What You Need to Know
- Treatment for lung cancer varies according to age, type of cancer, extent of disease, tolerance to medication and patient preference.
- Treatment options include a combination of surgery, radiation, chemotherapy, photodynamic therapy and targeted therapy.
Specific treatment for lung cancer will be determined by your doctor based on:
- Age, overall health and medical history
- The type of lung cancer
- Extent of the disease
- Your tolerance for specific medications, procedures or therapies
- Expectations for the course of the disease
- Your opinion or preference
Depending on its type and stage, lung cancer may be treated with surgery, chemotherapy or other medications, radiation therapy, local treatments such as laser therapy, or a combination of treatments. Combination treatment or multimodality treatment refers to having more than one type of treatment.
Treatment for lung cancer includes one or more of the following approaches.
Surgery is part of the treatment for early-stage lung cancers. The type of surgery depends on the size and location of the tumor in the lung, the extent of the cancer, the general health of the patient and other factors. Many surgeries are done with a long incision in the side of the chest, known as a thoracotomy. Some early stage tumors may be treated with video-assisted thoracic surgery (VATS), which uses several small incisions (instead of one large one) and special long surgical tools.
Types of surgery include:
Segmental or wedge resection: Removal of only a small part of the lung
Lobectomy: Removal of an entire lobe of the lung
Pneumonectomy: Removal of an entire lung
Sleeve resection: Removal of a piece of bronchus, after which the lung is reattached to the remaining part of the bronchus
Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. Radiation may also be used with chemotherapy to treat lung cancer. The following techniques are used to deliver radiation therapy:
External radiation (external beam therapy): A treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Because radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. The following forms of external radiation may be used to treat lung cancer:
- Intensity-modulated radiation therapy (IMRT): This radiation technology allows the operator to adjust the location and intensity of radiation beams in real time.
- Stereotactic body radiation therapy (SBRT): Used to treat lung cancer in its early stages, this radiation technology delivers very high doses of focused radiation to a small area. Using very sophisticated IMRT technology, the radiation oncologist can increase the intensity of the radiation while compressing the amount of radiation into only three to five sessions. With higher dose rates, SBRT is much more convenient for patients and offers improved success rates.
Internal radiation (brachytherapy, implant radiation): Radiation is given inside the body as close to the cancer as possible. Substances that produce radiation, called radioisotopes, may be swallowed, injected or implanted directly into the tumor. Some of the radioactive implants are called seeds or capsules. Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Some internal radiation treatments stay in the body temporarily. Other internal treatments stay in the body permanently, though the radioactive substance loses its radiation within a short period of time. Brachytherapy is rarely used to treat lung cancer. In some cases, both internal and external radiation therapies are used.
Chemotherapy is the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cells’ ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Chemotherapy may be given before other treatments, after other treatments or alone for lung cancer.
Photodynamic therapy (PDT) is a type of laser treatment that involves injecting photosensitizing chemicals into the bloodstream. Cells throughout the body absorb the chemicals. The chemicals collect and stay longer in the cancer cells than in the healthy cells. At the right time, when the healthy cells surrounding the tumor may already be relatively free of the chemical, the light of a laser can be focused directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells. For lung cancer, the light is delivered through a bronchoscope (a small, flexible tube with a light on the end) that is inserted through the mouth or nose.
These are drugs that target specific parts of cancer cells or nearby cells that help them grow. So far, these drugs have only been found to be useful for some non-small cell lung cancers. For example, as cancers grow, they form new blood vessels that nourish them. Research aimed at blocking the growth of these blood vessels has led to the development of medications called anti-angiogenesis medications. Bevacizumab is one of these medications. It has been found to be helpful in prolonging the survival of some patients with advanced lung cancer. It is used with the standard chemotherapy regimen. Medications with other specific targets, such as crizotinib, erlotinib and cetuximab, may also be useful.
There are specific names for the order in which treatment is given. Neoadjuvant treatment refers to having radiation or chemotherapy before surgery. Having one or both of these before surgery may help shrink the tumor, as a smaller tumor is easier to take out in surgery.
Chemotherapy or radiation soon after surgery is called adjuvant treatment. The goal of adjuvant treatment is to kill any cancer cells that may be left after the surgery. Even if there is no sign of cancer cells, your doctor may suggest adjuvant treatment, as it may lower the risk that the cancer will come back or spread.
Clinical trials are being conducted on prevention and treatment options for lung cancer, including photodynamic therapy and chemoprevention.
Immunotherapy is a new cancer treatment approach that uses drugs, vaccines and other therapies to activate the immune system’s natural defenses so it can fight cancer. One type of immunotherapy drug, called “anti-PD-1” has been shown to cause significant tumor regression in a quarter of patients who receive it after a round of chemotherapy.Three immunotherapy drugs—pembrolizumab, atezolizumab and nivolumab—have been approved to treat certain non-small cell lung cancers.
More Information About Lung Cancer in the Health Library