Cancer treatment team
Your treatment for lung cancer should be overseen by a group of specialists called a multi-disciplinary team (MDT). This team will contain all the specialists required to make a proper diagnosis, to stage your cancer and plan the best treatment. If you want to know more, ask your specialist about this.
The type of treatment you will receive for lung cancer depends on several factors, including:
- the type of lung cancer you have (non-small cell or small cell)
- the size and position of the cancer
- how far advanced your cancer is (the stage)
- your overall health
Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.
Treatment options include:
- surgery
- radiotherapy
- chemotherapy
Depending on your type of cancer and how advanced it is, you may receive a combination of these treatments.
Your treatment plan
Non-small cell and small cell lung cancers are treated differently.
Non-small cell lung cancer
Non-small cell lung cancer may be treated using surgery, chemotherapy and radiotherapy.
Small tumours (stages 1 or 2) can often be removed with surgery. You may have chemotherapy after your surgery to reduce the chances of the cancer returning. If you’re not fit enough for surgery, radiotherapy may be used as an alternative.
Larger tumours (stage 3) may also be suitable for surgery. If so, you may have chemotherapy and/or radiotherapy before or after your surgery. However, if the tumour is too large to be removed, surgery won’t be performed, and radiotherapy and/or chemotherapy will be used. If the cancer has spread to other parts of the lung or elsewhere in your body (stage 4), chemotherapy or radiotherapy will be used to try and shrink the tumour.
A new group of drugs is emerging, which work in a different way to chemotherapy. They are given in tablet form, and are known as “targeted agents” because they block certain processes in the cancer cells. These include erlotinib and gefitinib. Your doctor may send off your tumour biopsy to see if targeted drugs are likely to be successful in your case.
Small cell lung cancer
Small cell lung cancer is usually treated with chemotherapy, either on its own or in combination with radiotherapy. This often prolongs life and relieves symptoms.
Surgery isn’t usually used to treat this type of lung cancer. This is because often the cancer has already spread to other areas of the body by the time it’s diagnosed. However, if the cancer is found very early, surgery may be used. If so, chemotherapy or radiotherapy may be given after surgery to help reduce the risk of the cancer returning.
Surgery
There are three types of lung cancer surgery:
- Lobectomy – one or, in the case of the right lung, two lobes are removed. Your doctors will suggest this operation if the cancer is just in one part of one lung.
- Pneumonectomy – the entire lung is removed. This is used when the cancer is located in the middle of the lung or has spread throughout the lung.
- Wedge resection or segmentectomy – a small piece of the lung is removed. This procedure is used only if your doctors think that your cancer is small and limited to one area of the lung. This is usually very early-stage non-small cell lung cancer. This operation is only suitable for a small number of patients.
People are naturally concerned that they will not be able to breathe if some or all of a lung is removed. But it is possible to breathe normally with one lung. However, if you have breathing problems before the operation, such as breathlessness, it is likely that these symptoms will continue after surgery.
Before surgery can take place, you will need to have a number of tests to check your general state of health and your lung function. These tests may include:
- An electrocardiograph (ECG) – electrodes are used to monitor the electrical activity of your heart.
- Spirometry – you will breathe into a machine called a siprometer, which measures how much air your lungs can breathe in and out.
Surgery is usually performed by making an incision (cut) in your chest or side, and removing a section or all of the affected lung. Nearby lymph nodes may also be removed if it is thought that the cancer may have spread to them.
In some cases, an alternative to this approach, called video-assisted thoracoscopic surgery (VATS), may be suitable. VATS is a type of keyhole surgery, where small incisions are made in the chest. A small fibre-optic camera is inserted into one of the incisions. This then transmits images of the inside of your chest to a monitor.
You will probably be ready to go home 5–10 days after your operation. However, it can take many weeks to recover fully from a lung operation. After your operation, you will be encouraged to start moving about as soon as possible. Even if you have to stay in bed, you will need to keep doing regular leg movements to help your circulation and prevent blood clots from forming. A physiotherapist will show you breathing exercises to help prevent complications.
When you go home, you will need to exercise gently to build up your strength and fitness. Walking and swimming are good forms of exercise that are suitable for most people after treatment for lung cancer. Talk to your care team about which types of exercise are suitable for you.
As with all surgery, lung surgery carries a risk of complications. These are estimated to occur in one out of every five cases. These complications can usually be treated using medication or additional surgery. This might mean that you have to stay longer in hospital.
Complications of lung surgery can include:
- inflammation or infection of the lung (pneumonia)
- excessive bleeding
- a leak of air from the lung wall
- a blood clot in the leg (deep vein thrombosis), which could potentially travel up to the lung (pulmonary embolism)
Chemotherapy
Chemotherapy uses powerful cancer-killing medication to treat cancer. There are several different ways that chemotherapy can be used to treat lung cancer. For example, it can be:
- given before surgery to shrink a tumour, which can increase the chance of successful surgery
- given after surgery to prevent the cancer returning
- used to relieve symptoms and slow the spread of cancer when a cure is not possible
- combined with radiotherapy (chemoradiation), which can be given before and after surgery or to relieve symptoms
Chemotherapy treatments are usually given in cycles. A cycle involves taking the chemotherapy medication for several days, then having a break for a few weeks to let your body recover from the effects of the treatment.
