lung and airway disorders
Lung Cancer
Treatment of Lung Cancer
Surgery Radiation therapy Chemotherapy Targeted therapies Doctors use various treatments for both small cell and non–small cell lung cancer. Surgery, chemotherapy, and radiation therapy can be used individually or in combination. The precise combination of treatments depends on the Type of cancer Location of the cancer Severity of the cancer Degree to which the cancer has spread Person's overall health For example, in some people with advanced non–small cell lung cancer, treatment includes chemotherapy and radiation therapy before, after, or instead of surgical removal. Surgery is the treatment of choice for non–small cell lung cancer that has not spread beyond the lung (early-stage disease). In general, surgery is not used for early-stage small cell lung cancer, because this aggressive cancer that has often spread beyond the lungs at the time of diagnosis and therefore is treated with chemotherapy and radiation therapy. Surgery for non-small cell lung cancer may not be possible if the cancer has spread beyond the lungs, if the cancer is too close to the windpipe, or if the person has other serious conditions (such as severe heart or lung disease). Before surgery, doctors do Pulmonary Function Testing (PFT) to determine whether the amount of lung remaining after surgery will be able to provide enough oxygen and breathing function. If the test results indicate that removing the cancerous part of the lung will result in inadequate lung function, surgery is not possible. The amount of lung to be removed is decided by the surgeon, with the amount varying from a small part of a lung segment to an entire lung. Although non–small cell lung cancers can be removed surgically, removal does not always result in a cure. Supplemental (adjuvant) chemotherapy after surgery can help increase the survival rate and is done for all but the smallest cancers. Sometimes chemotherapy is given before surgery (called neoadjuvant therapy) to help shrink the tumor before surgery is done. Occasionally, cancer that begins elsewhere (for example, in the colon) and spreads to the lungs is removed from the lungs after being removed at the source. This procedure is recommended rarely, and tests must show that the cancer has not spread to any site outside of the lungs. Radiation therapy is used in both non–small cell and small cell lung cancers. It may be given to people who do not want to undergo surgery, who cannot undergo surgery because they have another condition (such as severe coronary artery disease), or whose cancer has spread to nearby structures, such as the lymph nodes. Although radiation therapy is used to treat the cancer, in some people, it may only partially shrink the cancer or slow its growth. Combining chemotherapy with radiation therapy improves survival in these people. Some people with small cell lung cancer who have been responding well to chemotherapy may benefit from radiation therapy to the head to prevent spread of cancer to the brain. If the cancer has already spread to the brain, radiation therapy of the brain is commonly used to reduce symptoms such as headache, confusion, and seizures. Radiation therapy is also useful for controlling the complications of lung cancer, such as coughing up of blood, bone pain, superior vena cava syndrome, and spinal cord compression. Chemotherapy is used in both non–small cell and small cell lung cancers. In small cell lung cancer, chemotherapy, sometimes coupled with radiation therapy, is the main treatment. This approach is preferred because small cell lung cancer is aggressive and has often spread to distant parts of the body by the time of diagnosis. Chemotherapy can prolong survival in people who have advanced disease. Without treatment, the median survival is only 6 to 12 weeks. In non–small cell lung cancer, chemotherapy usually also prolongs survival and treats symptoms. In people with non–small cell lung cancer that has spread to other parts of the body, the median survival increases to 9 months with treatment. Targeted therapies may also improve cancer patient survival. Some people with non–small cell lung cancer survive significantly longer when treated with chemotherapy, radiation therapy, or some of the targeted therapies. Targeted therapies include drugs, such as biologic agents that specifically target lung tumors. Studies have identified proteins within cancer cells and the blood vessels that nourish the cancer cells. These proteins may be involved in regulating and promoting cancer growth and metastasis. Drugs have been designed to specifically affect the abnormal protein's effects and potentially kill the cancer cells or inhibit their growth. Drugs that target such abnormalities includebevacizumab,gefitinib,erlotinib,crizotinib,vemurafenib, anddabrafenib. Immunotherapy drugs, which includenivolumab,pembrolizumab,durvalumab,ipilimumab, andatezolizumab, enable a person's own immune system to fight the cancer. These drugs may be used instead of the usual chemotherapy drugs, in combination with them, or after the conventional chemotherapy drugs have been tried and have not worked. Laser therapy, in which a laser is used to remove or reduce the size of lung tumors, is sometimes used. A high-energy current (radiofrequency ablation) or cold (cryoablation) can sometimes be used to destroy tumor cells in people who have small tumors or are unable to undergo surgery. Other treatments are often needed for people who have lung cancer. Many such treatments, called palliative treatments, aim to relieve symptoms and improve quality of life rather than cure cancer. Because many people who have lung cancer have a substantial decrease in lung function whether or not they undergo treatment, Oxygen Therapy and bronchodilators (drugs that widen the airways) may aid breathing. Pain often requires treatment. Opioids are often used to relieve pain but can cause side effects, such as constipation, that also require treatment. 