Lung Cancer Treatment Treatment for lung cancer is managed by a team of specialists from different departments who work together to provide the best possible treatment. This team includes the health professionals required to make a diagnosis, to stage the cancer and to plan the best treatment.. The type of treatment the patient receive for lung cancer depends on several factors, including: the type of lung cancer they have (non-small-cell or small-cell mutations on the cancer) the size and position of the cancer how advanced the cancer is (the stage) overall health of the patient The most common treatment options include surgery, radiotherapy, chemotherapy and immunotherapy. Depending on the type of cancer and the stage, you may receive a combination of these treatments. Non-small-cell lung cancer If you have non-small-cell lung cancer that's in only 1 of your lungs and you're in good general health, you'll probably have surgery to remove the cancerous cells. This may be followed by a course of chemotherapy to destroy any cancer cells that may have remained in your body. If the cancer has not spread far but surgery is not possible (for example, because your general health means you have an increased risk of complications), you may be offered radiotherapy to destroy the cancerous cells. In some cases, this may be combined with chemotherapy (known as chemoradiotherapy). If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy and / or immunotherapy is usually recommended. If the cancer starts to grow again after you have had chemotherapy treatment, another course of treatment may be recommended. In some cases, if the cancer has a specific mutation, biological or targeted therapy may be recommended instead of chemotherapy, or after chemotherapy. Biological therapies are medicines that control or stop the growth of cancer cells. Small-cell lung cancer Small-cell lung cancer is usually treated with chemotherapy, either on its own or in combination with radiotherapy or immunotherapy. This can help to prolong life and relieve symptoms. Surgery isn't usually used to treat this type of lung cancer. This is because the cancer has often already spread to other areas of the body by the time it's diagnosed. However, if the cancer is found very early, surgery may be used. In these cases, chemotherapy or radiotherapy may be given after surgery to help reduce the risk of the cancer returning. Surgery There are 3 types of lung cancer surgery: lobectomy – where one or more large parts of the lung (called lobes) are removed. Your doctors will suggest this operation if the cancer is just in 1 section of 1 lung. pneumonectomy – where the entire lung is removed. This is used when the cancer is located in the middle of the lung or has spread throughout the lung. wedge resection or segmentectomy – where a small piece of the lung is removed. This procedure is only suitable for a small number of patients. It is only used if your doctors think your cancer is small and limited to one area of the lung. This is usually very early-stage non-small-cell lung cancer. People may be concerned about being able to breathe if some or all of a lung is removed, but it's possible to breathe normally with 1 lung. However, if you have breathing problems before the operation, it's likely these symptoms will continue after surgery. Radiotherapy Radiotherapy uses pulses of radiation to destroy cancer cells. There are a number of ways it can be used to treat lung cancer. An intensive course of radiotherapy, known as radical radiotherapy, may be used to treat non-smallcell lung cancer if you are not healthy enough for surgery. For very small tumours, a special type of radiotherapy called stereotactic radiotherapy may be used instead of surgery. Radiotherapy can also be used to control the symptoms, such as pain and coughing up blood, and to slow the spread of cancer when a cure is not possible (this is known as palliative radiotherapy). A type of radiotherapy known as prophylactic cranial irradiation (PCI) is also sometimes used during the treatment of small-cell lung cancer. PCI involves treating the whole brain with a low dose of radiation. It's used as a preventative measure because there's a risk that small-cell lung cancer will spread to your brain. The 3 main ways that radiotherapy can be given are: conventional external beam radiotherapy – beams of radiation are directed at the affected parts of your body. stereotactic radiotherapy – a more accurate type of external beam radiotherapy where several highenergy beams deliver a higher dose of radiation to the tumour, while avoiding the surrounding healthy tissue as much as possible. internal radiotherapy – a thin tube (catheter) is inserted into your lung. A small piece of radioactive material is passed along the catheter and placed against the tumour for a few minutes, then removed. For lung cancer, external beam radiotherapy is used more often than internal radiotherapy, particularly if it's thought that a cure is possible. Stereotactic radiotherapy may be used to treat tumours that are very small, as it's more effective than standard radiotherapy alone in these circumstances. Internal radiotherapy is usually used as a palliative treatment when the cancer is blocking or partly blocking your airway. Courses of treatment Radiotherapy treatment can be planned in several different ways. People having conventional radical radiotherapy are likely to have 20 to 32 treatment sessions. Radical radiotherapy is usually given 5 days a week, with a break at weekends. Each session of radiotherapy lasts 10 to 15 minutes and the course usually lasts 4 to 7 weeks. Continuous hyperfractionated accelerated radiotherapy (CHART) is an alternative way of giving radical radiotherapy. CHART is given 3 times a day for 12 days in a row. Stereotactic radiotherapy requires fewer treatment sessions because a higher dose of radiation is given during each treatment. People having stereotactic radiotherapy usually have 3 to 10 treatment sessions. Palliative radiotherapy usually involves 1 to 5 sessions. Chemotherapy Chemotherapy uses powerful cancer-killing medicine to treat cancer. There are several ways that chemotherapy can be used to treat lung cancer. For example, it can be: given before surgery to shrink a tumour, which can increase the chance of successful surgery (this is usually only done as part of a clinical trial). given after surgery to prevent the cancer returning. used to relieve symptoms and slow the spread of cancer when a cure isn't possible. combined with radiotherapy. Chemotherapy treatments are usually given in cycles. A cycle involves taking chemotherapy medicine for several days, then having a break for a few weeks to