Treatment options for lung cancer depend on a few things like the progression and type of cancer you have, overall health, medical history, preference, and tolerance.
There are two types of lung cancer, non-small cell lung cancer, and small cell lung cancer. There are various treatment options for both types. Treatment options for cancer patients diagnosed with non-small cell lung cancer include surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of these treatments. Radiation therapy and chemotherapy are the more common treatment options for patients with small-cell lung cancer.
What Factors Contribute to Determining the Best Option for Treatment
Before starting treatment, your doctor will collect as much information about you as possible to present you with the best course of action. Your doctor will most likely ask you about the following topics.
Medical History (surgery, allergies, illness, medications, immunization)
Type of lung cancer
The extent of the disease
History of smoking
Your preference and tolerance
Expectations for the course of the disease
Types of Treatment for Non-Small Cell Lung Cancer (NSCLC)
There are a handful of options to choose from when treating NSCLC. A doctor will evaluate the patient and the type of lung cancer to narrow down the best course of treatment. Treatment depends on many factors, mainly the location and size of the tumor.
Surgery is when a doctor operates on the patient to remove cancer tissue. Surgery is common for early-stage treatment, but this depends on the size and location of the tumor, the type, and stage of cancer, as well as any other medical conditions. If the tumor is localized and not spreading, surgery is the best option for early-stage non-small cell lung cancers and carcinoid tumors.
If your doctor thinks surgery is an option, before moving forward, a doctor will order a few tests to make sure the patient is healthy enough before, during, and after the surgery.
Examination before surgery: checks the spread of cancer
Tests before surgery: checks the function of your organs to make sure they are healthy enough to withstand surgery
Pulmonary function tests: checks to see if enough healthy lung tissue will be left after surgery
There are two ways a surgeon can approach the surgery. The first approach is called a thoracotomy or a minimally invasive surgery called thoracoscopy.
A surgeon will cut an incision in the side of the chest along the curve of the rib cage. This long incision allows the surgeon to gain full access to the lung where the tumor is located. The type of operation the surgeon performs will depend on the size of the tumor, its location, and lung function. These operations require a larger incision to operate and the patient to be put to sleep. The recovery time is generally five to seven days in the hospital after surgery.
Types of Lung Surgery Operations
Segmental or wedge resection: This operation is more common among patients who will not have enough healthy lung function after the surgery, so a surgeon will only remove part of a lobe.
Lobectomy: A surgeon will remove the entire lobe containing the tumor. If it is safe to perform this operation, it is the preferred route to take. A surgeon may recommend this operation over a segmental or wedge resection if the lung is healthy enough.
Pneumonectomy: A surgeon will remove the entire lung if the tumor is close to the center of the chest.
Sleeve resection: This operation is more common among patients whose tumor is located in the airway of the lungs. A surgeon will cut above and below the tumor on the airway to remove it and then stitch up the gap. In some cases, a surgeon may suggest this operation over a pneumonectomy if it can save more of the lung.
A thoracoscopy or video-assisted thoracic surgery (VATS) is when a surgeon will cut one to four small incisions to gain access to the chest and will use a camera to see the lung. This procedure is used more frequently in early-stage lung cancer patients. It has fewer complications, is less invasive, and doesn't require a long hospital recovery time like thoracotomy.
Another option is robotically-assisted thoracic surgery (RATS). A surgeon controls robotic arms from a control panel to operate. RATS is similar to VATS in terms of less pain, blood loss, and recovery time.
Radiation therapy is similar to x-rays, using powerful, high-energy radiation to kill cancer cells or prevent them from growing and shrinking tumors. These treatments are painless and usually last a few minutes. Treatments can vary between patients, but usually, radiation therapy is conducted five days a week, for five to seven weeks.
Radiation therapy can be administered externally (outside the body), the more commonly used technique, or internally (inside the body).
It is not uncommon to use radiation therapy before and after doing surgery. This way, doctors can shrink the tumor, perform the operation, and kill any remaining cancer cells that may be leftover in the lungs.
Radiation may also be combined with chemotherapy to treat lung cancer. It also can be used to relieve symptoms caused by cancer, such as pain, bleeding, or blockage of airways by the tumor.
For small cell lung cancer, radiation is one of two methods to treat lung cancer. Sometimes patients will get radiation to the brain to lower the chances of lung cancer spreading to the brain (prophylactic cranial irradiation), which is common in SCLC.
Doctors use several different radiation techniques to administer therapy. These include:
External Beam Radiation Therapy
External radiation aims high levels of radiation directly to the cancer cells. The radiation kills the cancer cells only in the area it's directed at.
