Treatment

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The three primary forms of treatment for lung cancer are surgery, radiation therapy and chemotherapy. One or more of these therapies may be used to treat lung cancer, depending on the type and stage of the disease as well as your age and overall health. When you're considering treatment options, it's a good idea to seek a second opinion to get more information and help you feel more confident about your chosen treatment plan.

Surgery

Surgery is primarily used to remove the cancerous tumor from the lung. This therapy, called surgical resection, is typically used when the cancer has not spread to other tissues in the chest or elsewhere in the body. It may be the first type of treatment you receive or it may follow chemotherapy and/or radiation, which are sometimes used first to shrink the tumor(s).

During the procedure, a surgeon usually removes nearby lymph nodes to check them for cancer. A widespread misconception is that lung surgery exposes tumors to the air, which makes them spread. This is absolutely false. If the cancer does spread, the growth occurred microscopically before the cancer was diagnosed and before surgery was ever performed.

Three types of surgery are used in the treatment of lung cancer:

• Wedge or segmental resection: A small part of lung is removed. This is usually reserved for patients whose lung function does not allow for more lung to be removed.

• Lobectomy: An entire section (lobe) of the lung is removed. This is the most common operation performed for lung cancer.

• Pneumonectomy: Removal of the entire lung.

There are cases where initial surgery is not recommended. (Other types of surgery still may be used to relieve symptoms, however). For example, when:

• Cancer has spread to the other lung

• Cancer has grown from the lung into mediastinal lymph nodes or other organs in the chest

• Cancer has spread to the lymph nodes in the neck or to other organs, such as the liver, kidneys or brain

• There are other health-related problems that makes major surgery unsafe.

More recently, a less invasive surgical procedure for treating early stage lung cancer—called video-assisted thoracoscopic surgery—has been developed. This procedure involves the insertion of a small hollow tube with a video camera attached to the end into the chest to help the surgeon see the tumor. Only small incisions are needed to make room for the tube, so there is less pain and a shorter recovery period than with standard surgery. However, most experts recommend the procedure only be used for tumors smaller than three to four centimeters (about an inch and a half). Also, because this surgery requires more technical skill than the standard procedure, it is important that it be done by a specially trained and experienced surgeon.

After surgery, you may experience significant pain, but should receive pain medication to control it. Some pain, however, is tenacious. Many people who have lung surgery complain of lasting pain at the incision sites. This is especially difficult for women because the incision line is often right at the bra line. Many women find alternatives to tight clothing to avoid this irritating and lasting pain.

Radiation therapy:

Many women with lung cancer will need radiation therapy at some time during their illness, either as a primary treatment or as a means of symptom management called palliation. Radiation therapy consists of directing a beam of high-energy rays at a tumor. By injuring cancer cells so they can't continue to multiply, the radiation slows or stops tumor growth. The amount of radiation used is based on the size and location of the tumor. Another form of radiation, called brachytherapy, involves placing a small pellet of radioactive material through a bronchoscope right into the tumor or the airway closest to the cancer. Side effects associated with radiation include fatigue, dry or sore throat, skin irritation and loss of hair in the treated area.

Chemotherapy:

Anticancer drugs are taken intravenously or, sometimes, orally. They circulate throughout the bloodstream killing fast-growing cells like cancer cells. Chemotherapy can be used to destroy the cancer, slow its growth, keep it from spreading or relieve symptoms. Even if chemotherapy doesn't get rid of all the cancer, studies find it can help lung cancer patients live longer and more comfortable lives.

Chemotherapy is usually administered in an outpatient setting and in regular intervals (cycles) at regular doses for several months, but is rarely given for more than eight cycles.

A wide variety of chemotherapy drugs are used for the treatment of lung cancer. For non-small cell lung cancer, national guidelines call for the use of carboplatin (Paraplatin) and/or cisplatin (Platinol), in combination with a second drug.

The other most commonly used drugs are docetaxel (Taxotere) and paclitaxel (Taxol), vinorelbine (Navelbine), and gemcitabine (Gemzar).

Combining cisplatin or carboplatin with other agents such as gemcitabine, paclitaxel, and docetaxel appears to be more effective than using one drug alone to treat non-small cell lung cancer. Recent studies also find that combining two drugs is as effective as combining three, and that drug combinations that produce less severe side effects, such as gemcitabine with vinorelbine or paclitaxel, may be as effective as the combinations containing cisplatin or carboplatin that are more toxic.

Patients with small-cell cancer are usually treated with cisplatin plus etoposide (VePesid) and occasionally with irinotecan (Camptosar).

Newer biologic drugs designed to specifically target and interfere with some aspect of tumor cell function are also used to treat lung cancer. One, Tarceva (erlotinib) prevents the production of epidermal growth factor receptor (EGFR), a protein that helps tumor cells grow. It is an oral drug with few side effects. But it only appears to work on a small number of patients.

Women, particularly those who have never smoked, seem especially likely to benefit.

Pemetrexed (Alimta) is used for patients with advanced or metastatic non-small-cell lung cancer who have already been treated with standard chemotherapy and have relapsed. Docetaxel (Taxotere) has also been used in this setting. Both have been shown to shrink tumors in these patients.

These drugs and others are used in a variety of combinations. Because they reach all the parts of your body, they also affect normal cells. Side effects vary greatly. The most common include nausea and vomiting, hair loss, fatigue, susceptibility to infection and/or constipation. Your health care professional can help you manage these side effects, but you must be sure to communicate how you feel.