If lung cancer is diagnosed, other tests are done to find out how far it has spread through the lungs, lymph nodes, and the rest of the body. This process is called staging.
The type and stage of lung cancer tells doctors what kind of treatment you need. Lung cancer is treated in several ways, depending on the type of lung cancer and how far it has spread. People with non-small cell lung cancer can be treated with surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of these treatments. People with small cell lung cancer are usually treated with radiation therapy and chemotherapy. Doctors from different specialties often work together to treat lung cancer.
Pulmonologists are doctors who are experts in diseases of the lungs. Surgeons are doctors who perform operations. Thoracic surgeons specialize in chest, heart, and lung surgery.
Medical oncologists are doctors who treat cancer with medicines. Radiation oncologists are doctors who treat cancers with radiation. This site can also help you find a doctor or treatment facility external icon that works in cancer care. After surgery, the removed tissue is checked to see if there are cancer cells at the edges of the surgery specimen called positive margins.
This could mean that some cancer has been left behind, so a second surgery might be done to try to ensure that all the cancer has been removed. This might be followed by chemotherapy as well.
Another option might be to use radiation therapy after surgery. If you have serious health problems that prevent you from having surgery, you may get stereotactic body radiation therapy SBRT or another type of radiation therapy as your main treatment. Radiofrequency ablation RFA may be another option if the tumor is small and in the outer part of the lung. Sometimes removing the whole lung pneumonectomy is needed.
Any lymph nodes likely to have cancer in them are also removed. The extent of lymph node involvement and whether or not cancer cells are found at the edges of the removed tissues are important factors when planning the next step of treatment.
After surgery, the removed tissue is checked to see if there are cancer cells at the edges of the surgery specimen. This might mean that some cancer has been left behind, so a second surgery might be done to try to remove any remaining cancer.
This may be followed by adjuvant additional treatment with chemotherapy chemo , possibly followed by adjuvant immunotherapy with atezolizumab for up to a year. Another option is to treat with radiation , sometimes with chemo. Even if positive margins are not found, adjuvant chemo is usually recommended after surgery to try to destroy any cancer cells that might have been left behind.
As with stage I cancers, newer lab tests now being studied may help doctors find out which patients need this adjuvant treatment and which are less likely to benefit from it. For people whose cancer cells have certain mutations in the EGFR gene, adjuvant treatment with the targeted drug osimertinib might be an option at some point as well.
If you have serious medical problems that would keep you from having surgery, you may get only radiation therapy as your main treatment. Your treatment options depend on the size of the tumor, where it is in your lung, which lymph nodes it has spread to, your overall health, and how well you are tolerating treatment. For patients who can tolerate it, treatment usually starts with chemo, often combined with radiation therapy also called chemoradiation.
Surgery may be an option after this if the doctor thinks any remaining cancer can be removed and the patient is healthy enough. In some cases, surgery may be an option as the first treatment.
This is often followed by adjuvant chemo, which in turn might be followed by adjuvant immunotherapy with atezolizumab for up to a year in some cases. For people who are not healthy enough for surgery, radiation therapy, which may be combined with chemo, is often used.
If surgery, radiation, and chemoradiation are not likely to be good treatment options, an immunotherapy drug such as pembrolizumab Keytruda or cemiplimab Libtayo may be considered as the first treatment. If you are in fairly good health you may be helped by chemotherapy chemo combined with radiation therapy known as chemoradiation. Some people can even be cured with this treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment.
Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer.
Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide. This is called a multidisciplinary team.
Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others. Descriptions of these common types of treatments used for NSCLC are listed below, followed by an outline of the common treatment plans by stage.
Your care plan also includes treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment.
Shared decision making is particularly important for NSCLC because there are different treatment options. Learn more about making treatment decisions. The goal of surgery is to completely remove the lung tumor and the nearby lymph nodes in the chest.
The tumor must be removed with a surrounding border or margin of healthy lung tissue. A surgical oncologist is a doctor who specializes in treating cancer using surgery. A thoracic surgeon is specially trained to perform lung cancer surgery. The lungs have 5 lobes, 3 in the right lung and 2 in the left lung. A lobectomy is the removal of an entire lobe of the lung.
It is currently thought to be the most effective type of surgery, even when the lung tumor is very small. A wedge resection. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of healthy lung.
This is another way to remove the cancer when an entire lobe of the lung cannot be removed. In a segmentectomy, the surgeon removes the portion of the lung where the cancer developed. If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung. The time it takes to recover from lung surgery depends on how much of the lung is removed and the health of the patient before surgery.
Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery. Additional treatments can be given before and after your surgery to help lower the risk of recurrence. Neoadjuvant therapy, also known as induction therapy, is a therapy given before your surgery.
In addition to treating the primary tumor and lowering your risk of recurrence, this type of therapy is also used to help reduce the extent of surgery. More commonly, you will receive adjuvant therapy.
Adjuvant therapy is treatment that is given after surgery. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. This helps lower the risk of recurrence, though there is always some risk that the cancer will come back.
These types of adjuvant therapy used for NSCLC include radiation therapy and systemic therapies, such as chemotherapy, targeted therapy, and immunotherapy. Each therapy is described below. Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. If you need radiation therapy, you will see a specialist called a radiation oncologist.
A radiation oncologist is the doctor who specializes in giving radiation therapy to treat cancer. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.
A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to several weeks. Like surgery, radiation therapy cannot be used to treat widespread cancer.
Radiation therapy only destroys cancer cells directly in the path of the radiation beam. It also damages the healthy cells in its path. For this reason, it cannot be used to treat large areas of the body. Sometimes, CT scans see Diagnosis are used to plan out exactly where to direct the radiation beam to lower the risk of damaging healthy parts of the body. It is not an option for all patients, but it may be used for early-stage disease and small tumors when surgery is not an option.
Some people with Stage I NSCLC or people who cannot have surgery may be treated with radiation therapy as an alternative treatment to surgery. Listen to a Cancer. People with lung cancer who receive radiation therapy often experience fatigue and loss of appetite. If radiation therapy is given to the neck or center of the chest, side effects can include a sore throat and difficulty swallowing. Patients may also notice skin irritation, similar to sunburn, where the radiation therapy was directed.
Most side effects go away soon after treatment is finished. If the radiation therapy irritates or inflames the lung, patients may develop a cough, fever, or shortness of breath months and sometimes years after the radiation therapy ends.
If it is mild, radiation pneumonitis does not need treatment and goes away on its own. If it is severe, a patient may need treatment for radiation pneumonitis with steroid medications, such as prednisone Rayos. Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. The scarring does not usually cause symptoms. However, severe scarring can cause a permanent cough and shortness of breath.
For this reason, radiation oncologists carefully plan the treatments using CT scans of the chest to lessen the amount of healthy lung tissue exposed to radiation see above. Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Common ways to give systemic therapies include an intravenous IV tube placed into a vein using a needle or in a pill or capsule that is swallowed orally.
Each of these types of therapies are discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. The medications used to treat cancer are continually being evaluated.
Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements.
Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.
It has been shown to improve both the length and quality of life for people with lung cancer of all stages. A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. The type of lung cancer you have, such as adenocarcinoma or squamous cell carcinoma, affects which drugs are recommended for chemotherapy. Common drugs used to treat lung cancer include either 2 or 3 drugs given together or 1 drug given by itself.
Some common drugs include:. Chemotherapy may also damage healthy cells in the body, including blood cells, skin cells, and nerve cells.
The side effects of chemotherapy depend on the person and the dose used, but they can include fatigue, low numbers of blood cells, risk of infection, mouth sores, nausea and vomiting, loss of appetite, diarrhea, numbness and tingling in the hands and feet , and hair loss.
Some lung cancer chemotherapy treatments do not cause significant hair loss. Your medical oncologist can often prescribe drugs to help relieve many of these side effects. Hormone injections may be used to prevent white blood cell counts from becoming too low. Nausea and vomiting are also often avoidable. Learn more about preventing nausea and vomiting caused by cancer treatment.
In many cases, side effects usually go away after treatment is finished. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in the tumor. For some lung cancers, abnormal proteins are found in unusually large amounts in the cancer cells. This helps doctors better match each patient with the most effective treatment whenever possible.
In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments. Epidermal growth factor receptor EGFR inhibitors. Researchers have found that drugs that block EGFR may be effective for stopping or slowing the growth of lung cancer when the cancer cells have EGFR mutations.
This medication is a pill that can be taken by mouth. The side effects of EGFR inhibitors often include a rash that looks like acne and diarrhea. Erlotinib Tarceva has been shown to work better than chemotherapy if the lung cancer has a mutation in the EGFR gene. The side effects of erlotinib include a rash that looks like acne, and diarrhea. It is a type of drug called a tyrosine kinase inhibitor TKI. However, it is not frequently used.
It is more commonly used in Asia and some other parts of the world. Anaplastic lymphoma kinase ALK inhibitors. ALK is a protein that is a part of the cell growth process. When present, this mutation helps cancer cells grow.
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