Types of Treatment
After a patient receives a lung cancer diagnosis, the physician and the patient will choose the most appropriate treatment option, based on the type and stage of the patient's cancer and the patient's overall health. The oncologist will also consider what symptoms the patient is having, the patient's ability to carry on normal daily activities and need for bed rest, and the patient's opinion about quality of life. All of these are important considerations in choosing the best treatments. The main treatment options are surgery, radiation, and chemotherapy. New treatments are also showing promise.
- Chemotherapy regimens
- Targeted therapies
- Monoclonal antibodies
- Photodynamic therapy
- Anti-angiogenesis
- Gene therapy
- Lung cancer vaccines
Surgery
Because surgery actually removes a tumor and nearby lymph nodes, it offers the greatest chance for significant survival for some types of lung cancer. This is especially true for the early stage (I, II) cancers that have not spread to other parts of the body. Some patients may undergo surgery during the course of their diagnosis and treatment. Surgery may be the first step in treating lung cancer or it may be considered after chemotherapy and radiation.
A thoracic surgeon is specially trained to perform lung cancer surgery. During surgery, the surgeon will remove the tumor and a surrounding margin of tissue. This margin will be evaluated under a microscope to see if it contains any cancer cells. A "negative margin" means that no cancer is found in the tissue surrounding the tumor. A "positive margin" may require the surgeon to remove more of the lung tissue until a clear margin can be identified.
Types of surgery
- Curative surgery: The removal of a tumor when it appears to be confined to one area, which means an early stage cancer. This type of surgery aims to completely remove the cancerous tumor, and may include remove a wedge, a lobe, or an entire lung.
- Palliative surgery: The goal of this surgery is to make the patient more comfortable, e.g., laser surgery for the removal of an obstruction or opening of an airway.
Side effects
As with any type of treatment, there are certain side effects associated with surgery. These side effects may occur during or after the procedure and will vary depending on the type of surgery.
After surgery, potential side effects include:
- Pain. One of the most common side effects associated with surgery. Some surgery for lung cancer requires cutting through the ribs and/or cutting a nerve. This can take several months to heal. A patient should be honest with his or her health care team about pain because there are many options to alleviate it.
CancerCare has developed a booklet titled Controlling Cancer Pain: What You Need to Know to Get Relief 
that addresses this issue.
- Infection. Infections at the site of the wound and inside the body are another possible side effect. Antibiotics give by a doctor are able to treat most infections.
Chemotherapy
Chemotherapy uses strong chemicals or drugs to kill cancer cells, stop their reproduction, or slow their growth. There are many types of chemotherapy drugs, and they may be given in combination with each other, and also in combination with surgery and radiation. A medical oncologist prescribes, but it may be given by an oncology nurse.
Even though chemotherapy drugs may be administered intravenously, or taken orally in tablet, capsule, or liquid form, most chemotherapy for lung cancer is given intravenously. Chemotherapy is called systemic therapy, because it treats the entire body, or system. Chemotherapy can kill cancer cells that have metastasized from the original tumor because it travels through the blood system to all parts of the body.
The amount of chemotherapy a patient receives depends on the type of cancer, the drugs, and the patient's overall response to treatment. This therapy may be given daily, weekly, or monthly, and can continue for months or possibly years. Some drugs may be given in cycles, with rest periods between treatments to allow the body to recover.
Chemotherapy may be referred to as adjuvant therapy, because it is given in addition to surgery or radiation. When it is used as adjuvant therapy, it is intended to reduce the risk of a recurrence by traveling throughout the body and killing whatever cancer cells remain after surgery. Neo-adjuvant therapy is chemotherapy that is given prior to any surgery. The goal of neo-adjuvant therapy is to shrink the lung tumor so that it can more successfully be removed.
Side effects
Chemotherapeutic drugs affect normal cells, too. Particularly, cells that are rapidly dividing will take up chemotherapy and die. Examples of these include cells lining the gastrointestinal tract, those in the bone marrow, and those making up hair follicles. The most common side effects from chemotherapy, such as nausea and vomiting, a weakened immune system, and hair loss are due to these normal cells being damaged during chemotherapy. Fortunately, almost all side effects from chemotherapy are temporary and gradually disappear after treatment is finished.
It is important to know side effects of chemotherapy vary depending on the type of chemotherapy and how the patient responds. Some drugs are known to have more side effects than others. Your doctor will be able to explain the different drugs, their side effects, and why different drugs are recommended for different uses. Patients should discuss any side effects with their doctors because there are many medicines available to help alleviate them. Some common side effects of chemotherapy include:
- Nausea and vomiting. Chemotherapy may cause nausea and vomiting, but there are medications that may help with these issues. Even though eating may be difficult if the patient has nausea and vomiting, it is important to eat frequent, small meals to maintain strength. Eating and drinking slowly and avoiding fatty foods may help. After eating, it is important to not lie down flat for at least two hours, as this may worsen symptoms.
- Hair loss. Hair loss can occur on all parts of the body. Hair may fall out completely or may thin. Usually, hair grows back after treatment is completed.
- Fatigue. Chemotherapy affects the bone marrow and the body's ability to make red blood cells, which may temporarily cause anemia. Anemia can make patients feel weak and tired. Getting more sleep at night and resting during the day can help with fatigue. Eating foods rich in iron and regular exercise can also help.
- Infections. Chemotherapy's effects on bone marrow may also lower the number of white blood cells, which help fight infection. To prevent infection, patients should avoid exposure to people who have a cold, flu, or other contagious disease. Frequent hand washing helps minimize infections.
- Bleeding. Chemotherapy can affect other blood cells called platelets, which may lead to easier bruising or bleeding. Patients should alert their doctors if bleeding occurs.
- Mouth sores. Because the lining of the mouth contains cells that are susceptible to chemotherapy, a person may develop sores there during therapy. Because mouth sores are painful, a patient experiencing them may avoid eating. A dietician or oncology nurse will have ideas about how to get appropriate nutrition through beverages, such as liquid supplements and homemade smoothies, and through soothing foods, such as yogurt or puddings.
- Loss of appetite. Whether due to nausea or vomiting or some other reason, many patients undergoing chemotherapy report losing their appetites. Eating small meals of healthful foods can help and patients should keep in mind the importance of staying strong through good nutrition. Liquid supplements that contain vitamins and minerals can help maintain nutrition and avoid weight loss.
- Diarrhea. Chemotherapy may cause diarrhea because it affects the cells lining the gastrointestinal tract. There are medicines available to help with this side effect. Patients should alert their doctors if diarrhea continues.
There are many resources available to learn more about chemotherapy and its side effects. Here are a few that might be helpful to you.
- CancerCare's Connect® booklet Understanding and Managing Chemotherapy Side Effects
- The National Cancer Institute's Coping with Cancer Side Effects
- The National Comprehensive Cancer Network's Types of Treatment for Lung Cancer
Radiation
Radiation therapy (also called radiotherapy) may be effective for the treatment of lung cancer. It uses high-energy rays, similar to X-rays, but stronger, to kill or shrink cancer cells. Usually, lung cancers are treated from an external source of energy. However research is underway to study the use of implanted radioactive seeds into or near the lung cancer. This type of radiotherapy, called brachytherapy, has been successfully used in the treatment of prostate cancer.
Radiation oncologists are the physicians who administer radiation. Radiation-delivery machines are designed to focus the radiation in precise locations in the body for exact periods of time. This precision reduces the risk of damage to normal tissue surrounding the tumor. However, even with such advances and the use of shields to protect the parts of the body that do not require treatment, some healthy cells will be damaged by the radiation.
Radiation therapy is usually spaced over a number of weeks or months because the doses needed to kill cancer cells cannot be given all at once. The number of treatments a patient receives depends on the type and extent of the tumor, as well as the radiation dosage and how the patient is affected by the treatment.
External beam radiation (given from a source that is external, or outside, of the body) may be used at the main treatment for lung cancer for some patients. For other patients, radiation may be used after surgery to kill remaining cancer cells or to treat metastases.
Side effects
Depending on the specific regimen for each patient, side effects from radiation therapy may vary. However, a few common side effects include:
- Fatigue. Fatigue is the most common side effect of radiation. A patient undergoing radiation therapy should rest as much as possible at night and limit their activities during the day.
- Eating problems. Nausea may occur with radiation, as can loss of appetite. Some medications are available to help with nausea and some patients find it useful to eat frequent, small meals throughout the day.
- Hair loss. Hair loss may occur on the part of the body undergoing radiation.
- Skin reactions. The skin in the treatment area may become dry, irritated, and sensitive, and should be treated gently. In some cases, the skin may resemble skin that has been sunburned and it may peel. The affected area should be kept out of direct sunlight for at least a year after treatment.
New Treatments
Recently, there has been an increase in new treatment advances for lung cancer. Some of these advances are still undergoing research in clinical trials, while others have been approved and are being used for treatment of patients. The following are some of these new treatments.
- Chemotherapy regimens: Different combinations of existing chemotherapy drugs are being explored. Oncologists are constantly refining the way lung cancer is treated. Clinical trials often test new combinations of drugs to see if they will work better than what is currently the standard of care. CancerCare offers a podcast, Advances in the Treatment of Lung Cancer that explains some of the new combinations of therapies that have been announced at medical conferences.
- Targeted therapies: These therapies, which include monoclonal antibodies, anti-angiogenesis drugs, and growth factor inhibitors, are designed to treat only the cancer cells, thus sparing normal cells from damage. Many targeted therapies are being researched, and some are in active use.
- Monoclonal antibodies: these bioengineered molecules contain one part that can home in on the cancer cells coupled with another part that may contain a drug or radiation. Therefore, when the monoclonal antibodies are administered, they travel to the site of the cancer and release their drug or radiation. Monoclonal antibodies are designed to target only cancer cells, thus reducing side effects.
- Anti-angiogenesis agents: Angiogenesis is the process that tumors use to make new blood supplies, which enable the tumors to grow. Drugs that counteract this ability are called anti-angiogenesis agents. They are a very promising area of cancer therapy.
- Growth factor inhibitors: Cancer cells can grow so quickly because they often manufacture substances, called growth factors, that encourage their own growth. Specially designed drugs have been created that block the effects of the growth factors, which means the cancer cells can no longer grow.
- Photodynamic therapy: The use of light (photo) to shine on cancer tissue and activate drugs is another promising area of research.
- Lung cancer vaccines: Vaccines use the body's immune system to fight diseases by engineering cancer cells so that they are no longer cancerous, but still contain components that the immune system will recognize as foreign. The theory is that by introducing small amounts of the vaccine, the body's immune system will mount a defense against it. Unlike childhood vaccinations, cancer vaccines are promising not to prevent the primary occurrence of cancer, but to treat cancer that already exists.
- Gene therapy: As scientists learn more about how the genetic changes in cancer cells, they are working to design ways to correct those changes. The area of gene therapy, in which normal copies of damaged genes are inserted into cells, has much promise, but is still largely experimental.