Can Lung Cancer Be Cured?

Why don't doctors use the term 'cured' with cancer?

A question often asked is, "Can lung cancer be cured?" What if it's caught early? Can surgery or chemotherapy cure lung cancer? As with many questions regarding lung cancer, an honest answer about whether or not lung cancer is ever "curable" requires a careful explanation.

This is a difficult question because the answer can be yes or no depending upon how you define cure. Before explaining what this means and because hope is so important in the setting of cancer, it's important to keep in mind a few things:

  • Long-term survival with lung cancer is sometimes possible, especially when the disease is caught in the early stages, or if an advanced lung cancer responds to targeted therapies or immunotherapy.
  • Some people survive many years even with stage 4 lung cancer. A person only needs to glance at photos taken at one of the LUNGevity HOPE Summits to see images of not one, but groups of survivors who have lived with stage 4 lung cancer for over a decade. While these people may be the exceptions to the general rule about survival odds, it does happen, and improvements in treatment over the last decade, even moreso since 2015, make this scenario more likely.
  • Distant metastases, such as when lung cancer spreads to the brain, can sometimes now be treated with the hope of long-term survival.
  • There are reported cases—though rare—in which lung cancer has spontaneously regressed.
  • Even if a lung cancer is not curable, it is almost always treatable. And it's not just that advanced lung cancer is curable. The newer treatment options often have fewer side effects than conventional chemotherapy.

    What Does 'Cure' Mean With Regard to 'Solid Tumors'?

    In the truest sense of the word, lung cancer can't be "cured." What this means is that there is always a chance (in some cases this is very small) that lung cancer can recur, even many years or decades after it is originally found. The longer someone lives without evidence of cancer (no evidence of cancer is sometimes simply called NED) the lower the likelihood that it will come back.

    There are actually very few cancers in which people can be declared "cured" in the pure sense of the word, and most of these are blood-related cancers such as leukemia in children.

    Lung cancer is similar to other "solid tumors" such as breast cancer and colon cancer in which long-term remission is possible, but physicians are hesitant to use the word cured.

    An example to help explain this is that people who have survived lung cancer for five years have a persistent risk of death from lung cancer up to 18 years after their diagnosis. Recurrence is more likely in those with lung adenocarcinoma than squamous cell lung cancer; more likely if cancer has spread to lymph nodes, and more likely if surgery is not done (with inoperable tumors.)

    When Might Lung Cancer Truly be Called Cured?

    One exception in the literature is people who have stage 1A lung cancer with no vascular invasion—meaning the tumor is very small and has not extended into any blood vessels. In this case, if there is no evidence of cancer after five years, it appears the word cure may be used.

    Why Can Cancers Recur Years or Decades Later?

    We don't know exactly how cancer can hide for years or even decades and then reappear. One theory is that there is a hierarchy of cancer cells, with some of the cells (cancer stem cells) being more resistant to treatment and having the ability to lie dormant.

    Can Early Stage Lung Cancer Be Cured With Surgery?

    In general, surgery offers the best chance for long-term survival from lung cancer. As noted above, when surgery is done at any early stage, has not spread to lymph nodes or blood vessels, doctors may sometimes use the word cure.

    Surgery may be performed for those with stage 1, stage 2 and stage 3A non-small cell lung cancer.

    In a large study, among people with stage 1A lung cancer, 16 percent had a recurrence in the first five years, with the risk of recurrence after five years being 4.8 percent.

    In another study, 87 percent of people who had a successful surgery with lymph node dissection, and were alive five years after their diagnosis, survived another five years cancer free. Within this group:

    • For people with N0 disease (no spread of cancer to lymph nodes according the TNM system of lung cancer staging), 89 percent remained cancer free.
    • 84 percent of people with N1 disease (the spread of cancer to lymph nodes near the initial tumor) were cancer-free.
    • 65 percent of those with N2 disease (the spread of cancer to lymph nodes further away from cancer) were disease-free.

    Can Chemotherapy Cure Lung Cancer?

    In general, chemotherapy is not used with curative intent for people with lung cancer. There are two primary reasons chemotherapy may be used. One is as an adjuvant therapy. For example, if someone has lung cancer surgery, chemotherapy may be given as an additional treatment just in case any lung cancer cells have spread to other regions of the body—but are unable to be detected by imaging studies. These cells that may have spread but are undetectable are referred to as micrometastases.

    The other primary goal of chemotherapy with lung cancer is as a palliative therapy. This is a treatment that is given to extend life or reduce symptoms, but not meant to cure a disease.

    The role of chemotherapy for lung cancer is very important to understand. A 2014 study found that almost 70 percent of people with lung cancer didn't understand that chemotherapy was not at all likely to cure their cancer. Many people have a false expectation that perhaps chemotherapy will work to cure their cancer, but this is very unlikely for someone who has metastatic disease.

    If your doctor talks about palliative chemotherapy, make sure you know what she is talking about and what her goals are. Palliative chemotherapy is given with different goals in mind that traditional chemotherapy. In other words, if you are really hoping for a chance for a cure, you may want to consider a clinical trial or an option such as immunotherapy.

