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Treatments for lung cancer

There is no one-size-fits-all treatment for lung cancer. Your treatment plan will depend on the type and stage of your cancer, the size and location of the tumor(s), the genetic changes in your cancer cells, your overall health and your preferences and goals for treatment. You may also wish to explore complimentary and alternative medicine approaches that can be incorporated into your treatment plan.

 

It is important to speak to your care team about the goals of each treatment as well as any potential side effects and how these can be managed.

The less-common SCLC is typically more aggressive and grows and spreads more rapidly than NSCLC. In many cases, SCLC is diagnosed after the cancer has spread outside of the lungs (metastasized). SCLC responds well to a combination of chemotherapy and radiation, and these are often the recommended treatments for SCLC. 

Surgery to remove the tumor is often the recommended approach for early-stage NSCLC. Removing the tumor is considered the best option when the cancer is localized and unlikely to have spread. The goal of surgery is to completely remove the lung tumor. Often nearby lymph nodes in the chest will also be removed at the time.

Surgery can be used in combination with other treatments like radiation therapy and/or chemotherapy before or after the surgery.

How it works

The lungs have five lobes: three in the right lung and two in the left lung. There are different surgical methods and different types of surgeries depending on what/how much tissue is being removed. The more tissue that is removed, the more invasive the surgery. Your team will recommend the best approach for you by considering your age and health, the size of the tumor(s) and other factors.

Wedge resection involves removing only a small portion of the lung, a wedge-shaped piece that includes the cancerous cells and a small amount of surrounding tissue.

Segmentectomy is the removal of only a segment of the lobe in which the tumor is present. The amount of tissue removed is slightly more than a wedge resection.

Lobectomy is the removal of the entire lobe in which the cancer is located. This has often been called the “standard” for early-stage NSCLC because those who had this procedure were less likely to experience recurrence of lung cancer. With advances in surgical techniques and earlier detection, some research is showing that the less invasive segmentectomy may be the better option for some patients.

Pneumonectomy is the removal of the entire affected lung. This may be necessary if the tumor is close to the center of the chest, and less invasive options aren’t possible.

For more on surgery as a treatment for lung cancer, see:

Radiation therapy uses high-energy beams of radiation to damage to the DNA of cancer cells. The radiation will either kill the cells themselves or prevent them from making more cancer cells. Most commonly, external radiation is used in which a beam of radiation is aimed directly at your chest. Radiation therapy only destroys cells directly in the path of the radiation beam.

Radiation therapy may also be used in combination with surgery, for example before surgery to shrink the tumor(s) or after surgery to kill any remaining cancer cells that might remain.

If you are not a candidate for surgery because of your health or because your cancer has spread, external radiation may be recommended as your best option.

Depending on factors including your health and stage and type of cancer, your team will identify a schedule of radiation treatments, consisting of a specific number of treatments given over a set period of time. This could be, for example, treatment five days a week for several weeks.

If external radiation is not an option, your team may opt for internal radiation using brachytherapy. In this procedure, tiny radioactive implants are placed near the tumor using a bronchoscope. If high-dose implants are being used, the implant(s) are removed at the end of the treatment (which can last minutes or hours. In some cases, low-dose implants, may be left in place until the radiation become weaker.

Radiation treatment is also used palliatively to relieve symptoms such as cough, shortness of breath and bone pain. When using radiation therapy for palliative care, the schedule of treatments is typically shorter and less frequent.

For more on radiation therapy, see:

Chemotherapy drugs are used to shrink or stabilize a tumor, kill leftover cancer cells after surgery or relieving lung cancer symptoms.

Chemotherapy is an option for most stages of NSCLC. It is often used in combination with localized therapies, such as surgery or radiation therapy. It may also be used more advanced stages of the disease when surgery is not an option. Factors including the type of NSCLC you have, the stage of the tumor and your health will determine the chemotherapy drugs you will receive and how often you will receive them.

How does it work?

