Lung cancer treatments
There are several factors that need to be considered before selecting the right treatment. One of the most important factors to consider is the stage of the cancer. Cancer that is located only in the lungs may be removed by surgery while cancer that has spread to other parts of the body may be treated with chemotherapy.
Another important factor for determining treatment is your performance status (PS). Performance status is a medical term used to describe your ability to perform daily tasks and activities on your own or with assistance. If you're active and able to care for yourself without much assistance, you’re more likely to be able to tolerate certain treatments and combinations of treatments than if you were frail and require assistance to perform daily activities such as putting on a shirt or showering.
Your therapy may be managed by a team of specialised physicians, surgeons and nurses who are experienced in the use of these treatments. You may see several different doctors throughout your diagnosis and treatment.
You should discuss all treatment options with your doctor so that you can decide which options are best for you.
Surgery
Depending on the stage of cancer and your health, surgery may be used alone or in combination with radiation or chemotherapy. Surgery is usually used to treat cancer that is diagnosed early, such as Stage I or II. If your cancer is located only in the lungs and has not spread to the lymph nodes or outside the chest cavity, your doctor may perform surgery to remove the tumour. If your cancer has spread to other parts of your body, surgery is not generally an option.
Other factors that may play a role in deciding whether or not surgery is the best option are the size and location of the tumour and your general health. If your cancer is near your vital organs such as the heart, windpipe, or major blood vessels, your doctor may recommend other treatment options, because surgery too close to these organs may be complicated. Also, if you have other serious health conditions such as a heart condition or other lung problems, you may not be able to have surgery.
Your doctor will know whether or not surgery is the right option to treat your lung cancer. The surgery will often be a thoracotomy. This involves opening one side of your chest by cutting between your ribs to avoid damaging organs such as the heart or the windpipe. Your ribs are spread apart and a small piece of your ribs may even be removed, so that the surgeon can see into your chest to remove the tumour.
Depending on the location, size, and type of tumour, there are several different types of surgeries that can be performed. A small part of your lung, a lobe of your lung, or a whole lung may be removed. Below is a description of these procedures.
Wedge resection or segmentectomy
There are two operations to remove a small section of the lung: a wedge resection and a segmentectomy. A wedge resection involves removal of a smaller part of your lung compared to a segmentectomy. Your doctor may use these types of surgery if you have been diagnosed with an early stage and the cancer is very small.
Lobectomy
You may recall from your earlier reading that the right lung has three lobes and the left lung has two lobes. Your doctor may decide to remove an entire lobe of your lung if he or she believes that the cancer is just in one part of the lung. This process is known as lobectomy.
Pneumonectomy
Pneumonectomy is the removal of an entire lung. It is used when your doctor believes that cancer is present in only one lung but it may be anywhere in that lung. Although removing a lung can reduce the function of your lungs, you can breathe normally with only one lung. However, if you had breathing problems before, you may continue having those after your surgery.
Video-assisted thoracic surgery
Video-assisted thoracic surgery (VATS) is a recently developed technique, which may be used for several procedures. It can be used to confirm the diagnosis of lung cancer, and to remove cancer in patients who cannot tolerate open-chest surgery or have a small tumour confined to the lungs.
VATS is usually done before a thoracotomy. The surgeon makes small incisions on your chest, which allows him or her to look inside and remove tumours close to the outside edge of the lung. The doctor does not have to open your entire chest to see and remove a tumour. However, it can only be used to treat cancer if it has not spread throughout the lungs or other parts of the body.
What should I expect with surgery?
As with any major surgery, lung cancer surgery is associated with risks such as bleeding, infection, pain, and damage to the heart, lungs and other organs.
You will be admitted to the hospital and you may have to stay several days after the surgery. Your remaining lung function, overall health, the type of surgery done, and the amount of pain you are experiencing are some of the factors that will determine how long you will stay in the hospital.
Chest tubes may be placed in your chest to help drain fluid, blood, or air present around the lungs after your surgery. These tubes are removed once all the fluid has drained out of your chest. You will be shown how to do breathing exercises that will help you recover from the surgery and prevent complications.
