Treatment of lung cancer depends on
a number of factors, including the type of lung cancer (non-small or small
cell lung cancer), the size, location, and extent of the tumor, and the
general health of the patient. Many different treatments and combinations
of treatments may be used to control lung cancer, and/or to improve quality
of life by reducing symptoms.
Surgery is an operation to remove the cancer. The
type of surgery a doctor performs depends on the location of the tumor
in the lung. An operation to remove only a small part of the lung is
called a segmental or wedge resection. When the surgeon removes an entire
lobe of the lung, the procedure is called a lobectomy. Pneumonectomy
is the removal of an entire lung. Some tumors are inoperable (cannot
be removed by surgery) because of the size or location, and some patients
cannot have surgery for other medical reasons.
Chemotherapy is the use of anticancer drugs to kill
cancer cells throughout the body. Even after cancer has been removed
from the lung, cancer cells may still be present in nearby tissue or
elsewhere in the body. Chemotherapy may be used to control cancer growth
or to relieve symptoms. Most anticancer drugs are given by injection
directly into a vein (IV) or by means of a catheter, a thin tube that
is placed into a large vein and remains there as long as it is needed.
Some anticancer drugs are given in the form of a pill.
Radiation therapy, also called radiotherapy, involves
the use of high-energy rays to kill cancer cells. Radiation therapy
is directed to a limited area and affects the cancer cells only in that
area. Radiation therapy may be used before surgery to shrink a tumor,
or after surgery to destroy any cancer cells that remain in the treated
area. Doctors also use radiation therapy, often combined with chemotherapy,
as primary treatment instead of surgery. Radiation therapy may also
be used to relieve symptoms such as shortness of breath. Radiation for
the treatment of lung cancer most often comes from a machine (external
radiation). The radiation can also come from an implant (a small container
of radioactive material) placed directly into or near the tumor (internal
radiation).
Photodynamic therapy (PDT), a type of laser therapy,
involves the use of a special chemical that is injected into the bloodstream
and absorbed by cells all over the body. The chemical rapidly leaves
normal cells but remains in cancer cells for a longer time. A laser
light aimed at the cancer activates the chemical, which then kills the
cancer cells that have absorbed it. Photodynamic therapy may be used
to reduce symptoms of lung cancer – for example, to control bleeding
or to relieve breathing problems due to blocked airways when the cancer
cannot be removed through surgery. Photodynamic therapy may also be
used to treat very small tumors in patients for whom the usual treatments
for lung cancer are not appropriate.
Clinical trials (research studies) to evaluate new ways
to treat cancer are an option for many lung cancer patients. In some studies,
all patients receive the new treatment. In others, doctors compare different
therapies by giving the new treatment to one group of patients and the usual
(standard) therapy to another group. Through research, doctors are exploring
new and possibly more effective ways to treat lung cancer.
Treating nonsmall cell lung cancer
Patients with non-small cell lung cancer may be treated in several ways.
The choice of treatment depends mainly on the size, location, and extent
of the tumor. Surgery is the most common way to treat this type of lung
cancer. Cryosurgery, a treatment that freezes and destroys cancer tissue,
may be used to control symptoms in the later stages of non-small cell lung
cancer. Radiation therapy and chemotherapy may also be used to slow the
progress of the disease and to manage symptoms.
Treating small cell lung cancer
Small cell lung cancer spreads quickly. In many cases, cancer cells have
already spread to other parts of the body when the disease is diagnosed.
In order to reach cancer cells throughout the body, doctors almost always
use chemotherapy. Treatment may also include radiation therapy aimed at
the tumor in the lung or tumors in other parts of the body (such as in the
brain). Some patients have radiation therapy to the brain even though no
cancer is found there. This treatment, called prophylactic cranial irradiation
(PCI), is given to prevent tumors from forming in the brain. Surgery is
part of the treatment plan for a small number of patients with small cell
lung cancer.
