Inoperable Lung Cancer

Reasons Surgery May Not Work and Alternatives

empty operating room
What is inoperable lung cancer, why would surgery not be a good idea, and what other treatment options are available?. istockphoto.com

What is Inoperable Lung Cancer?

One of the more confusing terms we use when discussing lung cancer is the word “inoperable.” For those of us in medicine, it helps us place individuals in a category. Inoperable means that lung cancer surgery isn't considered the best treatment option.

Yet, sitting on the other side of the table as a patient, these words can sound entirely different. They can sound like a scary synonym to terminal.

While “inoperable” lung cancer does carry a poorer prognosis than lung cancers that can be treated with surgery, most of the time there are other treatments that can be used.

Why Might a Lung Cancer Be Considered Inoperable?

Surgery may not be the most appropriate treatment for lung cancer for several reasons. These can include the:

  • Type of Lung Cancer – Surgery is most often performed for non-small cell lung cancer. Small cell lung cancer tends to spread early, and surgery is usually suggested only for very small tumors.
     
  • Stage of Lung Cancer – Surgery is usually considered for stage 1, stage 2 and stage 3A non-small cell lung cancer. Stage 3B and stage 4 lung cancers are most often treated with non-surgical methods, such as chemotherapy, targeted therapies, immunotherapy, and radiation therapy.
     
  • Location of the Lung Cancer – If a lung tumor is located near vital structures, such as the heart, treatment options other than surgery are usually preferred.
     
  • General Health – Due to the risks related to lung surgery and general anesthesia, some medical conditions could make surgery too dangerous.
     
  • Lung Function – If breathing is already compromised by conditions such as chronic obstructive lung disease (COPD) or other lung diseases, surgery could further reduce lung function.

    Some Tumors Will Become Operable

    It's important to note that even if a lung cancer is inoperable, it could possibly become operable in the future. Sometimes chemotherapy and radiation therapy reduce the size or location of a tumor so that surgery is possible later on.

    What Treatments Are Available for Inoperable Lung Cancer?

    Even though a lung cancer is considered inoperable, several other treatment options may be considered. These include:

    • Chemotherapy - Many lung cancers respond, at least partially, to chemotherapy. Learn more about chemotherapy for lung cancer.
       
    • Radiation Therapy - Radiation may be used to shrink a tumor, and sometimes, to cure a cancer. Newer techniques of radiation therapy (called stereotactic radiation or cyber knife) are sometimes used with early stage lung cancer with results quite similar to those found with surgery, and it's expected that this may become even more of an option in the future.
       
    • Targeted Therapies - Targeted therapies are medications that are designed to either attack a cancer specifically or to interfere with the blood supply to tumors. An example of a targeted therapy for lung cancer is the use of crizotinib for ALK-positive lung cancer or ROS1 positive lung cancer.
    • Immunotherapy - Immunotherapy is an exciting new treatment approach for lung cancer, with the first drug in this category having been approved for lung cancer in 2015, and other drugs available in clinical trials. Immunotherapy works by essentially the body's own immune system to fight cancer, and may work even with the most advanced stage cancers.
       
    • Clinical Trials – Many individuals who are diagnosed with inoperable lung cancer choose to enroll in clinical trials, studies that evaluate a new drug or procedure that is not yet widely available for the treatment of lung cancer. A knowledge of types and phases of clinical trials, a list of questions to consider, and links to online databases and matching services for clinical trials (these are free) may help you decide if a clinical trial is right for you.  According to the National Cancer Institute, everyone with lung cancer should consider the option of clinical trials. It may help to keep in mind that every drug and procedure we have for treatment was once evaluated in a clinical trial.  Many clinical trials are ongoing, promising further improvements in the treatment and survival of this disease. Consider that between 2011 and 2015 more new drugs were approved for the treatment of lung cancer than were approved during the 40 year period prior to 2011. There is a lot of hope.

    If You are Newly Diagnosed with Lung Cancer

    Check out these steps (some may surprise you) if you are newly diagnosed with lung cancer. It's important to learn what you can about your disease.  

    If Your Loved One Has Been Diagnosed with Lung Cancer

    If you are caring for a loved one with inoperable lung cancer, you may be feeling not only frightened but also helpless. Check out this article on when your loved one has lung cancer in which people with lung cancer have shared what they wish their loved one knew about their disease and their thoughts and emotions.

    You may also want to check out these 12 tips on how best to support a loved one with cancer.

    Sources:

    Lancioni, R. et al. Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentr clinical trial (the RAPTURE STUDY). Lancet Oncology. July 2008. Early online publication 18 June 2008.

    National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ). Updated 01/22/16. http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/HealthProfessional/page2

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