Radiation
Radiation, or radiotherapy, uses high-energy rays to prevent cancer cells from dividing and spreading. Radiation is directed to the area where the tumour is located. It injures or destroys the cells by damaging their genetic material. This kills the cells or stops them growing . More than half of all patients with cancer are treated with some type of radiation.
In lung cancer, radiation therapy is most often administered to patients with early stage disease, such as Stage I, who may not be well enough to undergo surgery. It may also be given before or after surgery in early disease (Stage I or II) or in combination with chemotherapy in later stages of the disease (Stage III).
Some patients will also receive radiation therapy to relieve some of the symptoms of lung cancer or to treat an area of metastases in Stage IV disease. For example, if the lung cancer has spread to the bones and is causing pain, radiation to the bone may decrease the tumour size and reduce the bone pain.
It is virtually impossible to direct the radiation rays only at the cancer cells. As a result, both cancer cells and nearby healthy cells may be damaged. However, normal cells, unlike cancer cells, may recover from the effects of radiation. Your doctor will try to limit the effect of radiation on normal cells by aiming the radiation toward the tumour, limiting the dose of radiation, and spreading out the treatment over time.
How is radiation given?
There are two ways in which radiation can be given:
- External beam radiation
- Brachytherapy - a type of internal radiation.
You will probably not receive radiation at the weekend, which allows the normal cells time to recover. Another type of external beam radiation is called hyper-fractionated radiation. During hyper-fractionated radiation, the daily dose of radiation is given as smaller doses but more than once a day. You may receive radiation several times a day separated by 4 to 6 hours.
Brachytherapy is internal radiation. During this treatment, your doctor will place the source of radiation inside of your body, near the tumour. The source of radiation is a type of seed or small implant that is placed into the lung. This is done by inserting a tube through the nose, down the trachea, and into the lung. The radioactive seeds are then put down the tube and positioned near the tumour. The seeds may stay in the lung for a few minutes or permanently, depending on the dose of radiation needed.
Your doctor will determine the dose of radiation and how long the seeds need to stay in your lung. Brachytherapy allows a high dose of radiation to be given to a small area of the body, but it’s not often used in lung cancer.
What are the side effects of radiation?
Side effects will be different for every patient and they may continue for several months after radiation treatment is over. Most people who undergo radiation experience fatigue. You may feel tired for months after therapy, so you may want to get more rest during this time.
Other side effects you may experience include mild skin problems at the radiation site, nausea, and vomiting. If you get radiation to your chest area, you may experience shortness of breath, and cough. Since your oesophagus may be exposed to radiation, difficulty with swallowing may occur. Most of these side effects will usually lessen after treatment is completed.
If you have Stage IV disease and the cancer has spread to your brain, you may get radiation to your brain to relieve some of the symptoms that you are experiencing. Radiation to the brain may cause hair loss, memory loss, headache, or difficulty thinking.
Make sure you tell your doctor if you experience any of these side effects.
Chemotherapy
Chemotherapy is the use of drugs to attack cancer cells. The drugs circulate throughout the body in the bloodstream and kill rapidly dividing cells, including cancer cells and some healthy cells. Chemotherapy drugs are carefully controlled in both dosage and frequency so that cancer cells are destroyed while minimizing the risk to healthy cells.
How is chemotherapy given?
The drugs used for chemotherapy come in many different forms, some are given directly into a vein (intravenous) others may be taken by mouth (orally).
Some of the drugs must be given in the doctor’s office or clinic and others can be taken at home. Certain types of chemotherapy need to be given in the hospital because they require special monitoring of both the treatment and its possible side effects.
Chemotherapy may sometimes be used in combination with surgery or radiation for Stage II disease. It is more commonly used alone or with radiation to treat Stage III and IV disease.
When chemotherapy is used before surgery or radiation in earlier stage disease it is called neo-adjuvant therapy. Chemotherapy may reduce the size of the tumour so it’s easier to remove during surgery or easier to treat with radiation.
When chemotherapy is used immediately after surgery or radiation in earlier stage disease it is called adjuvant therapy. Adjuvant therapy may kill any cancer cells that remain in the body after surgery or radiation. The term minimal residual disease (MRD) is used to describe those cancer cells that may remain in the body despite successful surgery or radiation. MRD does not mean that you have metastatic disease. However, the remaining tumour cells may go undetected for years, and can develop into metastatic disease if they are not treated.
