This post explains the different lung cancer treatment options and the best options for the two types of cancers: NSCLC and SCLC in their different stages.
Doctors from different faculties work together to treat lung cancer.
Pulmonologists are doctors who are experts in diseases of the lungs.
Surgeons perform operations.
Thoracic surgeons specialize in chest, heart, and lung surgery.
Medical oncologists treat cancer with medicines.
Radiation oncologists specialize in treating cancers with radiation.
Your doctor will decide the best-suited treatment for your lung cancer based on your:
Age
General Health
Medical history
Type of lung cancer
The extent of the disease
Tolerance or preference for specific treatment options
Treatment will also include an option to give you relief from symptoms.
Lung cancer treatment options
There are several options to treat cancer in general and the same applies to lung cancer. Your doctor will decide the best option that suits your condition and the condition of your lung cancer. He will apply his judgment after he has seen the reports of all the diagnostic tests.
Combination therapy. Combination treatment consists of having more than one type of treatment at the same time.
Surgery
Surgery is indicated as part of the treatment for early-stage lung cancers. The type of surgery the doctor chooses will depend on the size and location of the tumor in the lung, its extent, the general health of the patient, and other factors.
The surgery performed will be with a long incision in the side of the chest, called thoracotomy, or with video-assisted thoracic surgery (VATS), which uses several small incisions.
Types of surgery include:
Segmental or wedge resection: In this type of surgery, the surgeon removes the cancerous tumor, as well as a wedge-shaped section of the lung around the cancer.
Lobectomy: In this type, the surgeon removes an entire lobe of the lung
Pneumonectomy: The entire lung is removed
Sleeve resection: This type of surgery involves the removal of the lung tumor and a piece of the main bronchus, after which the remaining part of the lung is reattached to the remaining part of the bronchus.
Surgery is usually used along with other therapies:
Neoadjuvant treatment refers to having radiation or chemotherapy before surgery. This helps to may help shrink the tumor before surgery, as it becomes easier for the surgeon to remove a smaller tumor.
Adjuvant treatment is the use of chemotherapy or radiation soon after surgery. The purpose 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 doctor may still suggest adjuvant treatment, as it lowers the risk of recurrence or spread of lung cancer.
Radiation Therapy
Radiation therapy is the use of high-energy radiation to target and kill cancer cells and stop their uncontrolled growth to shrink tumors. X-rays, gamma rays, and charged particles are used for radiation in treating cancer.
Radiation is also sometimes used with chemotherapy to treat lung cancer. Radiation therapy uses the following technique to deliver radiation therapy:
External radiation (external beam therapy): In this type, the radiation therapist directs high levels of radiation precisely to the cancer cells with the help of the radiation machine.
Since radiation is used to kill cancer cells and to shrink tumors, special shields are used to protect the tissue neighboring the treatment area. Radiation treatments are painless and usually last a few minutes.
Chemotherapy
Whereas surgery and radiation treatment focus precisely on the site of cancer, chemotherapy travels throughout the body to target cancer cells.
The chemotherapy drug is given through an intravenous infusion, in most cases. It acts by interfering with the ability of the cancer cells to grow or reproduce rapidly. Different types of chemotherapy drugs work in different ways to fight cancer cells.
The oncologist will recommend a treatment plan, which suits that particular patient the best. He may give chemotherapy with other types of cancer treatments either before, after other treatments, or alone.
Targeted therapy
Targeted therapy is akin to chemotherapy in that it also travels throughout the body to target cancer cells. But, targeted therapy works differently than chemotherapy.
After researchers learned more about the changes in non-small cell lung cancer (NSCLC) cells that help them proliferate, they developed drugs to specifically target these changes.
For example, tumors need to form new blood vessels to keep them nourished through a process called angiogenesis. Targeted drugs, such as angiogenesis inhibitors, block this new blood vessel growth.
So far, these targeted therapy drugs have only been found to be useful for some non-small cell lung cancers.
Immunotherapy
Immunotherapy, also called biotherapy or biologic therapy, is a new type of cancer therapy that stimulates the immune system of the body to fight cancer cells.
It uses drugs, vaccines, and other therapies to activate the immune system’s natural defenses so it can fight cancer.
There are two ways by which immunotherapy acts:
It stimulates the immune system to fight cancer cells through the administration of a cancer vaccine. This is called Active Immunotherapy.
It fights cancer cells with the help of the immune system through the administration of antibodies. This is called Passive Immunotherapy.
One type of immunotherapy drug, called “anti-PD-1” has been shown to significantly shrink the tumor in 25% of patients who receive it after a round of chemotherapy.
So far, three immunotherapy drugs, pembrolizumab, atezolizumab, and nivolumab, have been approved to treat certain non-small cell lung cancers.
Combination therapy
Combination therapy refers to the use of more than one therapy at the same time to treat lung cancer.
It is one of the latest advances in lung cancer research and has shown an increase in the overall survival rate for these patients in both non-small lung cancer (NSCLC) and small-cell lung cancer (SCLC).
Combination therapy increases the chances of eliminating all cancer cells in the body. Clinical trials have shown that combining immunotherapy with other therapies such as chemotherapy, radiotherapy, and targeted therapy achieves a better therapeutic effect, especially in SCLC.
Treatment plans for treating the two types of lung cancer.
Your treatment plan will depend on the type of lung cancer you have, whether you have non-small-cell lung cancer or small-cell lung cancer.
Non-small-cell lung cancer (NSCLC)
If you have non-small-cell lung cancer that is present in only one lung and you enjoy good overall health, your doctor will advise surgery to remove the tumor. Surgery is usually followed up with chemotherapy to destroy any cancer cells that may have remained in your body.
If cancer has spread only to the neighboring area and surgery is contraindicated for some reason such as your general health is not good, making you unfit for surgery, your doctor will recommend radiotherapy to destroy the cancerous cells. In some cases, your doctor may also combine this with chemotherapy (known as chemoradiotherapy).
If the lung cancer has undergone metastasis and cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy and/or immunotherapy are usually recommended.
If there is a recurrence and the lung tumor starts to grow again after you have had chemotherapy treatment, another course of chemo treatment may be recommended.
Your doctor may recommend immunotherapy or targeted therapy instead of chemotherapy, or after chemotherapy if the cancer has a specific mutation.
Small-cell lung cancer (SCLC)
Surgery is not recommended to treat small-cell lung cancer, because this cancer is often diagnosed late after it has spread to other areas of the body, because of the late onset of symptoms.
Small-cell lung cancer is usually treated with chemotherapy, either alone or in combination with radiotherapy or immunotherapy.
However, if the cancer is found in the early stages before it has spread, surgery may be useful. In such cases, your doctor will recommend chemotherapy or radiotherapy after the surgery to reduce the risk of the recurrence of cancer.
