The lung cancer treatment option plan you and your physician decide on will be based on a number of factors such as the type of lung cancer you have, where the cancer is within the lung, your overall health, the stage, results of blood tests and scans and your own wishes [32]. On your end, researching the available options and consulting with your support network, health provider and cancer team, helps immensely in choosing an appropriate treatment. Don’t be afraid to ask your doctor or specialist nurse any questions you have about your treatment.
Small cell lung cancer (SCLC) is primarily treated with chemotherapy. Surgery is usually only an option if there is no sign that the cancer has spread to the lymph glands in the centre of the chest (the mediastinal lymph glands). This is rare with small cell lung cancer, as it has usually spread at the time of diagnosis. So chemotherapy is usually the main treatment. Radiotherapy may also be used to treat this type of lung cancer [33].
Non-small cell lung cancer can be treated with surgery, chemotherapy, radiotherapy or a combination of these treatments, all depending on the stage when the cancer is diagnosed. Some people with advanced lung cancer may have biological therapy or immunotherapy [34].
Chemotherapy
Chemotherapy uses anti-cancer drugs to destroy cancer cells which work by disrupting the growth of cancer cells. Small cell lung cancer responds well to chemotherapy drugs and is used as the primary treatment for it. Physicians often use a combination of chemotherapy drugs, including either cisplatin or carboplatin. Chemotherapy is used to treat non-small cell lung cancer after surgery for early stage cancer; before, after or alongside radiotherapy treatment; for locally advanced lung cancer or cancer that has spread [35]. Read more about chemotherapy in-depth at Cancer Research UK.
Radiotherapy
Radiotherapy uses high energy rays to kill cancer cells. Surgery is the most common treatment for stages I-III non-small cell lung cancer and is sometimes followed by chemotherapy. But your doctor may suggest that you have radiotherapy instead of surgery to try to get rid of the cancer cells. This is called radical radiotherapy and your doctor may suggest it if one or more of the following applies to you
- You can’t have an operation due to a medical condition such as heart failure or chronic lung disease
- You have stage 3 cancer and the tumour is close to your heart
- The cancer is in an awkward place in the lung and surgery would be too difficult (an inoperable tumour)
Radiotherapy is often used for cancers that grow right at the top of the lung. These tumours can be very close to the nerves that supply the arm and are difficult to operate on. They are called pancoast tumours. The radiotherapy may be followed by chemotherapy. Sometimes this makes it possible to remove the tumour with surgery afterwards.
[36] Information taken from Cancer Research UK
Treatment by stage for small cell lung cancer
If you have early stage small cell lung cancer you are most likely to have chemotherapy and then radiotherapy to the lung. People who are in good health may have chemotherapy and radiotherapy at the same time (chemoradiation). It is quite common for this type of cancer to spread to the brain so doctors often recommend radiotherapy to the brain for people whose tumours shrink with chemotherapy treatment. You typically will have radiotherapy to the brain at the end of the chemo treatment. The radiotherapy aims to kill any remaining cancer cells that may have spread to the brain but are too small to show up on scans. Doctors call this prophylactic cranial irradiation or PCI.
For very early stage small cell lung cancer that has not spread to the lymph nodes in the centre of the chest (the mediastinal lymph nodes), you may have surgery to remove the part of the lung containing the tumour (a lobectomy). The surgery is followed by chemotherapy and sometimes radiotherapy. But usually the cancer has already spread at the time of diagnosis and surgery is not then possible.
If you have small cell cancer that has spread to lymph nodes or other areas of the body you may have chemotherapy, radiotherapy or treatment to relieve symptoms. If the chemotherapy shrinks the lung tumour down and you are fairly fit you may also receive radiotherapy to the brain to kill any cancer cells that may have already spread there.
[37] Information taken from Cancer Research UK
Treatment by stage for non-small cell lung cancer
Stage 1
Stage 1 non-small cell lung cancer is uncommon. You normally have surgery to remove part of the lung or the entire lung. If pre-existing health reasons don’t allow for the operation, your doctor may suggest targeted radiotherapy instead. Another option for small tumours if you cannot have surgery is radio frequency ablation (RFA).
Stage 2
For stage 2 non-small cell lung cancer, you may be offered surgery. Depending on the position of the tumour, your surgeon may remove part of the lung or the entire lung. If the cancer is removed, your specialist may suggest chemotherapy. This lowers the risk of the cancer coming back. This is called adjuvant chemotherapy. If the surgeon cannot remove all of the tumour you may have radiotherapy afterwards.
If you can’t have surgery due to other health concerns, your doctor may offer radiotherapy or combined radiotherapy and chemotherapy (chemoradiation). This treatment aims to try to get rid of the cancer completely.
