapy is described below. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. It also can decrease the risk of recurrence, though there is always some risk that the cancer will come back.
Along with staging, other tools can help determine prognosis and help the patient and the doctor make decisions about whether adjuvant therapy would be helpful in the treatment.
Radiation therapy uses high-energy X-rays or other types of radiation to kill dividing cancer cells. If a patient needs Radiation therapy, he / she will be asked to see a Radiation Oncologist (a doctor who specializes in giving radiation therapy to treat cancer). The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine (Linear Accelerator) outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to several weeks. When radiation treatment is given using implants, it is called internal radiation therapy, or brachytherapy. However, brachytherapy is rarely used for lung cancer.
Like surgery, radiation therapy cannot be used to treat widespread cancer. Radiation only destroys cancer cells directly in the path of the radiation beam. It also damages the normal cells in its path; for this reason, it cannot be used to treat large areas of the body.
Sometimes, CT scans are used to plan out exactly where to direct the radiation to lower the risk of damaging healthy parts of the body. This is called intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). It is not an option for all patients, but it may be used for patients with early disease and small tumors when surgery is not an option.
Patients with lung cancer who receive radiation therapy often experience fatigue and loss of appetite. If radiation therapy is given to the neck or center of the chest, patients may also develop a sore throat and have difficulty swallowing. Patients may also notice skin irritation, similar to sunburn, where the radiation was directed. Most side effects go away soon after treatment is finished.
If the radiation therapy irritates or inflames the lung, patients may develop a cough, fever, or shortness of breath months and sometimes years after the radiation therapy ends. About 15% of patients develop this condition, called radiation pneumonitis. If it is mild, radiation pneumonitis does not need treatment and goes away on its own. If it is severe, a patient may need treatment for radiation pneumonitis with steroid medications. Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. Typically, the scarring does not cause symptoms. However, severe scarring can cause a permanent cough and shortness of breath. For this reason, radiation oncologists carefully plan the treatments using CT scans of the chest to lessen the amount of normal lung tissue exposed to radiation.