Lung Cancer
Treatment
Treatments
for lung cancer depend on the type and stage of cancer,
as well as on your overall health. If you have emphysema,
for instance, your poor lung function may prevent you from
having surgery, even if you have a tumor that would otherwise
be operable.
Other
factors also come into play, no matter what type of lung
cancer you have. There are times, for instance, when the
potential side effects of treatment outweigh the benefits.
When that is the case, your doctor may suggest comfort (supportive)
care only. This means treating the symptoms the cancer is
causing, such as pain and difficulty breathing, but not
treating the cancer itself.
Small
cell lung cancer
Because most small cell lung cancers have spread beyond
the lungs by the time they're discovered, an operation usually
isn't a treatment option. Instead, the most effective treatment
is chemotherapy, either alone or in combination with radiation
therapy.
* Chemotherapy. This treatment uses drugs to kill cancer
cells. In cases of small cell lung cancer, chemotherapy
may be used to shrink the cancer, to slow the cancer's growth,
to prevent it from spreading further, or to relieve symptoms
and make you more comfortable (palliative care). A combination
of drugs usually is given in a series of treatments over
a period of weeks or months, with breaks in between so that
your body can recover. Even so, because the drugs damage
healthy cells along with malignant ones, they can cause
serious side effects. In fact, for many people, side effects
from chemotherapy are the most disturbing aspect of cancer
treatment. Fast-growing cells such as those in your digestive
tract, bone marrow and hair are especially likely to be
affected. But although side effects are common, their severity
depends on the drugs used and your response to them. Sometimes
you may have few reactions. On the other hand, you may experience
symptoms such as nausea and vomiting, dizziness, severe
fatigue and an increased risk of infection. Ask your treatment
team about the side effects of any treatment you're considering
and the best ways to minimize those effects. If you choose
to receive chemotherapy, be sure you understand the long-
and short-term goals of your therapy and the overall risks
and benefits.
*
Radiation therapy. This uses X-rays to kill cancer cells.
In some cases, the radiation may come from outside your
body (external radiation). In others, a radioactive substance
may be placed inside needles, seeds or catheters and inserted
into or near the cancer (internal radiation). The way in
which radiation is delivered depends on the type and stage
of the cancer being treated. Radiation therapy may be given
before, during or after chemotherapy. In all cases, however,
the goal of treatment is to destroy cancer cells while harming
as little normal tissue as possible. Side effects of treatment
may include redness and swelling of the skin where the radiation
enters your body, a cough, shortness of breath, fatigue
and sometimes difficulty swallowing if your esophagus is
within the area receiving the radiation. You may not be
a candidate for chest radiation if you have severe lung
disease.
Small cell lung cancer often spreads to the brain. For that
reason, your doctor may sometimes recommend brain radiation
therapy to prevent cancer from metastasizing to that part
of the body or to eliminate micrometastases that aren't
yet detectable with imaging studies. Brain radiation therapy
can cause short-term memory problems, fatigue, nausea and
other serious side effects. If your cancer is in remission,
discuss the risks and benefits of this treatment with your
doctor.
Non-small
cell lung cancer
Surgery is usually the best treatment for early-stage non-small
cell lung cancer. In some cases, only the portion of the
lung that contains the tumor is removed. In others, one
lobe or even the entire lung may be taken. Surgery to remove
all or part of a lung often involves opening one side of
the chest, a procedure called a thoracotomy.
Operations
to treat lung cancer include:
* Wedge resection. In this operation, your doctor removes
only the section of your lung that contains the tumor along
with a margin of normal tissue.
* Lobectomy. The most common type of lung cancer surgery,
lobectomy involves removing an entire lobe of one lung.
* Pneumonectomy. In this operation, an entire lung is removed.
Because pneumonectomy will decrease lung function considerably,
as well as lead to other complications, it's performed only
when absolutely necessary and then only if your breathing
capacity is sufficient to allow you to breathe with a single
lung.
Sampling
lymph nodes
No matter which operation is performed, your surgeon will
sample lymph nodes from the center of your chest (mediastinum)
and from the hilum — the region where the bronchus and blood
vessels to the lungs originate. A pathologist usually examines
the sample immediately, and your surgeon receives the report
within 10 minutes. If cancer has spread to these nodes,
your surgeon may decide not to remove any lung tissue. Unless
the affected lymph nodes are at the base of the lobe containing
the cancer, it's nearly impossible to remove all of the
cancerous nodes. In addition, extensive lymph node involvement
usually means that the cancer already has spread to other
parts of the body, even though this spread may not yet have
been detected.
Effects
of surgery and your recovery
Surgery to remove lung tissue is a major operation. Depending
on the extent and type of your surgery, you're likely to
spend up to a week in the hospital. Once you return home,
it may take weeks or even months to regain your strength.
If you have other lung conditions, such as emphysema or
bronchitis, your hospital stay and recovery may be even
longer.
You're
also likely to experience certain complications following
surgery. The muscles of your chest and arm on the side where
you had the operation will be very sore, for example, making
it difficult to use the arm the way you used to. In that
case, your doctor may recommend physical therapy or other
rehabilitation program to help restore your strength and
range of motion.
In
addition, because you have less lung tissue, you initially
may feel short of breath. Over time, however, your remaining
lung tissue should expand, improving your ability to breathe.
But if you have emphysema or other lung conditions, the
shortness of breath may become worse.
No
matter how much lung tissue is removed, you're likely to
experience pain following your operation. Your doctor will
work with you to ensure that you receive medication to keep
you as comfortable as possible.
Treating
advanced non-small cell lung cancer
More advanced non-small cell lung cancers are generally
treated with chemotherapy, radiation, or a combination of
both chemotherapy and radiation, although treatment of stage
III non-small cell lung tumors is often individualized.
Some people, for instance, may have surgery after first
being treated with chemotherapy and radiation.
Still,
because the best treatment for this stage of the disease
isn't known, your doctor may suggest that you participate
in a clinical trial — a research study that tries to improve
current treatments or find new treatments for specific diseases.
This can give you access to experimental therapies that
might not otherwise be available. There are no guarantees
with clinical trials, however, and you should fully understand
the potential risks as well as possible benefits before
undertaking this step.
New
treatments
Researchers are developing new treatments for all types
of cancer, including lung cancers, such as:
* Erlotinib. This oral medication targets the epidermal
growth factor receptors on the surface of cells that are
involved in cell growth and proliferation. Abnormalities
in these receptors, which can lead to the constant production
of new cells, have been associated with several types of
cancer. Erlotinib has been approved for use in treating
recurrent non-small cell lung cancers and is being studied
for use in other stages of the disease.
* Bevacizumab. Given as an injection in conjunction with
standard chemotherapy, this treatment helps stop the growth
of blood vessels that supply nutrients to tumors. Bevacizumab
has improved survival in some people with colorectal and
lung cancers, but because the drug can have potentially
fatal side effects, it's only used in certain cases.
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The information on this page has been extracted from http://www.mayoclinic.com/health/lung-cancer/DS00038/DSECTION=7
