How Lung Cancer Is Treated

Treatments for lung cancer have improved dramatically in recent years. With these advances, physicians can personalize lung cancer treatment to the patient. As a result, survival rates have improved as well.

Cancer patient in oncology unit
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The goals of lung cancer treatment can differ depending on the type of cancer, the stage, and other factors. In some cases, the intent may be to cure cancer. Or, it may be to control it to keep it from growing or spreading. It also may be to reduce your symptoms and allow you to have a better quality of life.

This article discusses the different types of treatments available for lung cancer, how they work, and why they may be recommended.

Local Treatments
  • Treat cancer at its source

  • Remove the tumor but are unable to reach cells that have traveled beyond the original site

  • May be enough to attempt to cure early-stage lung cancer

  • E.g., surgery, radiation therapy

Systemic Treatments
  • Kill cancer cells wherever they happen to be in the body

  • Often best when cancer has spread to lymph nodes or other regions of the body

  • May be used before or after surgery

  • E.g., chemotherapy, targeted therapies, immunotherapy

Surgeries and Procedures

Your physician may recommend surgery or radiation therapy depending on the type of cancer you have and its stage.

Surgery and radiation therapy are local treatments, meaning they treat cancer at its source. They may be the only treatments needed if the tumor is early-stage (that is, it has not spread beyond the lungs).

Surgery

The goal of surgery is to remove the tumor, surrounding lung tissues, and lymph nodes (glands that are part of the immune system) in the area. This may be enough to cure lung cancer caught in the early stages.

Surgery is often considered for non-small cell lung cancers in stages 1 to 3a . On rare occasions, it may also be considered for early (limited-stage) small cell lung cancer.

There are five primary surgical procedures that may be done to treat lung cancer:

  • Pneumonectomy: The whole lung is removed.
  • Lobectomy: One of the sections (lobes) of a lung is removed.
  • Wedge resection: The tumor and a wedge-shaped area of lung tissue surrounding it are removed.
  • Sleeve resection: A lobe of the lung and part of the bronchus (the airways leading to the lung) are removed.
  • Segmentectomy: A segment of a lobe is removed. The amount of tissue removed by this procedure is more than with a wedge resection, but less than with a lobectomy.

Common side effects of surgery include infections, bleeding, and shortness of breath. The side effects may depend on lung function prior to surgery and the amount of lung tissue removed.

Radiation Therapy

Radiation therapy for lung cancer uses high-energy X-rays applied from outside the body to kill cancer cells.

There are a few ways in which radiation is used for lung cancer:

  • As an adjuvant treatment to treat any cancer cells that remain after surgery
  • As a neoadjuvant therapy to help decrease the size of a tumor so surgery is possible
  • As a palliative treatment to decrease pain or airway obstruction in people who have cancers that cannot be cured
  • As a curative treatment: A type of radiation therapy known as stereotactic body radiotherapy (SBRT) uses high-dose radiation on a small area in the lungs. This may be used as an alternative to surgery when surgery is not possible.

Common side effects of radiation therapy include redness and irritation of the skin, fatigue, and inflammation of the lungs (radiation pneumonitis).

Recap

Surgery removes the tumor, surrounding tissues, and lymph nodes. It is often considered for early-stage, non-small cell lung cancers. Radiation therapy uses high energy X-rays to kill cancer cells. It may be used before surgery to decrease the tumor's size or after surgery to get rid of any remaining cancer cells.

Prescriptions

Systemic treatments, on the other hand, are those that treat the whole body.

Specific medications, taken by mouth or given via an IV, have the ability to fight cancer cells. They may be recommended as systemic treatment if cancer has spread or if there's a chance of it spreading.

These treatments include chemotherapy, targeted therapies, and immunotherapies.

Chemotherapy

Chemotherapy for lung cancer uses medications designed to kill rapidly dividing cells, such as cancer cells. Since it is a systemic treatment, chemo may be recommended if your cancer has spread to other areas of the body.

