Treatment of Lung Cancer

Treatment for lung cancer involves surgical removal of the cancer, chemotherapy, or radiation therapy, as well as combinations of these treatments.

Updated: June 16, 2022

Treatment for lung cancer involves surgical removal of the cancer, chemotherapy, or radiation therapy, as well as combinations of these treatments.
The location and extent of the tumor, as well as the overall health status of the patient will be taken in to account to determine the appropriate type of treatments for a given individual.

Surgery:

Stage 1 or sometimes stage 2 NSCLC and for cancer that has not spread beyond the lung, surgical removal of the tumor is generally performed. But removal does not always result in a cure, since the tumors may already have spread and can recur at a later time. Although a tumor may be anatomically suitable for resection, surgery may not be possible if the person has other serious conditions such as severe heart or lung disease that would limit their ability to survive an operation.
Surgery is less often performed with SCLC than with NSCLC because these tumors are less likely to be localized to one area that can be removed. Depending upon the size and location of the tumor, the surgical procedure is chosen. Surgery can be done to remove of a portion of one lobe, entire lobe or an entire lung. Sometimes lymph nodes in the region of the lungs also are removed. Patients may experience difficulty breathing, shortness of breath, pain, and weakness after the surgery.
The risks of surgery include complications due to bleeding, infection, and complications of general anesthesia.

Radiation:

Radiation therapy uses high-energy X-rays or other types of radiation to kill dividing cancer cells for both NSCLC and SCLC. The radiation is either given externally by using a machine that directs radiation toward the cancer, or internally through placement of radioactive substances in sealed containers within the area of the body where the tumor is localized.
When a small pellet of radioactive material placed directly into the cancer or into the airway next to the cancer through a bronchoscope, that is known as brachytherapy . If a person refuses surgery, if a tumor has spread to areas such as the lymph nodes or trachea making surgical removal impossible or if a person has other conditions that major surgery is not possible, radiation therapy can be given.
Radiation therapy generally only shrinks a tumor or limits its growth when given as a sole therapy. Combining radiation therapy with chemotherapy can prolong survival. Radiotherapy can not be given to a person who has severe lung disease with lung cancersince the radiation can further decrease function of the lungs.
Gamma knife is a  type of external radiation therapy used to treat single brain metastases. In this procedure, multiple beams of radiation from different directions are focused on the tumor over a few minutes to hours while the head is held in place by a rigid frame. This reduces the dose of radiation that is received by noncancerous tissues. Brain radiation therapy can cause short-term memory problems, fatigue, nausea, and other side effects. Radiation therapy can have side effects, including fatigue and lack of energy. A reduced white blood cell count and low blood platelet levels also can occur with radiation therapy. If the digestive organs are in the field exposed to radiation, patients may experience nausea, vomiting, or diarrhea. Radiation therapy can irritate the skin in the area that is treated, but this irritation generally improves with time after treatment has ended.

Chemotherapy:

Chemotherapy refers to the administration of drugs that stop the growth of cancer cells by killing them or preventing them from dividing for both NSCLC and SCLC.  the platinum-based drugs have been the most effective in treatment of lung cancers.
For most SCLC chemotherapy is the treatment of choice, since the tumors are generally widespread in the body when they are diagnosed. Chemotherapy may be given as pills, as an intravenous infusion, or as a combination of the two. Unfortunately, the drugs used in chemotherapy also kill normally dividing cells in the body, resulting in unpleasant side effects such as increased susceptibility to infections and difficulties with blood clotting. Other side effects include fatigue, weight loss, hair loss, nausea, vomiting, diarrhea, and mouth sores.
The side effects generally disappear during the recovery phase of the treatment or after its completion.

Targeted therapy:

If the tumors have specific genetic changes that promote tumor growth, molecularly targeted therapy is done. Erlotinib and gefitinib are targeted drugs that more specifically target cancer cells, resulting in less damage to normal cells than general chemotherapeutic agents. Other targeted therapies include ALK tyrosine kinase inhibitor drugs crizotinib and ceritinib that are used in patients whose tumors have an abnormality of the ALK gene as the driver mutation.

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