In some cases, external radiation may be the only treatment option because the cancer patient is not healthy enough to have surgery or the cancer has spread too much.
Intensity Modulated Radiation Therapy (IMRT)
IMRT is a form of 3D therapy using radiation beams to match the shape of the tumor. This method has two benefits, firstly, it can cover more surface area of the tumor at once. Second, it allows the intensity of the beams to be adjusted, avoiding damage to surrounding areas. For instance, if the tumor was near the spinal cord, this technique is the best option.
Volumetric modulated arc therapy (VMAT) is an alternative to IMRT. A machine rotates once around the body while delivering radiation quickly. This allows each treatment to be quick and painless.
Brachytherapy (internal or implant radiation therapy)
A doctor places a sealed radioactive material directly into the tumor or near it. Doctors can control the spread of radiation so it only travels a short distance from the source. This ensures the surrounding healthy tissue is not harmed or damaged.
After a short period, doctors will remove the radioactive material. If the radioactive material doesn't get removed, within weeks, radiation grows weaker.
Stereotactic Body Radiation Therapy (SBRT) / Stereotactic Ablative Radiotherapy (SABR)
Stereotactic Body Radiation Therapy (SBRT), also called Stereotactic Ablative Radiotherapy (SABR), uses a very high level of radiation. It is delivered very accurately to tumors in the lung or other organs while limiting the dose to the surrounding organs.
Doctors will consider this treatment if the patient is in the early stages of lung cancer and if surgery isn't an option. It might also be an option for tumors that have limited spread to other parts of the body, such as the brain or adrenal gland.
To focus the radiation precisely onto the tumor, you are put into a specially designed body frame during treatment to minimize movement of the lung tumor. SBRT takes roughly one to five treatments.
Three-dimensional conformal radiation therapy (3D-CRT)
Special computers can precisely map out the location of the tumor. Radiation beams are then shaped and aimed at the tumor from several directions. This decreases the chance of damaging the surrounding normal tissue.
Stereotactic Radiosurgery (SRS)
Stereotactic radiosurgery is commonly used in lung cancer cases where the patient's tumor has spread to the central nervous system (brain or spinal cord). Depending on the patient's case, SRS can be used with surgery or as a substitute for surgery. It can be administered in one of two ways.
First, a machine focuses roughly 200 radiation beams on the tumor from various angles. Your head is kept in a frame to minimize movement. This can last anywhere from a few minutes to hours.
A second way is a computer-controlled machine (called a linear accelerator), which moves around your head while creating radiation aimed at the tumor. This linear accelerator and can cover the tumor from multiple angles and can be repeated if needed.
Chemotherapy is very different from surgery and radiation therapy. Surgery and radiation focus on the origin of the tumor, whereas chemotherapy uses medication that travels through the body searching for tumor cells.
Chemotherapy medications can be pills or injected into your veins via a syringe or IV infusion. These medications can prevent cancer cell's from reproducing resulting in the tumor-shrinking and eventually killing cancer. There are many drugs in different groups, serving different purposes to fight cancer cells. An oncologist will assist with finding the best medication(s) for treatment.
Chemotherapy may be used before or after other treatments, or by its self.
Targeted therapy, like chemotherapy, uses drugs to prevent the spread of cancer cells. These drugs travel through the body on the hunt for cancer cells and hinders their ability to grow.
Medication can be in pill form or given in your veins. A doctor will order tests before starting this treatment if they feel targeted therapy might be an option for your cancer treatment.
These drugs are not full proof in ridding the body of cancer cells. It is common for these medications to be combined with other treatment options such as chemotherapy.
Having radiation, chemotherapy, or both before surgery. A doctor may use one or both methods to shrink the tumor as much as possible to make surgery easier.
Having chemotherapy or radiation therapy after surgery. A doctor may use this treatment to rid the body of any cancer cells that may remain in the body after surgery. Even if there is no sign of cancer cells after surgery, your doctor may suggest adjuvant treatment. This can help lower the risk of cancer returning or spreading.
The immune system can keep itself from attacking healthy, normal cells that the body needs by using "checkpoints." Sometimes cancer cells can avoid being attacked by the immune system by using these checkpoints.
To prevent cancer cells from disguising themselves at these checkpoints, medication or checkpoint inhibitors can be used to treat some patients with NSCLC.
Immunotherapy is a newer approach that uses medication to activate the body's immune system. This approach uses the body's natural defense to fight off the cancer cells.