Treatment of lung cancer depends on the size, location and type of cancer, as well as on your overall health.
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 powerful drugs to kill cancer cells. In cases of small cell lung cancer, chemotherapy may be used 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 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 always is to destroy cancer cells while harming as little normal tissue as possible. Side effects of treatment may include redness, swelling, and sloughing of the skin where the radiation enters your body, increased likelihood of infection, nausea, vomiting, change in taste, fatigue and a general feeling of being unwell (malaise). You're not a candidate for chest radiation if you have severe lung disease or other health problems in addition to cancer.
Small cell lung cancer often spreads to the brain. For that reason, your doctor may sometimes recommend brain radiation therapy to prevent cancer from spreading 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.
Comfort (supportive) care. If you have extensive small cell lung cancer and are in poor health, you may not be able to tolerate either radiation or chemotherapy. In that case, you may choose to receive comfort care only. This means treating any symptoms the cancer is causing, but not treating the cancer itself.
Non-small cell lung cancer
Surgery is usually the treatment of choice 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 penumonectomy can 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.
Less invasive procedures for the removal of lung tumors are being developed. In video-assisted thoracoscopy, for example, surgeons use a video camera to help visualize and operate on the lung. The incisions in this operation are smaller than those used for other procedures, and you may heal more quickly. But because video-assisted thoracoscopy may not allow surgeons to fully examine the lungs and lymph nodes, it's usually appropriate only for early-stage cancers. It's most commonly used when a nodule occurs in the peripheral — as opposed to the centrally located — part of the lungs and the lymph nodes in the center of the chest aren't enlarged.
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 other cancerous nodes. In addition, extensive lymph node involvement usually means that the cancer already has spread to other parts of your body, even though this spread may not yet have been detected.
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 may 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.
More advanced non-small cell lung cancers are generally treated with chemotherapy, radiation, or a combination of both chemotherapy and radiation. People with stage IIIA or IIIB disease usually receive chest radiation in combination with systemic chemotherapy. Some studies have suggested that receiving both at the same time is more effective than receiving them sequentially, but side effects are more severe with concurrent treatment.
A few people with stage IIIA lung cancer may first be offered chemotherapy in an effort to shrink the tumor. If that proves successful, surgical removal of the cancer may be an option. Other people with stage IIIA cancer may receive radiation only, which may be helpful in relieving symptoms.
Still, because the best treatment for this stage of the disease isn't known, your doctor may encourage you to 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.
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