The number of cycles of chemotherapy that you need will depend on the type and the grade of your lung cancer. Most people require 4–6 courses of treatment over 3–6 months.
Chemotherapy for lung cancer involves taking a combination of different medications. The medications are usually delivered through a drip into your vein, or into a tube that is connected to one of the blood vessels in your chest.
Side effects of chemotherapy can include:
- fatigue
- nausea
- vomiting
- mouth ulcers
- hair loss
These side effects should gradually pass once your treatment has finished, or you may be able to take other medicines to make you feel better during your chemotherapy.
Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Tell your care team or GP as soon as possible if you have the possible signs of an infection, such as:
- a high temperature (fever) of 38C (100.4F) or higher
- suddenly feeling generally unwell
Targeted agents
Several newer therapies for lung cancer have recently been approved for use in non-small cell lung cancer. These include growth factor inhibitors called erlotinib and gefitinib. These therapies work by disrupting the growth of the cancer cells. However, they are only suitable for certain people. Your doctor may be able to request tests on your biopsy samples to determine whether targeted agents are likely to be suitable for you.
Radiotherapy
Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancer cells.
Radiotherapy can be used after surgery to treat lung cancer, or it can be used to control the symptoms and slow the spread of cancer when a cure is not possible (this is known as palliative radiotherapy).
A more intensive course of radiotherapy, known as radical radiotherapy, can be used to try to cure non-small cell lung cancer if the person is not healthy enough to have surgery.
A type of radiotherapy known as prophylactic cranial irradiation (PCI) is also used to treat small cell lung cancer. PCI involves directing high-energy pulses at your brain.
It is used as a preventative measure because there is a risk that small cell lung cancer will spread to your brain.
The two ways that radiotherapy can be given are described below.
- External beam radiotherapy – a machine is used to beam high-energy pulses of radiation at affected parts of your body.
- Internal radiotherapy – a catheter (thin tube) is inserted down a bronchoscope and into your lung. A small piece of radioactive material is placed inside the catheter and positioned against the site of the tumour before being removed after a few minutes. This is often used if the cancer is blocking or partly blocking your airway.
A course of radiotherapy treatment can be planned in several different ways.
Radical radiotherapy is usually given five days a week, with a break at weekends. Each session of radiotherapy lasts 10–15 minutes. The course of radiotherapy usually lasts 3–7 weeks.
Continuous hyperfractionated accelerated radiotherapy (CHART) is an alternative method of delivering radical radiotherapy. CHART is given three times a day for 14 days in a row.
Palliative radiotherapy usually only requires one or two sessions to control your symptoms.
Side effects of radiotherapy include:
- chest pain
- fatigue
- persistent cough that may bring up blood-stained phlegm (this is normal and nothing to worry about)
- difficulties swallowing (dysphagia)
- redness and soreness of the skin, which looks and feels like sunburn
- hair loss, which can occur on your chest and, if you are receiving PCI, on your head
Side effects should pass once the course of radiotherapy has been completed.
Radiofrequency ablation
Radiofrequency ablation is a new type of treatment that can treat stage 1 non-small cell lung cancer.
The doctor carrying out the treatment will use a CT scanner to guide a needle to the site of the tumour. The needle will be pressed into the tumour and radiowaves will be sent through the needle. These waves generate heat, which kills the cancer cells.
The most common complication of radiofrequency ablation is that a pocket of air gets trapped between the inner and outer layer of your lungs (pneumothorax). This can be treated by placing a tube into the lungs to drain away the trapped air.
Cryotherapy
Cryotherapy is a treatment that can be used if the cancer starts to block your airways. This is known as endobronchial obstruction, and it can cause symptoms such as:
- breathing problems
- cough
- coughing up blood
Cryotherapy is performed in a similar way to internal radiotherapy, except that instead of using a radioactive source, a device known as a cryoprobe is placed against the tumour. The cryoprobe can generate very cold temperatures, which help shrink the tumour.
Photodynamic therapy
Photodynamic therapy (PDT) is a treatment that can be used to treat early-stage lung cancer when a person is unable or unwilling to have surgery. It can also be used to remove a tumour that is blocking the airways.
Photodynamic therapy is carried out in two stages. Firstly, you will be given an injection of a medication that will make the cells in your body very sensitive to light.
The next stage is carried out 24–72 hours later. A bronchoscope will be guided to the site of the tumour, and a laser will be beamed through it. The cancerous cells, which are now sensitive to light, will be destroyed by the laser beam.
Side effects of photodynamic therapy include:
- inflammation of the airways
- a build-up of fluid in the lungs
Both these side effects can cause symptoms of breathlessness and lung and throat pain. However, these symptoms should gradually pass as your lungs recover from the effects of the treatment.
Read more about photodynamic therapy.
- Chemotherapy
- Chemotherapy is a treatment of an illness or disease with a chemical substance, such as in the treatment of cancer.
- Radiotherapy
- Radiation therapy uses X-rays to treat disease, especially cancer.