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

If your doctor has told you that your lung cancer is inoperable, what exactly does that mean? We will explain why many lung cancers are inoperable, but also why this does not mean that a cancer is untreatable or even that long term survival is not possible. Treatments for lung cancer have changed dramatically in just the past few years, and there are now many options for controlling the disease even when surgery is not possible.

Overview

One of the more confusing terms we use when discussing lung cancer is the word “inoperable.” The term can be useful in medicine, as it helps physicians place individuals in a category. Inoperable means that lung cancer surgery isn't considered the best treatment option.

Yet, for those living with lung cancer as a patient, these words can sound entirely different. It might even 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; treatments that can sometimes establish long-term control of the disease similar to that of surgery.

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:

  • 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. When chemotherapy is used in this way, it is referred to as "neoadjuvant chemotherapy."

Treatments

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. Stereotactic body radiotherapy (SBRT), also referred to as gamma knife or cyber knife, is also increasingly used to control oligometastases. Oligometastatses is a big word that simply means only a few metastases. For example, if a person has three metastases to their brain from lung cancer, they may possibly receive SBRT to treat those metastases while other treatments, such as chemotherapy, targeted therapies, or immunotherapy are used to control the cancer in the rest of the body.
     
  • 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 erlotinib for EGFR mutations or of crizotinib for ALK-positive lung cancer or ROS1 positive lung cancer. This is only an example of a few of the targetable mutations found in people with lung cancer. Absolutely everyone with non-small cell lung cancer should have molecular profiling (genetic testing) done on their tumor to see if they are a candidate for any of these therapies.
  • 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 have become available since that time with further drugs being studied in clinical trials, either alone, or in combination with other therapies ranging from chemotherapy, to radiation, to the use of a combination of immunotherapy drugs. Immunotherapy works by essentially the body's own immune system to fight cancer and may work even with the most advanced stage cancers. While immunotherapy only works at the current time for 20 to 30 percent of lung cancers, it can be extremely effective for these people. Enough so that some oncologists are even wondering if immunotherapy will be able to cure some people with stage 4 lung cancer, a word never mentioned before when discussing advanced lung cancer.
     
  • 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:

American Society of Clinical Oncology. Lung Cancer – Non Small Cell: Treatment Options. Updated 06/16. http://www.cancer.net/cancer-types/lung-cancer-non-small-cell/treatment-options

Continue Reading