Chemotherapy drugs stop cells that grow and divide quickly (such as cancer cells) from growing and/or reproducing. These drugs can also affect other healthy cells in your body that are constantly growing and dividing, such as hair cells, skin cells and cells lining your digestive tract. Your body is able to repair or create new, healthy cells to replace the healthy cells damaged by chemotherapy drugs.

Chemotherapy is usually given through the veins (intravenously or IV). Your care team will determine a regimen or schedule to receive chemotherapy, which usually consists of a specific number of cycles over a set period of time. A cycle is a period when you receive chemotherapy treatment followed by a period of rest. This allows the healthy cells to recover and increases the likelihood that the drugs will kill all the cancer cells. You can receive chemotherapy at a clinic or a hospital or even at home.

For more information on chemotherapy, see:

Immunotherapy helps to strengthen or restore the ability of your own immune system to fight cancer. Cancer cells can “hide” from the immune system by disguising themselves as normal, healthy cells. In some cases, immunotherapy drugs can help your immune system find cancer cells more easily. If the immune system does recognize cancer cells, it may not be strong enough to destroy these cells. Some immunotherapy drugs make your immune system work harder to destroy cancer cells.

Immunotherapy can stop lung cancer cells from growing and spreading, kill cancer cells and/or control symptoms of advanced cancer or cancer that has spread from its original site. Immunotherapy drugs are often given intravenously (via a needle in a vein).

Immunotherapy can be used on its own or together with other treatments.

Because immunotherapy is less likely to affect healthy cells in your body, its side effects are often less serious than compared to other treatments.

For more information on immunotherapy for lung cancer, see:

Targeted therapy involves taking medication that targets specific gene mutations in cancer cells. The first step is molecular or biomarker testing to determine if your cancer cells have one of the mutations that can be targeted. A sample of your tumor cells will be taken surgically or by biopsy. The testing will determine what genetic mutations are present in your tumor cells and if there is a “matching” medication for that mutation.

Targeted therapy can be used alone or in combination with other treatments. It is given as a pill or capsule or an injection (needle). Targeted therapy specifically targets only the cells with the mutation (tumor cells) and it doesn’t affect the nearby healthy cells. People undergoing targeted therapy often have fewer side effects than those undergoing other treatments like chemotherapy or radiotherapy.

Research is currently being done into the use of targeted therapy for SCLC, although it’s currently not an option. This is due to the differences in the genetic makeup of the cancer cells in the two types of lung cancer and the variation and complexity of genes involved in SCLC.

For more information on targeted therapy for lung cancer, see:

Clinical trials are studies to test new drugs, already approved drugs, devices, or other forms of treatments. Your doctor may tell you about trials that may benefit you. You can also search for clinical trials online and follow up with your doctor to determine if you’re eligible. Taking part in a clinical trial is entirely up to you. To make an informed decision, it is important that you ask questions of not only your doctor but also the company running the trial. You need a good understanding of things like the logistics, purpose, possible risks and benefits of the trial to make an informed decision.

In some trials, participants may be given a placebo. A placebo is a medicine or treatment that has no therapeutic benefit. Placebos are rarely used in clinical trials for cancer unless no treatment exists. It is more likely that you will receive either the standard treatment plus a placebo, or the standard treatment plus the new treatment being testing.

For more information on clinical trials:

Clinical Trials. Global Lung Cancer Coalition.
A fact sheet to learn more about participating in clinical trials

Clinical Trials Database. Health Canada. 
A source of information about Canadian clinical trials involving human pharmaceutical and biological drugs. This is not a registry, and therefore, it does not contain comprehensive information about each clinical trial.

Canadian Cancer Trials Group
An academic cooperative oncology group that designs and conducts clinical trials testing cancer therapy, supportive care and prevention interventions across Canada

ClinicalTrials.gov
A place to learn about clinical studies from around the world.

 

This section was made possible by an unrestricted educational grant from Merck Canada, Sanofi Canada and Astra Zeneca Canada.