let the therapy work and for your body to recover from the effects of the treatment. The number of cycles you need will depend on the type and grade of lung cancer. Most people need 4 to 6 cycles of treatment over 3 to 6 months. You will see your doctor after these cycles have finished. If the cancer has improved, you may not need any more treatment. If the cancer has not improved after these cycles, your doctor will tell you if you need a different type of chemotherapy. Alternatively, you may need maintenance chemotherapy to keep the cancer under control. Chemotherapy for lung cancer involves taking a combination of different medicines. The medicines are usually given through a drip into a vein (intravenously), or into a tube connected to one of the blood vessels in your chest. Some people may be given capsules or tablets to swallow instead. Before you start chemotherapy, your doctor might prescribe you some vitamins and/or give you a vitamin injection. These help to reduce some the side effects. Immunotherapy Immunotherapy is a group of medicines that stimulate your immune system to target and kill cancer cells. It can be used on its own or combined with chemotherapy. Pembrolizumab and atezolizumab are types of immunotherapy used to treat lung cancer. You might have immunotherapy through a plastic tube that goes into: a large vein your chest (central line) a vein in your arm (cannula) It takes around 30 to 60 minutes to receive a dose, and you will normally take a dose every 2 to 4 weeks. If the side effects are not too difficult to manage and the therapy is successful, immunotherapy can be taken for up to 2 years. Common side effects of immunotherapy include: feeling tired or weak feeling and being sick diarrhoea loss of appetite pain in your joints or muscles shortness of breath changes to your skin, such as your skin becoming dry or itchy Speak to your doctor or nurse for more information about side effects and things you can do to help manage them. Targeted therapies Targeted therapies (also known as biological therapies) are medicines designed to slow the spread of advanced non-small cell lung cancer. Targeted therapies are only suitable for people who have certain proteins in their cancerous cells. Your doctor may request tests on cells removed from your lung (a biopsy) to see if these treatments are suitable for you. Side-effects of targeted therapies include: flu-like symptoms such as chills, high temperature and muscle pain fatigue diarrhoea loss of appetite mouth ulcers feeling sick Other treatments As well as surgery, radiotherapy and chemotherapy, other treatments are sometimes used to treat lung cancer, such as: Radiofrequency ablation Radiofrequency ablation may be used to treat non-small-cell lung cancer at an early stage. The doctor uses a CT scanner to guide a needle to the site of the tumour. The needle is pressed into the tumour and radio waves are sent through the needle. These waves generate heat, which kills the cancer cells. The most common complication of radiofrequency ablation is a pocket of air may become trapped between the inner and outer layer of your lung (pneumothorax). This can be treated by placing a tube into the lungs to release the trapped air. Cryotherapy Cryotherapy can be used if the cancer starts to block your airways. This is known as endobronchial obstruction, and it can cause symptoms such as: breathing problems a cough coughing up blood Cryotherapy is done in a similar way to internal radiotherapy, but instead of using a radioactive source, a device known as a cryoprobe is placed against the tumour. The cryoprobe can generate very cold temperatures, which help to shrink the tumour. Photodynamic therapy Photodynamic therapy (PDT) can be used to treat early-stage lung cancer when a person is unable or unwilling to have surgery. It can also be used to remove a tumour that's blocking the airways. Photodynamic therapy is done in 2 stages. First you'll be given an injection of a medicine that makes the cells in your body very sensitive to light. The next stage is done 24 to 72 hours later. A thin tube is guided to the site of the tumour and a laser is beamed through it. The cancerous cells, which have become more sensitive to light, are destroyed by the laser beam. Side effects of PDT can include inflammation of the airways and a build-up of fluid in the lungs. Both these side effects can cause breathlessness and lung and throat pain. However, these symptoms should gradually pass as your lungs recover from the effects of the treatment. PROGNOSIS A prognosis is the doctor's best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. A prognostic factor is an aspect of the cancer or a characteristic of the person (such as their overall health) that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis. The following are prognostic and predictive factors for lung cancer. Stage The stage of lung cancer is the most important prognostic factor. Early stages of non-small lung cancer (stages 0 and 1) have a better prognosis than later stages (stages 2, 3 or 4). With small cell lung cancer, limited stage cancers have a better prognosis than extensive stage cancers. Weight loss People who have lost more than 5% of their body weight before treatment starts have a less favourable prognosis than people who haven’t lost much weight. Performance status Performance status measures how well a person can do their daily activities and everyday tasks. People with a higher performance status score have a better prognosis than people who have a lower performance status score. Sex Women with lung cancer have a slightly better prognosis than men who are diagnosed with the same cancer. Overall health People who are in better overall health are more likely to be able to have surgery to remove the lung cancer, which may improve survival. They may also be able to tolerate chemotherapy and radiation better than people in poor health. People with lung and heart problems have a less favourable prognosis when diagnosed with lung cancer. Genetic changes to the cancer cells Tissue tests are done on lung cancer cells during diagnosis to see if there are certain changes (mutations) to the genes of the cancer cells. Lung cancers that have certain genetic changes may respond better to treatments that are designed to target that specific change. Survival statistics for non–small cell lung cancer Survival statistics for non–small cell lung cancer (NSCLC) are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular person’s chances of survival. Survival statistics for small cell lung cancer Survival statistics for small cell lung cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular person’s chances of survival.
