Specific treatment for lung cancer will be determined by your physician based on:
- Your age, overall health, and medical history
- Extent of the disease
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Lung cancer may be treated with surgery, chemotherapy or other medications, radiation therapy, 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:
- Surgery– Three main types of surgery are most often used in lung cancer treatment. The choice 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.
- 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.
- Radiation therapy– 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. There are two ways to deliver radiation therapy, including the following:
- 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. Since 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.
- 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. In some cases, both internal and external radiation therapies are used.
- Chemotherapy – The use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s 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) – 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.
- Targeted therapy – As cancers grow, they form new blood vessels which nourish them. Research aimed at blocking the growth of these blood vessels has led to the development of medications called antiangiogenesis medications. Bevacizumab (Avastin) is one of these medications. It has been found to be helpful in prolonging the survival of patients with advanced lung cancer. It is used with the standard chemotherapy regimen. Medications with other specific targets, such as erlotinib (Tarceva) and cetuximab (Erbitux), may also be useful.
- Stereotactic body radiotherapy (stereotactic radiosurgery, SRS, SBRT) – a relatively new technology, used to deliver high doses of radiation very accurately to tumors. This results in outcomes similar to that of a surgical procedure, without the use of open surgical techniques
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 – 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 physician may suggest adjuvant treatment, as it lowers the risk that the cancer may come back or spread.
Clinical trials are being conducted on prevention and treatment options for lung cancer, including photodynamic therapy and chemoprevention.