Chemotherapy drugs may be used:

  • As a primary treatment for advanced lung cancer
  • To reduce the size of a tumor before surgery
  • After surgery to treat cancer cells that may have spread, even if they are not yet detectable

Combination chemotherapy—using more than one chemotherapy drug at the same time—is most commonly used. Different medications interfere with cell division at different points in the cell cycle. Targeting this process in more than one way increases the likelihood of simultaneously treating as many lung cancer cells as possible.

Some chemotherapy medications used for people with lung cancer include:

  • Platinol (cisplatin)
  • Paraplatin (carboplatin)
  • Gemzar (gemcitabine)
  • Taxotere (docetaxel)
  • Taxol (paclitaxel) and Abraxane (nab-paclitaxel)
  • Alimta (pemetrexed)
  • Navelbine (vinorelbine)

While the purpose of chemo is to kill cancer cells, there are healthy cells in the body that also divide rapidly. Unfortunately, the treatment does not discern between the two.

This leads to some of the common side effects of chemotherapy, including:

  • Bone marrow suppression (reduction in red blood cells, white blood cells, and platelets)
  • Hair loss
  • Fatigue

Nausea and vomiting are dreaded side effects of chemotherapy. Thankfully, managing these has improved dramatically in recent years.

Recap

Chemotherapy drugs may be recommended to kill cancer cells throughout the body. They may be used to reduce a tumor before surgery or treat cancer cells that remain after surgery.

Targeted Therapies

Targeted therapies are medications used to zero-in on and treat specific gene mutations in a tumor. Because these drugs are tailored to attack certain parts of cancer cells while minimizing damage to other cells, they may have fewer side effects than traditional chemotherapy.

Not all genetic changes can be treated with targeted therapies. Those that can be are called targetable gene mutations.

Getting gene profiling (molecular profiling) of your tumor can determine if you have a targetable mutation. This testing is strongly recommended for those with non-small cell lung cancer, particularly lung adenocarcinoma.

Treatments have been approved for those with EGR mutations, ALK rearrangements, ROS1 rearrangements, KRAS mutations, and other less common genetic alterations. There are also clinical trials studying medications for other mutations and genetic changes in cancer cells.

This area of science is changing very rapidly, and it's likely that new targets and new medications will continue to be discovered.

While targeted therapies can be very effective, the body tends to become resistant to these treatments over time. However, newer drugs are now available and being studied for when this occurs.

Some targeted medications approved for lung cancer include:

  • ALK inhibitors: Xalkori (crizotinib), Zykadia (ceritinib), and Alecensa (alectinib)
  • Angiogenesis inhibitors: Avastin (bevacizumab) and Cyramza (ramucirumab)
  • EFGR inhibitors: Tarceva (erlotinib), Gilotrif (afatinib), Iressa (gefitinib), Tagrisso (osimertinib), and Portrazza (necitumumab)
  • RAS GTPase inhibitor: Lumakras (sotorasib) 

If you don't have a genetic change with an available targeted therapy, your doctor may recommend chemotherapy or immunotherapy instead.

Recap

Some lung cancer cases may be treated with targeted therapy. This involves using medication to attack cancer cells and minimize damage to healthy cells. Your doctor may use gene profiling of your tumor to determine if targeted therapy would be effective for you.

Immunotherapy

Immunotherapy is another treatment approach that uses medication to help your immune system recognize cancer cells and get rid of them.

Though medical news is often overhyped, immunotherapy is truly a reason to get excited about the future of lung cancer. In fact, after becoming available in 2015, the treatment was named the 2016 Clinical Cancer Advancement of the Year by the American Society for Clinical Oncology. Immunotherapy 2.0, which includes updates in the field, was cited for the award in 2017.

Immunotherapies may be more effective in people who smoked and have non-small cell lung cancer.

Immunotherapy drugs currently approved for lung cancer include:

  • Opdivo (nivolumab)
  • Keytruda (pembrolizumab)
  • Tecentriq (atezolizumab)
  • Imfinzi (durvalumab)
  • Yervoy (ipilimumab)

A study in 2018 followed non-small cell lung cancer patients who received chemotherapy with or without pembrolizumab. Adding the immunotherapy drug improved overall 12-month survival rates by about 20%.

Recap

Immunotherapy uses medications to help your immune system fight cancer cells. For lung cancer patients, it may be more effective for those who have smoked and have non-small cell lung cancer.