Side effects
The side effects of cancer treatment depend on the type of treatment and
may be different for each person. Side effects are often only temporary.
Doctors and nurses can explain the possible side effects of treatment, and
they can suggest ways to help relieve symptoms that may occur during and
after treatment.
Surgery for lung cancer is a major operation. After lung surgery,
air and fluid tend to collect in the chest. Patients often need help
turning over, coughing, and breathing deeply. These activities are important
for recovery because they help expand the remaining lung tissue and
get rid of excess air and fluid. Pain or weakness in the chest and the
arm and shortness of breath are common side effects of lung cancer surgery.
Patients may need several weeks or months to regain their energy and
strength.
Chemotherapy affects normal as well as cancerous cells. Side
effects depend largely on the specific drugs and the dose (amount of
drug given). Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores,
and fatigue.
Radiation therapy, like chemotherapy, affects normal as well
as cancerous cells. 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 are a dry, sore throat; difficulty
swallowing; fatigue; skin changes at the site of treatment; and loss
of appetite. Patients receiving radiation to the brain may have headaches,
skin changes, fatigue, nausea and vomiting, hair loss, or problems with
memory and thought processes.
Photodynamic therapy makes the skin and eyes sensitive to light
for 6 weeks or more after treatment. Patients are advised to avoid direct
sunlight and bright indoor light for at least 6 weeks. If patients must
go outdoors, they need to wear protective clothing, including sunglasses.
Other temporary side effects of PDT may include coughing, trouble swallowing,
and painful breathing or shortness of breath. Patients should talk with
their doctor about what to do if the skin becomes blistered, red, or
swollen.
Today, because of what has been learned in clinical trials, doctors are
able to control, lessen, or avoid many of the side effects of treatment.
Importance of follow-up care
Follow-up care after treatment for lung cancer is very important. Regular
checkups ensure that changes in health are noticed, and if the cancer returns
or a new cancer develops, it can be treated as soon as possible. Checkups
may include physical exams,
chest X-rays,
or lab tests. Between scheduled appointments, people who have had lung cancer
should report any health problems to their doctor as soon as they appear.
Emotional support
Living with a serious disease, such as cancer, is challenging. Apart from
having to cope with the physical and medical challenges, people with cancer
face many worries, feelings, and concerns that can make life difficult.
They may find they need help coping with the emotional as well as the practical
aspects of their disease. In fact, attention to the emotional and psychological
burden of having cancer is often part of a patient's treatment plan. The
support of the health care team (doctors, nurses, social workers, and others),
support groups, and patient-to-patient networks can help people feel less
alone and upset, and improve the quality of their lives. Cancer support
groups provide a safe environment where cancer patients can talk about living
with cancer with others who may be having similar experiences. Patients
may want to speak to a member of their health care team about finding a
support group.
Questions for your doctor
Asking your doctor the following questions will help you further understand
your condition. To help you remember what the doctor says, you may take
notes or ask whether you may use a tape recorder. Some people also want
to have a family member or friend with them when they talk to the doctor
– to take part in the discussion, to take notes, or just to listen.
Diagnosis
What tests can diagnose lung cancer? Are they painful?
How soon after the tests will I learn the results?
What type of lung cancer do I have?
Treatment
What treatments are recommended for me?
What clinical trials are appropriate for my type of cancer?
Will I need to be in the hospital to receive my treatment? For how
long?
How might my normal activities change during my treatment?
Side effects
What side effects should I expect? How long will they last?
What side effects should I report? Whom should I call?
Follow-up
After treatment, how often do I need to be checked? What type of follow-up
care should I have?
Will I eventually be able to resume my normal activities?
Health care team
Who will be involved with my treatment and rehabilitation? What is
the role of each member of the health care team in my care?
What has been your experience in caring for patients with lung cancer?
Resources
Are there support groups in the area with people I can talk to? Are
there organizations where I can get more information about cancer, specifically
lung cancer?
