Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.
Treatment for lung cancer depends on:
- the stage of the disease
- the location of the cancer
- the severity of symptoms
- your general health and wishes.
Treatment may involve the following.
Early-stage non–small cell lung cancer (stages 0, I or II, and sometimes stage III) may be treated by surgery to remove the tumour. Some of the tests used for diagnosis and staging may be used to see whether the cancer has spread outside the lung. If it has spread, surgery might not be helpful. However, sometimes surgery is used to remove a metastasis in the brain or adrenal gland if there is only 1 tumour, provided that the tumour in the lung can also be completely removed.
Pulmonary function tests are often done before surgery to measure how well the lungs are working, so that the doctor can assess whether surgery is a good option.If lung function is poor, removal of part or all of a lung might not be possible.If lung function is good, the surgeon might be able to remove more of the lung tissue, to increase the chance of curing the cancer.
Types of surgery that can be used include:
- pneumonectomy: removal of an entire lung
- lobectomy: removal of 1 of the lobes of the lung (the right lung is divided into 3 lobes; the left lung is divided into 2 lobes)
- segmentectomy or wedge resection: removal of part of a lobe.
Nearby lymph nodes will also be removed during the surgery to see if the cancer has spread.
These operations usually involving a surgical incision between the ribs in the side of the chest (thoracotomy). Recovery from surgery can take weeks to months. Increasingly, lung cancer surgery is done with a ‘keyhole’ approach, known as video-assisted thoracic surgery (VATS). This involves the use of 3 tubes inserted through small cuts between the ribs. This type of surgery is associated with faster recovery, but is not suitable in all cases.
Surgery is rarely used as the main treatment for small cell lung cancer because the cancer has usually spread to lymph nodes or other organs by the time it is found.
In the few cases, where small cell lung cancer is found as a single lung tumour, with no spread to lymph nodes or other organs, surgery may be an option, usually followed by additional treatment (chemotherapy often with radiation therapy).
Radiofrequency ablation uses high-energy radio waves to heat the tumour and kill the cancer cells. Although this might be an option for some patients, such as those with stage I non–small cell cancers, further studies are needed before it can be recommended as routine.
Along with surgery, some people may receive chemotherapy.
Chemotherapy might be used either as the main treatment for lung cancer, especially for stage IV non–small lung cancer or after surgery to kill microscopic cancer cells that may remain but cannot be detected (adjuvant chemotherapy), or before surgery to shrink the tumour (neoadjuvant chemotherapy).
Chemotherapy is usually the main treatment for small cell lung cancer.
Along with surgery, some people may receive radiotherapy.
Radiotherapy might be used either as the main treatment for lung cancer, after surgery to kill cancer cells that remain, before surgery to shrink the tumour, or to relieve symptoms of advanced lung cancer. Radiotherapy can be used for stage I non–small cell lung cancer using a precision technique called stereotactic ablative body radiotherapy (SABR), especially in patients who are not fit for surgery. This may only require 3 or 4 treatments. For stage II and III non–small cell lung cancer, the SABR technique is usually not suitable, and treatment is usually given more slowly, over 5–6 weeks.
Small cell lung cancer often spreads to the brain, and for some patients who have responded to initial treatment, radiotherapy to the brain might be used to reduce the risk that the cancer will cause problems there. This increases the chance of cure.
Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells. They are most effective in patients whose cancer is due to damaged genes (mutation).
Erlotinib and gefitinib are drugs that target mutations in the epidermal growth factor receptor (EGFR).
Crizotinib targets another mutation (ALK gene rearrangement) that occurs in the cells of some types of adenocarcinomas.
Immunotherapy involves treatment with medicines that boost the ability of the immune system to attack cancer cells. Immunotherapy can be used to treat some forms of non–small cell lung cancer.
Nivolumab is a medicine that boosts the immune response against cancer cells by targeting a protein on immune system (T) cells that normally stops these cells attacking the body’s normal tissues.
Other types of treatment that may be used for non–small cell lung cancer are:
- laser therapy: a laser beam is used to kill cancer cells
- photodynamic therapy: a laser light, combined with a medicine that becomes active when it is exposed to light, is used to kill cancer cells
- cryosurgery: an instrument is used to destroy abnormal tissue by freezing it
- electrocautery: a needle heated by an electric current is used to destroy abnormal tissue.
These treatments are mostly used for advanced disease.
After treatment for lung cancer, you will need regular follow-up examinations and tests to look for return of the cancer or side effects from treatment. These might include X-rays or CT scans.
Stage IV lung cancer is very hard to cure because tumours have spread to other parts of the body.Palliative treatment to control the symptoms of the disease may be the best option. Surgery, chemotherapy, radiotherapy and targeted treatments may relieve symptoms, slow the spread of the cancer and help you to live longer.
Specific treatments may also be used to:
- remove fluid buildup around the lungs, which can press on the lungs and make breathing difficult
- remove fluid buildup around the heart, which can press on the heart and affect its function
- relieve blockages in airways caused by the cancer.
Lung cancer can recur (come back) after treatment. The cancer can recur in the lungs or somewhere else in the body, and is classified as local or distant (often called metastatic cancer). Secondary cancer is when the cancer spreads to another part of the body.
Treatment of recurrent and secondary lung cancer will depend on where the cancer is, how large it is, what treatments have been used before and the person’s general health.It might involve surgery, chemotherapy, radiotherapy, targeted treatments or immunotherapy.