What Is Inoperable Lung Cancer?

Hearing an oncologist tell you that your lung cancer is "inoperable" may lead you to think that your case is terminal. That is not necessarily so. Inoperable lung cancer cannot be treated with surgery, but your healthcare provider can select from various other lung cancer treatments that can successfully improve your symptoms, or slow or reverse disease progression.

Reasons Why Lung Cancer Is Inoperable

All lung cancer cases are different, and it's possible that someone with a diagnosis similar to yours in many ways is able to have surgery while you are not. It's important to as your healthcare providers why your lung cancer cannot be operated on.

Surgery may not be appropriate because of factors such as:

• Type of lung cancer: Surgery is most often performed for early-stage non-small cell lung cancer (NSCLC). Small cell lung cancer, which accounts for 10% to 15% of all lung cancer cases, tends to grow and spread early. When the tumors are too large or spread out, surgery isn't effective.
• Lung cancer stage: Surgery is usually considered for stage 1, stage 2, or stage 3A NSCLC. In more advanced stages of lung cancer, the disease has often spread too far for surgery to be an option.
• Tumor location: Surgery may be too dangerous if the tumor is too deep in the lung or located too close to a vital structure, such as the heart.
• Lung function: If your breathing is already compromised by conditions such as chronic obstructive lung disease (COPD) or other lung diseases, surgery could further reduce lung function, making such a procedure too dangerous to undertake.
• General health: If you have a pre-existing health condition, you may be at too high of a risk for complications associated with major surgery such as reactions to anesthesia, excessive bleeding, blood clots, infections, or pneumonia.

Exceptions

In some of these instances, surgery may not be ruled out completely. For instance, healthcare providers may still recommend operating on small cell lung cancer, late-stage NSCLC, and tumors that are in sensitive regions.

First, though, it might be recommended that you undergo chemotherapy to shrink the tumors so surgery will be more successful. This is called neoadjuvant chemotherapy. Radiation is also sometimes used to decrease the size of a tumor before your healthcare provider operates.

Surgery for stage 3B or stage 4 lung cancer will not cure the disease. However, it can relieve symptoms and improve your quality of life.

Non-Surgical Treatment Options

Treatments for lung cancer have advanced dramatically in recent years. There are now many treatment options that can control the disease even when surgery is not possible.

Chemotherapy

Chemotherapy may be used alone, with surgery, or with other treatments to more effectively manage metastatic lung cancer—cancer that has spread to other organs or tissue beyond the site of the primary tumor.

Chemotherapy treatments involve cytotoxic (cell-killing) medications that kill cancer cells. These medications may be given as an oral pill, but are most often administered via an intravenous drip.

Several cycles of chemotherapy that use platinum compounds are usually used to treat advanced-stage lung cancer. These treatments can increase survival rates.

In some instances, though, chemotherapy is used to provide palliative care, which means it is intended to ease symptoms, but it will not necessarily extend life.

Be sure to discuss the goals and purpose of any treatment with your healthcare provider so you clearly understand the pros and cons.

Radiation Therapy

Radiation therapy targets lung cancer tumors with high-energy X-rays that kill cancer cells. It is more effective when used on small tumors and may be the best option for inoperable early-stage lung cancer.

A newer type of radiation therapy known as stereotactic body radiation (SBRT), or cyberknife, delivers precise doses of radiation to a tumor while minimizing damage to nearby tissue.

SBRT can be used to treat non-small cell lung cancer and small cell lung cancer, including some metastatic cancers. It may even be recommended in place of surgery for stage 1 lung cancer, providing an equally effective outcome and long-term survival.

Targeted Therapies

Using molecular profiling (gene testing), healthcare providers can identify mutations in cancer cells. They can then prescribe targeted therapy medications to stop mutated cancer cells from growing.

Several mutations can be treated with targeted therapy medications. These include:

• EGFR mutations: Approved therapies include the tyrosine kinase inhibitors Tagrisso (osimertinib), Tarceva (erlotinib), and Iressa (gefitinib).
• ALK rearrangements: Medications to stop cells with these mutations include Xalkori (crizotinib), Zykadia (ceritinib), Alectinib (alencensa), and Alunbrig (brigatnib),
• ROS1 rearrangements: These cells can be managed with the medications Xalkori (crizotinib), Lorbrena (lorlatinib), Rozlytrek (entrectinib), and Zykadia (ceritinib).

Targeted therapy treatments have allowed people to live with lung cancer almost as a form of chronic disease, which means that as long as they don't build up a resistance to the medication, they can live a healthy life.

Tests can also identify MET, KRAS, HER2, and BRAF mutations. Ongoing clinical trials are looking at ways these mutations can be targeted with specific medications as well.

Immunotherapy

The term immunotherapy refers to medications that boost your immune system so you can effectively fight cancer. It includes treatments that alter your body's immune response or that use substances made by the immune system to target cancer cells.

Over the past decade, several drugs have been approved for use on their own or in combination with chemotherapy, radiation, or surgery. Currently, immunotherapy only works currently for 20% to 30% of lung cancers, but it can be extremely effective for those who have a positive response.

The success of immunotherapy medications is in their ability to stop cancer cells from causing harm by performing functions such as:

• Helping the immune system recognize cancer
• Activating immune cells 
• Preventing cancer cell from hiding
• Altering signals that cancer cell send out

One of the advantages of these drugs is that they have less intense side effects compared to chemotherapy drugs. However, certain side effects are possible, including skin irritation, flu-like symptoms, muscle aches, shortness of breath, heart palpitations, and water retention.

Clinical Trials

Many individuals who are diagnosed with inoperable lung cancer choose to enroll in clinical trials—studies that evaluate a new drug or procedure. The medications or procedures offered in these trials may not currently have strong research behind them or proof of their effectiveness. But, at some point, that was the case for every treatment now proven to be successful.

Fewer than 1 in 20 people with cancer participate in clinical trials. This is unfortunate because these trials allow those who may have a poor prognosis with current treatments access to groundbreaking therapies that might offer hope for remission.

A Word From Verywell

Treatment options for lung cancer are making incredible strides in extending life and reducing debilitating side effects. Even if surgery isn't possible, there are options to help you manage lung cancer and enjoy a longer, fuller life compared to patients of previous generations.