Lung cancer is a leading cause of cancer death and accounted for more than one-quarter of all cancer deaths in 2016. While a diagnosis of lung cancer is still very serious, early detection and improved treatment options are helping some lung cancer patients live longer. “Treatment has changed dramatically, especially in the last 10 to 15 years,” says Dr. Leena Gandhi, director of thoracic medical oncology at the Perlmutter Cancer Center at NYU Langone Medical Center.
[See: 7 Things You Didn’t Know About Lung Cancer.]
Lung Cancer Treatment for Non-Small Cell Lung Cancer
About 85 percent of lung cancers are non-small cell lung cancers. Treatment for NSCLC depends in large part on the stage of the cancer at the time of diagnosis. In stage I, the cancer is limited to part of the lung without involving the lymph nodes (part of the immune system), says Dr. Raja M. Flores, chairman of the department of thoracic surgery at Mount Sinai and the Steven and Ann Ames Professor in Thoracic Surgery at the Icahn School of Medicine at Mount Sinai. “This is the most curable [stage], and we usually catch it with screening.”
Surgery, called wedge resection, is the standard treatment for early stage lung cancer. Your surgeon will remove the tumor and a small portion of healthy tissue surrounding it (in the shape of a wedge) to help make sure he removed all of the cancer. “If we get the tumor when it’s small, it’s less likely to spread,” Flores says, “and the operation is [less involved] and minimally invasive. Stage I cancer is about 80 percent curable.”
Invasive cases of NSCLC cancer (stage 2 and stage 3) require more extensive surgery. Your surgeon may have to remove a lobe (a section of lung) or even an entire lung (this is called a pneumonectomy). Flores says patients can still live a good life with just one lung. When the cancer is in the bronchi, the tubes that lead from the windpipe to the lungs, surgery (called sleeve resection) removes the part of the bronchus with the tumor.
Once a lung cancer tumor begins to spread, surgery alone is generally not enough. Patients with stage 2 and stage 3 NSCLC generally require additional (adjuvant) treatment. “We offer chemotherapy [in the] hope [it will] prevent a recurrence,” says Dr. Abraham Chachoua, associate director of cancer services at Perlmutter Cancer Center at NYU Langone Medical Center.
Chachoua says there is a 50 to 60 percent chance these cancers will come back because microscopic disease (cancer too small to be removed with surgery) can spread to other parts of the body. Chemotherapy uses powerful chemicals to kill cancer cells or to prevent them from growing. These patients may also undergo radiation therapy.
Patients diagnosed with stage 4 cancer (cancer that has metastasized, or spread) are not curable. Oncologists will offer these patients palliative chemotherapy to alleviate symptoms and prolong survival, Flores says.
[See: What Not to Say to Someone With Lung Cancer.]
Treatment for Small Cell Lung Cancer
The other 15 percent of lung cancers are small cell lung cancers. SCLC is fast-growing, and most SCLC patients are diagnosed after their disease has spread. According to the National Cancer Institute, if you have SCLC in one lung, you usually have it in both lungs, so these patients generally do not undergo surgery. SCLCs respond well to chemotherapy and radiation, especially if the disease is not too extensive, and it helps prolong survival, but SCLC is generally not curable.
New Treatment Options Having a Positive Effect
According to Dr. David Carbone, recent advances in radiation therapy, such as stereotactic body radiation therapy, are making a difference. Carbone is a medical oncologist and director of the Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
Historically, radiation was highly toxic, and patients often had poor outcomes. SBRT, in contrast, uses very high — but extremely targeted — doses of radiation, so it doesn’t damage normal tissue as much as traditional radiation does. “Stereotactic radiation is highly effective at curing small lesions,” Carbone says. “It’s a non-invasive approach.”
Oncologists are also getting better at analyzing the genetic makeup of cancers. Gandhi says doctors are identifying oncogenic drivers, or mutations, that can lead to effective treatments. For example, EGFR (epidermal growth factor receptor) is a protein found in some lung cancer cells (usually in non-smokers) that can cause them to grow and divide. Oncologists can treat the cancer in this small subset of patients by inhibiting EGFR. This is a type of targeted therapy.
[See: 7 Innovations in Cancer Therapy.]
Lung cancer treatment is an area of active research. Patients with lung cancer, especially those with SCLC, may want to consider participating in a clinical trial, a type of research study, to evaluate new treatment options. Ask your doctor if there’s a clinical trial you may qualify for.
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