Stage 3
For stage 3 non-small cell lung cancer you may be able to have surgery, depending on where the cancer is located in the lung or you may need to have the whole lung removed). If the surgeon succeeds in removing the cancer, adjuvant chemotherapy will be used to lower the risk of the cancer coming back. However, if the surgeon finds cancer cells in the lymph nodes during the surgery they are likely to advise you to have chemotherapy and possibly radiotherapy after the operation. If you can’t have surgery due to other health concerns, your doctor may offer radiotherapy or combined radiotherapy and chemotherapy (chemoradiation). This treatment aims to try to get rid of the cancer completely.
If your scans showed that there are cancer cells in the middle area of the chest (the mediastinum), your doctor may suggest radiotherapy instead of surgery. If the cancer is too close to your heart, a surgeon cannot operate safely. Your doctor may advise that you have a course of chemotherapy followed by radiotherapy. Some people who are in good health and have small tumours have radiotherapy concurrent to chemotherapy (concomitant chemoradiotherapy). Concomitant chemoradiotherapy causes more side effects than the treatments on their own, so the patient must be well enough to cope with the increase in side effects.
If scans show signs of cancer in the lymph nodes on the opposite side of your chest, surgery is not possible. Chemotherapy will be an option, potentially followed up by radiotherapy. As mentioned above, patients in good physical health may receive chemoradiation.
Stage 4
Treatment for stage 4 non-small cell lung cancer tries to control the cancer and to shrink the tumour down to reduce symptoms. Many clinical trials have used chemotherapy in this situation and research has shown that it can help people to live longer as well as relieve symptoms.
People whose cancer cells have particular proteins (receptors) may have treatment with biological therapy drugs called erlotinib (Tarceva), gefitinib (Iressa) or crizotinib (Xalkori).
If you have had chemotherapy and it is no longer controlling the cancer, you may have further chemotherapy if you are well enough. If your cancer has EGFR receptors your doctor may offer erlotinib treatment. Or you may choose to have no further active treatment but to control your symptoms with medicines.
You may have radiotherapy to control symptoms such as pain or a cough. As well as radiotherapy, other treatments can relieve a blockage and reduce symptoms if you have a tumour in one of the main airways (the left or right bronchus). These treatments include:
- Internal radiotherapy (brachytherapy)
- Laser treatment
- Freezing the tumour (cryotherapy)
- Using a rigid tube (a stent) to keep the airway open
- Light therapy (photodynamic therapy – PDT)
To get more in-depth information on different kinds of treatment available during the different stages, please visit the Canadian Cancer Society.
[38] Information taken from Cancer Research UK
Discussing things with your doctor
An appointment where you are given your diagnosis and told about your treatment options is very important. You are likely to be shocked and might find it hard to take in information or make decisions. When you go to see the doctor it often helps to write down a list of questions you want to ask. There may be more than 1 treatment option that is suitable for you.
It’s important that you feel OK about the treatment your specialist recommends. Most people feel more comfortable about this if they understand why a particular treatment decision has been made. Doctors expect patients to want to ask questions and they appreciate that you need things explained in a way you can understand. It is important that your doctor fully explains all options to you and their benefits and possible problems.
Your doctor won’t give any treatment without your permission (consent). In some situations you may feel that you don’t want to have treatment, for example if the treatment has only a small chance of helping you and may cause bad side effects. Your doctor can explain what will happen if you don’t have the treatment and they will go along with your wishes.
Support during appointments
You could take a close friend or relative with you to the appointment. They can help you to remember what is said. If you feel that you need more time to think things through or discuss the options, you can ask your specialist to see you again. Then you can discuss things more fully before you make a decision. There are also lung cancer specialist nurses you can talk to. They can answer questions about your cancer and its treatment.
Second opinions
Some people feel they would like to get an opinion from a second doctor before they decide on their treatment. Most doctors are happy to refer you to another specialist for a second opinion if you would find this helpful. You can discuss this with your GP or cancer specialist, who can make the referral for you.
[39] Information taken from Cancer Research UK
References
[32] “Types of Treatment for Lung Cancer.” Cancer Research UK. Cancer Research UK, 28 Mar. 2014. Web. 02 June 2016.
[33] ibid.
[34] ibid.
[35] “About Chemotherapy for Lung Cancer.” Cancer Research UK. Cancer Research UK, 28 Mar. 2014. Web. 02 June 2016.
[36] “Radiotherapy for Non-small Cell Lung Cancer.” Cancer Research UK. Cancer Research UK, 28 Mar. 2014. Web. 02 June 2016.
[37] “Treatment by Stage for Small Cell Lung Cancer.” Cancer Research UK. Cancer Research UK, 28 Mar. 2014. Web. 02 June 2016.
[38] Treatment by Stage for Non-small Cell Lung Cancer.” Cancer Research UK. Cancer Research UK, 28 Mar. 2014. Web. 02 June 2016.
[39] ibid.