Pain Medications

Your healthcare provider may also prescribe a variety of other medications to address pain and side effects of surgery or other therapies. Some drugs to treat cancer pain, such as morphine, can also relieve shortness of breath from lung cancer.

Always discuss anything you are taking with your healthcare provider, including supplements. Some products may interact with the treatments or produce side effects such as bleeding with surgery.

Complementary Medicine

Complementary medicine may be used alongside traditional methods like surgery and medication. While complementary treatments can't cure lung cancer, they may help with issues such as pain, nausea, and stress management.

Techniques like acupuncture and massage therapy may help with the side effects of lung cancer treatment or symptoms.

A 2013 research review found acupuncture was effective as an adjunct treatment for patients who experience vomiting or nausea from chemotherapy or radiation therapy. Massage therapy was also found to help reduce anxiety and pain in cancer patients when used in addition to traditional treatments.

The review also found that mind-body techniques can help reduce anxiety, mood disturbances, and sleep disturbances in those with lung cancer. These techniques include yoga, tai chi, and meditation.

Mind-body techniques can also help you with symptoms like shortness of breath. Try using relaxation methods like meditation or focused breathing, which involves taking slow, deep breaths.

These can be useful add-ons to traditional therapy, but should never replace it. Check with your doctor to make sure that the treatment is safe for you.

Lifestyle

Making healthy lifestyle choices can help you feel your best while managing lung cancer.

If you are a current smoker, quitting smoking can improve your chances of surviving early-stage lung cancer. It can help prevent the worsening of some symptoms and lower your risk of recurrence of cancer after treatment.

Shortness of breath and side effects from treatment may make it difficult to exercise. However, it's best to stay as physically active as you can tolerate. Try walking, riding a bike, or gardening. Pick an activity that's fun for you. Start slowly with about 10 minutes of activity, taking breaks when you need them.

Getting enough rest is important as well. You may need to modify your schedule and tasks so you can save your energy or take breaks when tired.

Recap

A healthy lifestyle can help you feel your best while undergoing cancer treatment. Some tips include quitting smoking, finding ways to stay active, and taking breaks when you feel tired.

Consider a Clinical Trial

Every lung cancer treatment used today was once studied as part of a clinical trial before being approved.

The National Cancer Institute (NCI) recommends that everyone with lung cancer consider enrolling in such a study. Talk to your healthcare provider if this is something you'd like to explore.

The NCI provides a searchable database of supported trials. Your healthcare provider can help identify options that match the particular characteristics of your cancer.

Summary

Treatment plans can be personalized for each person depending on the type of lung cancer they have.

Surgery and radiation therapy are local treatments, meaning they treat cancer at its source in the lung. Systemic treatments, like chemotherapy, may be used to help kill cancer cells in different parts of the body. Targeted therapies and immunotherapy target the cancer cells while preventing damage to healthy cells.

Complementary and alternative medicine, like massage, may help manage symptoms when used with traditional treatment. Living a healthy lifestyle by quitting smoking and staying active can also help to improve your quality of life during your treatment.

A Word From Verywell

The most important thing you can do as you consider lung cancer treatments is to become your own advocate in your cancer care. Find a lung cancer treatment center you trust. Don't be afraid to get a second opinion. You may also wish to ask your oncologist where they would seek treatment if they were to be diagnosed with this disease.

Treatment is your own decision. Certainly, welcome input from loved ones, but stress to them (and yourself) that your ultimate decision must be based on what you feel is best. It may help to remind others who witnessed someone being treated for lung cancer years ago that the disease is treated much differently today.

Frequently Asked Questions

  • What are the symptoms of lung cancer?

    Common lung cancer symptoms include a persistent cough, coughing up blood, shortness of breath, unexplained weight loss, and pain in your bones, such as in the back or hips.

  • Can lung cancer be detected early?

    Yes. Lung cancer screening is available for people who have a 20 pack-year history of smoking, are between ages 50 and 80, and currently smoke or quit within the past 15 years. Imaging tests, lab tests, and lung biopsy can diagnose lung cancer when it is suspected.

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