Most often chemotherapy is used to treat advanced stages of lung cancer (Stages IIIb and IV). Often two different chemotherapy drugs are given together to treat advanced lung cancer. Some combinations of chemotherapy can prolong survival, improve the quality of life, and reduce lung cancer symptoms in people with advanced stages of lung cancer. When chemotherapy is used to ease the symptoms of lung cancer but not used to prolong survival, it is called palliative therapy.
The first chemotherapy regimen that a person receives to treat a cancer is referred to as “first-line” chemotherapy.
If first-line chemotherapy doesn’t work or if the disease reoccurs following first-line therapy, second-line therapy may be given. Some people with lung cancer go on to receive more than 4 or 5 different chemotherapy regimens.
Your doctor will determine what drug or combinations of drugs is the most appropriate for you by considering your type and stage of lung cancer, other illnesses you may have, and the possible side effects of the therapy.
What should I expect with chemotherapy?
Chemotherapy is administered in “cycles.” A cycle is usually made up of 21 days in a row. You will not receive chemotherapy on every day of a cycle.
For example, you may receive one chemotherapy drug on day 1 of a cycle, while you may get a second chemotherapy drug in combination with the first drug on day 5 and by itself on day 8. You may be given up to 6 cycles of treatment.
Sometimes, after you finish your chemotherapy your doctor may recommend you continue on some additional therapy for a longer period of time in order to keep the cancer from coming back. This type of therapy is called maintenance therapy.
Chemotherapy may be given at a clinic or hospital over a period of several hours, so you will need to make arrangements to get to your scheduled appointments. Depending on the type of chemotherapy that you receive, you may be given “pre-medications” (medications given before the chemotherapy) in order to prevent certain side effects. You may also have to receive intravenous fluids before or after the chemotherapy.
What are the side effects of chemotherapy?
Chemotherapy drugs circulate throughout the whole body and they can affect both healthy and cancer cells.
When healthy cells are affected you may experience side effects. The specific side effects depend upon which drugs and regimens are used. The most common side effects include hair loss, nausea, vomiting, diarrhoea, lowered blood counts, reduced ability of the blood to clot, a tingling or numbing sensation of the hands and feet, and an increased risk of infection.
Other side effects may include blisters or sores in the mouth and throat and a feeling of tiredness. Some of these side effects occur only temporarily or are more noticeable when treatment is first started. Many of the side effects disappear when the drugs are stopped,for instance, hair usually grows back once chemotherapy is stopped.
You should talk to your doctor about what side effects to expect for your therapy and how to manage them if they occur.
Targeted therapies
Researchers are constantly trying to find new ways to treat cancer. In recent years scientists have been working to develop “new kinds of therapies” for the treatment of various cancers including breast, colorectal and lung. These “novel therapies” are designed to look for certain markers on cancer cells or work on specific pathways important for cancer cell growth.
While some of these drugs are available on prescription, others are only available through enrolment in a clinical trial. Talk with your doctor to discuss whether one of these therapies may be suitable for you.
Investigational therapies
There may be additional options for treatment available to you, by participating in a clinical trial of an investigational therapy.
A clinical trial, also known as a research study, is used to answer specific questions about a new type of therapy or to study new ways of using a therapy. The purpose of a clinical trial is to determine whether a therapy is safe in humans and effective in treating a particular disease or condition. This includes looking at the benefits, as well as the potential risks, of the therapy.
If you are eligible and decide to participate in a lung cancer clinical trial, you will obtain expert medical care from physicians in the field of cancer research, and may gain access to investigational treatments. Also, your health will be closely monitored, and you will be evaluated for any side effects that you may experience from therapy.
However, if you participate in a clinical trial, you may experience side effects to the therapy or procedure. You may receive a therapy that is less effective than current therapy. In addition, you may receive a therapy that is beneficial to others, but ineffective for you.
You should discuss participation in a clinical trial with your physician so that you know about all the available treatment options. Your doctor can help you determine if a clinical trial is right for you.