    Can Lung Cancer be Cured With Radiation?

    Stereotactic body radiotherapy (SBRT), known popularly as "cyber knife" procedures, may have effectiveness similar to surgery in some people with early stage lung cancer, and whose cancers can't be treated with surgery. In a small study of patients who survived five years following SBRT, 25 percent had a later recurrence of their disease.

    Traditional radiation therapy is often used an either an adjunct therapy (as with chemotherapy), to reduce the chance of recurrence, to extend life, or to decrease the symptoms of lung cancer such as bone pain or airway obstruction.

    Can Targeted Therapies Cure Lung Cancer

    With lung cancer that is stage 4 (or stage 3B), the goal of treatment is not usually a cure, but rather extending life and controlling symptoms. That said, and especially with some of the newer targeted therapies for lung cancer such as Tarceva erlotinib), Xalkori (crizotinib), as well as many second and third generation drugs, some people are able to live a long time, sometimes many years while treating their cancer as they would another chronic disease such as kidney disease or diabetes. In addition to the several drugs that have been approved recently for lung cancer, many more are being evaluated in clinical trials.

    It's important that everyone with advanced lung cancer have molecular profiling (gene profiling) done on their tumors. In addition to treatments which are now approved for people with EGFR mutations, ALK rearrangements, ROS1 rearrangements, and some other genetic changes in cancer cells there are clinical trials evaluating many other novel characteristics of some lung cancer cells.

    To understand why the word "cure" isn't used with targeted therapies, these treatments are designed to control the growth of a cancer, not to kill off cancer cells. Resistance almost always develops in time, though newer targeted therapies appear to work for longer periods of time. When resistance occurs, there are now alternative treatments available for some mutations, such that some people have developed resistance on one or two drugs and are on a third drug that has been developed.

    Can Immunotherapy Cure Lung Cancer

    Immunotherapy breathes the promise of long-term disease-free survival for at least some people with advanced lung cancer. Not everyone responds to these treatments, but when they are effective they may lead to long-term survival for some individuals. In addition, we don't really know how to determine who will best respond to these drugs and who will not, though people who have higher "mutation loads" in their tumors may have better responses.

    In 2015 the first two immunotherapy drugs, Opdivo (nivolumab) and Keytruda (pembrolizumab) were approved for the treatment of lung cancer and two other medications in this category have now been improved. In addition, combinations of immunotherapy drugs are being evaluated in clinical trials, and early results are very encouraging.

    At the current time, immunotherapy has resulted in a "durable response" for some people to the point at which some oncologists, for the first time in 2018, are whispering the word cured along with stage 4 lung cancer.

    This news is not to cast false hope. It's only a relatively small number of people who have these robust responses to immunotherapy drugs. Yet, what we are seeing is extremely encouraging.

    Finally, unlike many treatment approaches, such as chemotherapy and targeted therapy, are usually only effective as long as a person is receiving treatment, or for a short while after, the response to immunotherapy drugs is sometimes lasting. To understand this it helps to know a little about how immunotherapy works. Very simplistically, immunotherapy drugs work by stimulating our own immune systems to both recognize and attack cancer cells. Once the immune system is "primed" in this way, it may continue to recognize and eliminate cancer cells, even when a person isn't being actively treated.

    Treatment of Oligometastases​

    Though rare, long-term survival is sometimes possible even when lung cancer has spread. There are reports of more than a dozen people who have lived 10 years or more after brain metastases from lung cancer have been treated. A recent report also suggests that treating metastases at multiple sites with stereotactic body radiotherapy may be a way of improving long-term survival for some people with stage 4 lung cancer in the future.

    Learn more about treatment options for lung cancer with bone metastases, adrenal gland metastases, and liver metastases.

    What About Natural Cures?

    The internet is rampant with links to so-called "natural cures" for cancer. Unfortunately, studies to date fail to show a survival benefit for any of these approaches. At best, some of the products may help with symptoms related to lung cancer and its treatments, but at worst, may interfere with chemotherapy, may drain already strained cancer patients of their finances, and, if used instead of conventional treatments, could shorten life expectancy.

    It's unfortunate that quack remedies and false advertising have undermined alternative treatments in many ways. Administered by licensed professionals who specialize in integrative medicine some of these treatments, such as acupuncture or ginger for chemotherapy-induced nausea, may help people cope with the symptoms of conventional medical treatment for cancer, and in doing so, improve the quality of life.

    Coping with Uncertainty

    Coping with uncertainty with cancer is one of the most difficult aspects of survivorship. Becoming involved in the lung cancer community has helped many people cope with "scanxiety" and the fear of cancer recurrence and progression, as you realize that not only are you not alone but can be a blessing to others who have been diagnosed with the disease.

    While we know that sometimes people who do everything right still have progression of their cancer, there are a few things you can do yourself which may improve survival. We're also learning that eating a healthy diet may play some role in reducing recurrence, and you may want to check out this list of lung cancer-fighting foods that have been tested to see what, if any, effect they may have on lung cancer cells specifically.

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