Treatment Options

Treatment options for lung cancer vary depending upon the kind and stage of the disease. It is important to know if you have been diagnosed with non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). Knowing as much as you can about the kind and stage of your lung cancer will help to you better identify and understand your options for treatment. Staging indicates the size or extent of the cancer, and indicates if it has spread.

NSCLC has four stages: I, II, III, and IV. NSCLC also has several subtypes, the most common of which are adenocarcinoma, squamous cell carcinoma and large cell carcinoma. If NSCLC is caught early, surgery is generally an option. In later stage NSCLC, chemotherapy and/or targeted therapies are used, with or without radiation.

SCLC is staged as either limited or extensive. Occasionally, surgery may be an option for SCLC but chemotherapy, often with radiation, is generally the recommended treatment.

Treatment options differ for each individual and may depend on other factors such as age, physical condition, other medical problems, and where a tumor is located. The following information about common treatment options for lung cancer is provided so that you can begin your discussion of your options with your treatment team.

Surgery

The type of surgery depends on the location and size of the tumor. Depending on the kind and stage of the lung cancer, chemotherapy and/or radiation may be given. The goal of chemotherapy/radiation before surgery is to shrink the size of a tumor so that it can be removed. The goal of chemotherapy after surgery is to destroy tiny cancer cells - those that may not even be detected by imaging tests - that have spread or may have been missed during surgery.

Types of surgery

• Segmental Resection - Surgery to remove only a small part of the lung where the tumor is isolated. Also called a "wedge resection."
• Lobectomy - The surgical removal of a lobe of the lung. The right lung is divided into three lobes, the left lung has two lobes.
• Bilobectomy – The surgical removal of two lobes of the lung. If both lobes of the left lung, this would be an pneumonectomy.
• Pneumonectomy - The surgical removal of the entire lung.

Surgical procedures

• Thoracotomy - A surgical procedure in which an incision is made across the side of the chest and the ribs are spread apart so that the surgeon can gain access to the lung.
• Video Assisted Thoracic Surgery (VATS) – Less invasive than thoracotomy, this surgical procedure involves making small incisions into the chest wall through which a small video camera and surgical instruments placed which allow the surgeon to see inside and remove diseased portions of the lung. .

Other Treatments

Chemotherapy--Drugs used to kill rapidly dividing cells in the body, including cancer cells.  A systemic treatment, chemotherapy drugs circulate through the body to kill cancer cells throughout. Chemotherapy for lung cancer often includes a platinum-based drug (cisplatin or carboplatin) in combination with another chemotherapy drug (paclitaxel, docetaxel, etoposide, gemcitabine, pemetrexed, etc).

Targeted therapies--Treatments designed to target cancer cells in more specific ways, usually involving the mechanisms that cause cancer cells to grow or divide. Current targeted therapies used for lung cancer include Tarceva, Avastin, and Erbitux (see Emerging Treatments page for further details).

Radiation Therapy--The goal of radiation therapy may be to kill or shrink cancer cells at the site of the tumor; for palliative care, such as to relieve pain; or to prevent cancer from spreading to the brain, as in prophylactic cranial irradiation after treatment for small cell lung cancer.

• General radiation (external beam): Use of carefully aimed doses of radiation at specific sections of the lungs or surrounding areas (such as the neck or center of the chest)
• Stereotactic Radiosurgery (SRS or STRS): ie., Gamma Knife, Cyber Knife: a precise delivery of a single, high dose of radiation delivered in a one-day session
• Brachytherapy: A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called internal radiation therapy, and implant radiation therapy
• Whole brain radiation:  External radiation therapy to the head. Generally used to treat brain metastases from lung cancer
• PCI (Prophylactic Cranial Irradiation):  Radiation to the head with the goal of reducing the risk of brain metastases.  It is commonly recommended after successful treatment for small cell lung cancer

Ablation Therapies

• Radiofrequency Ablation (RFA): Radiofrequency ablation uses radio waves to heat up and destroy tumors
• Cryoablation: Uses liquid nitrogen or argon gas to freeze tumors

Photodynamic Therapy (PDT)--A procedure in which a special chemical is injected into the blood stream. The chemical is absorbed by all the cells but does not stay in normal cells long. It remains in cancer cells quite awhile and a laser aimed at the cancer activates the chemical to kill the cancer cells. At this time, PDT is approved for relief of symptoms (such as breathing problems or bleeding) in non-small cell lung cancer and can also treat small tumors.

For more information about lung cancer treatment, please visit the National Cancer Institute’s website:
http://cancernet.nci.nih.gov/cancertopics/treatment/lung