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Lung Cancer Treatment

There are four basic ways to treat lung cancer: Surgery, Radiation Therapy, Chemotherapy, and Targeted Therapy. Each treatment option is described below, followed by an outline of common treatment plans by the type and stage of cancer. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health.

Surgery

A surgical oncologist is a doctor who specializes in treating cancer using surgery. For lung cancer, a thoracic surgeon is specially trained to perform lung cancer surgery. The goal of surgery is the complete removal of the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surrounding border or margin of normal lung tissue. A “negative margin” means that when the pathologist examines the lung, or piece of lung that has been removed by the surgeon, no cancer was found in the healthy tissue surrounding the tumor.

The following types of surgery may be used for lung cancer:

Lobectomy. The lungs have five lobes, three in the right lung and two in the left lung. For NSCLC, the removal of an entire lobe of the lung in a procedure called a lobectomy is often the most effective type of surgery, even when the lung tumor is very small.

A wedge. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of normal lung.

Segmentectomy. 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.

Pneumonectomy. If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung.

Radiofrequency ablation. Radiofrequency ablation (RFA) is the use of a needle inserted into the tumor to destroy the cancer with an electrical current. It is sometimes used for a lung tumor that cannot be removed with the other types of surgery listed above.

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.

Adjuvant therapy

Adjuvant therapy is treatment that is given after surgery to lower the risk of the lung cancer returning. Adjuvant therapy may include radiation therapy, chemotherapy, and possibly targeted therapy. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. It also can decrease the risk of recurrence, though there is always some risk that the cancer will come back.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. If you need radiation therapy, you will be asked to see a specialist called a radiation oncologist, a 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 (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. When radiation treatment is given using implants, it is called internal radiation therapy, or brachytherapy. However, brachytherapy is rarely used for lung cancer.

Like surgery, radiation therapy cannot be used to treat widespread cancer. Radiation only destroys cancer cells directly in the path of the radiation beam. It also damages the normal 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 to lower the risk of damaging healthy parts of the body. This is called intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). It is not an option for all patients, but it may be used for patients with early disease and small tumors when surgery is not an option.

Patients 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, patients may also develop a sore throat and have difficulty swallowing. Patients may also notice skin irritation, similar to sunburn, where the radiation 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. About 15% of patients develop this condition, called radiation pneumonitis. 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 (multiple brand names). Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. Typically, the scarring does not 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 normal lung tissue exposed to radiation.

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