From surgery to chemotherapy, learn what treatments are available for lung cancer in this comprehensive overview. We provide information on the effectiveness of each option so you can make an informed decision.

Surgery

Surgery for lung cancer aims to completely remove the tumor and nearby lymph nodes in the chest. The tumor must be removed with healthy lung tissue surrounding it, resulting in a “negative margin.” A surgical oncologist specializes in cancer treatment through surgery, and a thoracic surgeon is specially trained for lung cancer surgery.

The following surgeries may be used for Non-Small Cell Lung Cancer:

• Lobectomy: Removal of an entire lobe of the lung, which is considered the most effective surgery, even for small tumors. Trials are ongoing to assess less extensive surgeries for tumors smaller than 2 centimeters.
• Wedge resection: Removal of the tumor with healthy lung tissue if an entire lobe cannot be removed.
• Segmentectomy: Removal of the portion of the lung where cancer developed if an entire lobe cannot be removed. This typically involves more tissue and lymph node removal than a wedge resection.
• Pneumonectomy: Removal of the entire lung if the tumor is close to the chest’s center. This surgery carries more risks than a lobectomy, and the patient’s heart and lung health must be considered before proceeding.

Recovery time after lung surgery depends on the amount of lung tissue removed and the patient’s health. Exercise is essential before and after surgery to prevent side effects and shorten hospital stays. Discuss exercise recommendations with the doctor or healthcare team.

Many of these surgeries are minimally invasive compared to the past. The healthcare team should be consulted about the possible side effects of the specific surgery. Additional treatments may be given before or after surgery to lower the risk of recurrence.

Neoadjuvant therapy is given before surgery to treat the primary tumor, lower the risk of recurrence, and reduce the extent of surgery. Adjuvant therapy is given after surgery to eliminate any remaining lung cancer cells and lower the risk of recurrence. Adjuvant therapies for Non-Small Cell Lung Cancer include radiation therapy and systemic therapies such as chemotherapy, targeted therapy, and immunotherapy, sometimes used in combination.

Radiation therapy

Radiation therapy for cancer treatment involves using high-energy x-rays or other particles to eliminate cancer cells, and a radiation oncologist is a specialist who administers this treatment to cancer patients. External-beam radiation therapy is the most common form of radiation therapy, delivered from a machine outside of the body. The treatment is given over a specific period of time, ranging from a few days to several weeks, and its regimen varies depending on the patient’s condition.

However, radiation therapy cannot be used to treat cancer that has spread throughout the body. The therapy only targets cancer cells that are directly in the path of the radiation beam, and it can also damage healthy cells along its path. Intensity-modulated radiation therapy (IMRT) is the most commonly used type of radiation therapy, but some patients may require specialized treatments, such as stereotactic body radiation therapy (SBRT) or proton therapy. These treatments use imaging technologies like CT or PET scans to pinpoint where to direct the radiation beam, thereby minimizing the risk of damaging healthy cells.

For patients with stage I Non-Small Cell Lung Cancer or those who cannot undergo surgery, stereotactic radiation therapy may be a viable alternative to surgery.

Chemotherapy

Chemotherapy is a cancer treatment option that involves the use of drugs to eradicate cancer cells by inhibiting their growth, division, and ability to produce more cells. It has been shown to improve both the duration and quality of life for people with lung cancer at any stage.

A chemotherapy schedule typically involves a specific number of cycles administered over a fixed duration. The recommended drugs for chemotherapy depend on the type of lung cancer present, such as adenocarcinoma or squamous cell carcinoma. Adjuvant chemotherapy, given after surgery, is generally prescribed for a shorter time (such as four cycles) than for stage IV lung cancer patients.

Chemotherapy may also harm healthy cells in the body, including blood, skin, and nerve cells. Side effects vary depending on the individual and the dosage but can include fatigue, reduced blood cell counts, increased risk of infection, mouth sores, nausea and vomiting, loss of appetite, diarrhea, numbness and tingling in the hands and feet, and hair loss. However, some lung cancer chemotherapy treatments do not cause significant hair loss. Many of these side effects can be relieved with drugs prescribed by the medical oncologist, and nausea and vomiting can often be prevented. Typically, these side effects disappear after treatment completion.

