Treatment for lung cancer includes surgery, radiation, or chemotherapy, either alone or in different combinations.The treatment form is determined by the stage of the disease, tissue type (small or non-small cell) and the general health status of the patient (performance status) or any other comorbid conditions.
Non-small cell lung cancer
The patient is offered surgery if he/she is technically and medically operable. Co-existing heart or lung disease often excludes the patient from surgery. Postoperative chemotherapy is offered in stage II-situations in fit patients under 70 years. When potential risk of residual cancer tissue, postoperative radiation treatment is recommended. In patients who are medically inoperable, curative radiation treatment is considered. Curative radiation treatment is given either as 30 fractions or more over a time period of 6–7 weeks, or as stereotactic radiation with 3-8 fractions over a period of 1-2 weeks.
For locally advanced lung cancer, (stage III) an operation is often not possible due to surgically inaccessible mediastinal lymph node metastasis. If there are positive prognostic factors, curative radiation treatment is the first choice of treatment possibly in combination with chemotherapy. In special cases, treatment with chemotherapy and radiation may render the tumor operable. If there are poor prognostic factors, the patient is offered palliative radiation or chemotherapy.
If the disease has metastasized, the patient will be offered palliative treatment with radiation or chemotherapy. Occasionally, it is best to not give active tumor-directed treatment.
Small cell lung cancer
Limited disease (SCLC-LD)
When the cancer is confined to one hemithorax, the disease is treated with curative intent with chemotherapy combined with radiation. For small peripheral tumors, surgery is considered, followed by chemotherapy. Brain metastasis from small cell lung cancer occur frequently and can be prevented by administering radiation treatment to the brain.
Extensive disease (SCLC-ED)
Treatment for extensive cancer is palliative and usually consists of chemotherapy. Even in extensive disease, prophylactic brain irradiation should be offered if response of initial chemotherapy is achieved. Symptom-causing metastasis can be treated with radiation therapy. Manifest brain metastases from small cell lung cancer will often respond to chemotherapy. This is in contrast to non-small cell lung cancer, where brain metastases are treated with radiation.
Emergency help for acute conditions
The most common acute conditions requiring oncology treatment are:
- compression of airways
- superior vena cava syndrome (compression of central venous blood vessels)
- spinal cord compression syndrome (tumors which can damage the spinal cord)
Treatment should be expedient with high-dose steroids (methyl prednisolone or dexamethasone) and the patient is transferred to a department of radiation therapy to start tumor-reductive treatment within 24 hours of the start of symptoms. For previously untreated intrathoracic disease with small-cell histology chemotherapy should be started without unnecessary delay, whereas in non-small cell carcinomas radiation therapy is therapy of choice.
Patients with lung cancer will often have symptoms from the airways, either caused by the tumor, infections, or underlying lung disease. These problems will often become more prominent towards the end of the patient's life.
Primary cachexia is often present in lung cancer due to metabolic changes from the tumor disease. In all phases of the disease, it is important to stimulate nutrition.
As treatment of pain, a combination of analgesics with radiation and chemotherapy is optimal. Invasive analgesic methods are also available. Satisfactory pain relief is almost always achievable.
Nausea and vomiting are common symptoms both due to advanced tumors or tumor-directed treatment, but can today be treated with modern antiemetics.
Difficulty in breathing is a frequent symptom in all phases of lung cancer and may be caused and exacerbated by a series of conditions:
- tumor involvement of airways
- chronic obstructive pulmonary disease
- pleural fluid
- lung embolism
- lung fibrosis after radiation therapy
Treatment may consist of: