Lung Cancer

Lung Cancer Treatment Options

An Overview of Lung Cancer Treatments

There are many treatment options for people with lung cancer, but this has not always been true. Treatments themselves—as well as the survival rates associated with them—have also improved dramatically in recent years. While this is all wonderful news, it doesn't make having to choose which options are best for you any less overwhelming. 

Getting to know more about the lung cancer treatments that are available, and getting the support you need, can go a long way in helping you make this important decision.

Can Treatments Cure Lung Cancer?

For people with early-stage lung cancer, surgery may offer the chance for a cure. Even if you have advanced stage lung cancer, there are many options for treatment. Recent advances that allow physicians to personalize lung cancer treatments, as well as a better understanding of how our immune systems work to fight cancer, have significantly increased the methods we have for treating this disease.

It's important to state right away that while lung cancer is admittedly much easier to treat in the early stages, there are long-term survivors of even the most advanced stages. It's also important to note that treating lung cancer goes beyond increasing survival alone. Lung cancer treatments can play a significant role in decreasing the symptoms of cancer and make it possible for most people to have a good quality of life throughout treatment.

Types of Treatments for Lung Cancer

Since there are many different treatments available for lung cancer, it can be helpful to break these therapies down into two major approaches:

  • Local Treatments: Local treatments treat cancer at its source—in other words, locally. These include surgery and radiation therapy, treatments that remove the tumor but are unable to reach cells which have traveled beyond the original site of the tumor. 
  • Systemic Treatments: Systemic treatments kill cancer cells wherever they happen to be in the body. These treatments include chemotherapy, targeted therapies, and immunotherapy.

With early stage lung cancers, local treatments may be enough to attempt to cure the cancer. When a lung cancer has spread to lymph nodes or to other regions of the body, systemic therapies are often the best treatment option. 

A confusing term you may encounter is adjuvant therapy. Sometimes systemic treatments are used even if a cancer does not appear to have spread. For example, chemotherapy or a targeted therapy drug may be given even though surgery was also done. Adjuvant treatments are those that are done to treat any cells that have spread beyond the initial site of the cancer, but may not yet be detectable with the imaging tests we currently have.

Surgery for Lung Cancer

When lung cancer is caught in the early stages—before it has spread beyond the lungs—surgery may be curative. For early-stage, non-small cell lung cancers (specifically stage I to stage IIIA non-small cell lung cancers), surgery is often considered. On rare occasions, surgery may be considered for early (limited-stage) small cell lung cancer.

There are five primary procedures that may be done to treat lung cancer:

  • Pneumonectomy: A pneumonectomy refers to the removal of a whole lung.
     
  • Lobectomy: In a lobectomy, one of the lobes of a lung is removed. (The right lung has three lobes, and the left lung has two lobes.)
     
  • Wedge Resection: In a wedge resection, the tumor is removed along with a wedge-shaped area of lung tissue surrounding the tumor.
     
  • Sleeve Resection: In a sleeve resection, a lobe of the lung, along with part of the bronchus (the airways leading to the lung,) is removed.
     
  • Segmentectomy: In a segmentectomy, a segment of a lobe is removed. The amount of tissue removed by this procedure is more than a wedge resection, but less than a lobectomy.

    Common side effects of surgery include infections, bleeding, and shortness of breath, depending on lung function prior to surgery and the amount of lung tissue removed.  

    Radiation Therapy for Lung Cancer

    Radiation therapy for lung cancer uses high-energy X-rays applied from outside the body to kill cancer cells. There are a few ways in which radiation is used for lung cancer:

    • As an adjuvant treatment to treat any cancer cells that remain after surgery
    • To help decrease the size of a tumor so surgery is possible
    • As a palliative treatment to decrease pain or airway obstruction in people who have cancers that cannot be cured
    • As a curative treatment: A specific type of radiation therapy known as stereotactic body radiotherapy (SBRT) uses high-dose radiation given to a small area in the lungs. This may be used as an alternative to surgery when surgery is not possible.

    Common side effects of radiation therapy can include redness and irritation of the skin, fatigue, and inflammation of the lungs (radiation pneumonitis).

    Chemotherapy

    Chemotherapy for lung cancer uses medications designed to kill rapidly dividing cells such as cancer cells. Chemotherapy drugs may be used as a primary treatment for advanced lung cancer, after surgery (adjuvant chemotherapy), or before surgery to reduce the size of a tumor (neoadjuvant therapy.)

    Combination chemotherapy—using more than one chemotherapy drug at the same time—is most commonly used. Different medications interfere with cell division at different points in the cell cycle, and targeting this process in more than one way increases the likelihood of treating as many lung cancer cells as possible. Some chemotherapy medications used for people with lung cancer include:

    • Platinol (cisplatin)
    • Paraplatin (carboplatin)
    • Gemzar (gemcitabine)
    • Taxotere (docetaxel)
    • Taxol (paclitaxel) and Abraxane (nab-paclitaxel)
    • Alimta (pemetrexed)
    • Navelbine (vinorelbine)

    Common side effects of chemotherapy include bone marrow suppression (a reduction in red blood cells, white blood cells, and platelets), hair loss, and fatigue. Nausea and vomiting are dreaded side effects of chemotherapy, but thankfully the management of these adverse effects has improved dramatically in recent years.

    Targeted Therapies

    Targeted therapies for lung cancer are drugs that are tailored to attack certain characteristics of cancer cells and, hence, may have fewer side effects than traditional chemotherapy.

    It is extremely important that everyone who is diagnosed with non-small cell lung cancer, particularly lung adenocarcinoma, have gene profiling (molecular profiling) of their tumor performed. You may hear your doctor talk about "targetable" gene mutations and genetic changes. What this means is that some lung cancer cells have genetic changes that can be targeted (and treated) with specific medications that address these changes.  

    Treatments have been approved for those with EGR mutations, ALK rearrangements, ROS1 rearrangements, and there are also clinical trials studying medications for other mutations and genetic changes in cancer cells. This area of science is changing very rapidly, and it's likely that new targets and new medications will continue to be discovered.  

    While targeted therapies can be very effective, resistance to these treatments usually develops over time. However, second- and third-generation drugs are now available and being studied for when this occurs. Some targeted medications approved for lung cancer include:

    • ALK inhibitors - Xalkori (crizotinib), Zykadia (ceritinib), and Alecensa (alectinib)
    • Angiogenesis inhibitors - Avastin (bevacizumab) and Cyramza (ramucirumab)
    • EFGR inhibitors - Tarceva (erlotinib), Gilotrif (afatinib), Iressa (gefitinib), Tagrisso (osimertinib), and Portrazza (necitumumab)

    Immunotherapy

    A new type of treatment for lung cancer became available in 2015. Immunotherapy drugs work by essentially harnessing your immune system to help rid your body of cancer cells. Though we tend to hear a lot of hype in the news, immunotherapy is truly a reason to get excited about the future of lung cancer and was named the 2016 clinical cancer advancement of the year by the American Society for Clinical Oncology.

    While targeted therapies tend to be more effective in people who have not smoked, immunotherapies may be more effective in people who smoked and who have cancers such as squamous cell lung cancer. Immunotherapy drugs currently approved for lung cancer include:

    • Opdivo (nivolumab)
    • Keytruda (pembrolizumab)

    Alternative Lung Cancer Treatments

    While alternative treatments for lung cancer have not been found beneficial in treating lung cancer specifically, there are several integrative cancer treatments that may help people cope with the symptoms of cancer and cancer treatments. Some of these include acupuncture, massage therapy, and meditation.

    Lung Cancer Clinical Trials

    The National Cancer Institute recommends that everyone with lung cancer consider a clinical trial, and this is more important than ever.  Every treatment we have for lung cancer was once studied as part of a clinical trial before being approved. To emphasize the importance of these trials, it may help to mention that between 2011 and 2015, more new treatments were approved for lung cancer than during the four-decade period prior that.

    Talk to your doctor about clinical trials and decide if this is something you'd like to explore. Several of the lung cancer organizations have put together a free lung cancer clinical trial matching service in which health professionals can help match the particular characteristics of your cancer with clinical trials in progress anywhere in the world.

    Choosing the Best Lung Cancer Treatment Options For You

    As noted above, there may be several different options available for treating your lung cancer. While this can seem daunting, there are a few things you can do to make the decision-making process easier. 

    If you've just recently learned you have lung cancer, take a moment to look at these first steps to take when newly diagnosed. Studies suggest that learning as much as you can about cancer helps decrease anxiety and may even affect outcomes. Learn how to research your cancer and find reliable information. You can start right here on Verywell.

    One of the best things you can do to get the best treatment is to find a cancer center you trust. Review these tips on choosing a lung cancer treatment center as well as the importance of getting a second opinion with lung cancer. Take time to talk to your family and friends. You may also wish to ask your oncologist where she would seek out treatment if she were to be diagnosed with lung cancer.

    It can't be emphasized enough that this is your own decision. We all have different ideas about how we would address cancer treatments for ourselves, and emotions can run strong at this time. Welcome the input from your loved ones, but make sure to make a decision based on what you are comfortable with and what you feel is best for you alone.

    A Word From Verywell

    The most important thing you can do as you consider treatments is to become your own advocate in your cancer care. ​Even if you are not a "social butterfly" or an "Internet geek," getting involved with online lung cancer support groups and lung cancer communities is priceless. Not only are these ways to get support from others who have "been there" and can understand, but these groups can help you learn about and understand the latest developments in lung cancer. The hashtag to help you locate these communities is #LCSM, which stands for lung cancer in the social media world.

    Don't let the stigma of lung cancer or questions you may receive about your smoking status derail you. Anyone who has lungs can get lung cancer. Don't let the notion that lung cancer is untreatable interfere either. You may need to remind your friends that what they experienced with relatives 10 years ago is much different than how lung cancer is treated today. And even though you may see fewer white lung cancer ribbons than pink breast cancer ribbons, don't be fooled. What the lung cancer community lacks in numbers it makes up for in depth. Reach out to the many people who will have your back as you face this disease.

    Sources:

    Masters, G. Immunotherapy in Lung Cancer Treatment: Current Status and Future Directions. American Society of Clinical Oncology: ASCO Newshttps://am.asco.org/immunotherapy-lung-cancer-treatment-current-status-and-future-directions

    National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ) – Health Professional Version. http://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq

    National Cancer Institute. Small Cell Lung Cancer Treatment (PDQ) – Health Professional Version. Updated 07/07/16. http://www.cancer.gov/types/lung/hp/small-cell-lung-treatment-pdq

    Pass, J., Carbone, D., Johnson, D. et al. Principles and Practice of Lung Cancer. 4th Edition. Williams and Wilkins: 2010.

    Rocco, G., Morabito, A., Leone, A., Muto, P., Fiore, F., and A. Budillon. Management of Non-Small Cell Lung Cancer in the Era of Personalized Medicine. International Journal of Biochemistry and Cell Biology. 2016. 78:173-179.

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