Targeted therapy

Targeted therapy is a cancer treatment that specifically targets the genes, proteins, or tissue environment that contribute to cancer growth and survival. Unlike chemotherapy, which can damage healthy cells along with cancer cells, targeted therapy focuses on blocking the growth and spread of cancer cells while minimizing harm to normal cells.

Not all tumors have the same targets, so doctors may conduct tests to identify the specific genes, proteins, and other factors in the tumor to determine the most effective treatment. For some types of lung cancer, certain proteins are found in excessive amounts in cancer cells, which can help doctors match each patient with the most effective treatment.

Ongoing research is constantly discovering new molecular targets and treatments directed at them, leading to rapidly changing options for targeted therapy for non-small cell lung cancer. Clinical trials are underway for new targeted therapies, and patients should discuss with their doctors the latest options that may be available to them.

Treatment by Stage of Non-Small Cell Lung Cance

Cancer treatment options for Non-Small Cell Lung Cancer can vary depending on the stage of the disease. The specific treatments available for each stage are outlined below. Your doctor will collaborate with you to create an individualized treatment plan that is tailored to your unique diagnosis and needs. Additionally, clinical trials may be an option for treatment at any stage of Non-Small Cell Lung Cancer.

Stage I:

The main cancer treatment option for stage I Non-Small Cell Lung Cancer is surgery to remove the tumor. For patients who are not candidates for surgery, radiation therapy may be used.

Stage II:

Cancer treatment options for stage II Non-Small Cell Lung Cancer include surgery to remove the tumor, radiation therapy, or a combination of both. Chemotherapy may also be used in some cases.

Stage III:

Cancer treatment for stage III Non-Small Cell Lung Cancer typically involves a combination of chemotherapy, radiation therapy, and surgery. The order and timing of these treatments may vary depending on the individual patient and the specific characteristics of the cancer.

Stage IV:

Cancer treatment for stage IV Non-Small Cell Lung Cancer may involve chemotherapy, radiation therapy, targeted therapy, immunotherapy, or a combination of these approaches. The specific treatment plan will depend on the individual patient’s diagnosis and medical history.

Your doctor will work with you to determine the best treatment plan based on your specific diagnosis and needs. Additionally, clinical trials may be an option for treatment at any stage of Non-Small Cell Lung Cancer.

Remission and the chance of recurrence.

When cancer is undetectable in the body and there are no symptoms, it is known as remission, or “no evidence of disease” (NED). However, remissions can be temporary or permanent, causing uncertainty and anxiety about the possibility of cancer recurrence. While some remissions are permanent, it’s essential to discuss the risk of recurrence and treatment options with your doctor to feel more prepared in case cancer returns. Coping with the fear of recurrence is crucial.

If cancer returns after the initial treatment, it is referred to as recurrent cancer, which may occur in the same place (local recurrence), nearby (regional recurrence), or in another area (distant recurrence). Recurrence often indicates stage IV disease.

A new round of testing will commence understanding recurrent cancer better, followed by a discussion with your doctor regarding treatment options. The treatment plan may involve surgery, chemotherapy, and radiation therapy, as previously described, but given in a different combination or pace. Clinical trials studying innovative ways to treat recurrent Non-Small Cell Lung Cancer may also be suggested by your doctor. Palliative care plays a crucial role in relieving symptoms and side effects.

People with recurrent cancer may experience disbelief or fear, and it’s essential to communicate these feelings with your healthcare team and seek support services to cope.

If treatment does not work

Not all cancers can be cured or controlled, making recovery impossible. In such cases, the disease is referred to as advanced or terminal, and receiving this diagnosis can be stressful and difficult to discuss for some individuals. However, it’s crucial to have open and honest conversations with your healthcare team to express your feelings, preferences, and concerns. They possess the expertise, experience, and knowledge to support patients and their families and are available to help. Ensuring that a person is physically comfortable, pain-free, and emotionally supported is of utmost importance.

People with advanced cancer who are expected to live less than 6 months may want to consider hospice care. Hospice care aims to provide the best possible quality of life for people near the end of life. It’s recommended that patients and their families discuss hospice care options with their healthcare team, which may include hospice care at home, a specialized hospice center, or other healthcare facilities. Nursing care and special equipment can make staying at home a viable option for many families.

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