Treatment
of Lung cancer
Treatment for lung cancer can involve surgical removal of tumor, chemotherapy,
or radiation therapy, as well as combinations of these methods. The decision
about which treatments will be appropriate for a given individual must take into
account the localization and extent of the tumor as well as the overall health
status of the patient.
As with other cancers, therapy may be prescribed that is intended to
be curative (removal or eradication of a cancer) or palliative
(measures that are unable to cure a cancer but can reduce pain and
suffering). More than one type of therapy may be prescribed. In such
cases, the therapy that is added to enhance the effects of the primary
therapy is referred to as adjuvant therapy. An example of adjuvant
therapy is chemotherapy or radiotherapy administered after surgical
removal of a tumor in order to be certain that all tumor cells are
killed.
Surgery - Surgical removal of the tumor is generally performed for limited-stage
(Stage I or sometimes Stage II) NSCLC and is the treatment of choice for cancer
that has not spread beyond the lung. About 10-35% of lung cancers can be removed
surgically, but removal does not always result in a cure, since the tumors may
already have spread and can recur at a later time. Among people who have an
isolated, slow-growing lung cancer removed, 25 to 40% are alive 5 years after
diagnosis. Surgery may not be possible if the cancer is too close to the trachea
or if the person has other serious conditions (such as severe heart or lung
disease) that would limit their ability to tolerate an operation. Surgery is
less often performed with SCLC because these tumors are less likely to be
localized to one area that can be removed.
The surgical procedure chosen depends upon the size and location of the tumor.
Surgeons must open the chest wall and may perform a wedge resection of the lung
(removal of a portion of one lobe), a lobectomy (removal of one lobe), or a
pneumonectomy (removal of an entire lung). Sometimes lymph nodes in the region
of the lungs are also removed (lymphadenectomy). Surgery for lung cancer is a
major surgical procedure that requires general anesthesia, hospitalization and
follow-up care for weeks to months. Following the surgical procedure, patients
may experience difficulty breathing, shortness of breath, pain, and weakness.
The risks of surgery include complications due to bleeding, infection, and
complications of general anesthesia.
Radiation - Radiation therapy may be employed as a treatment for both NSCLC and
SCLC. Radiation therapy uses high-energy x-rays or other types of radiation to
kill dividing cancer cells. Radiation therapy may be given as curative therapy,
palliative therapy (using lower doses of radiation than with curative regimens)
or as adjuvant therapy to surgery or chemotherapy. The radiation is either
delivered externally, by using a machine that directs radiation toward the
cancer, or internally through placement of radioactive substances in sealed
containers within the area of the body where the tumor is localized.
Radiation therapy can be given if a person refuses surgery, if a tumor has
spread to areas such as the lymph nodes or trachea making surgical removal
impossible, or if a person has other conditions that make them too ill to
undergo major surgery. Radiation therapy generally only shrinks a tumor or
limits its growth when given as a sole therapy, yet in 10-15% of persons it
leads to long-term remission and palliation of the cancer. Combining radiation
therapy with chemotherapy can further increase the chances of survival when
chemotherapy is administered. External radiation therapy can generally be
carried out on an outpatient basis while internal radiation therapy requires a
brief hospitalization. A person who has severe lung disease in addition to a
lung cancer may not be able to receive radiotherapy to the lung.
For external radiation therapy, a process called simulation is necessary prior
to treatment. Using CT scans, computers, and precise measurements, simulation
maps out the exact location where the radiation will be delivered, called the
treatment field or port. This process usually takes 30 minutes to two hours. The
external radiation treatment itself generally is done over four or five days a
week for several weeks.
Radiation therapy does not carry the risks of major surgery, but it can have
unpleasant side effects including tiredness and lack of energy. A reduced white
cell count (rendering a person more susceptible to infection) and low blood
platelet levels (making blood clotting more difficult) can also occur with
radiation therapy. If the digestive organs are in the field exposed to
radiation, patients may experience nausea, vomiting, or diarrhea. Radiation
therapy can irritate the skin in the area that is treated, but this irritation
generally improves with time after treatment has ended.
Chemotherapy - Both NSCLC and SCLC may be treated with chemotherapy.
Chemotherapy refers to the administration of drugs that stop the growth of
cancer cells by killing them or preventing them from dividing. Chemotherapy may
be given alone, as an adjuvant to surgical therapy, or in combination with
radiotherapy. While a number of chemotherapeutic drugs have been developed, the
platinum-based drugs have been the most effective in treatment of lung cancers.
Chemotherapy is the treatment of choice for most SCLC, since these tumors are
generally widespread in the body when they are diagnosed. Only half of people
who have SCLC survive for four months without chemotherapy. With chemotherapy,
their survival time is increased up to four- to fivefold. Chemotherapy alone is
not particularly effective in treating NSCLC, but when NSCLC have metastasized;
it can prolong survival in many cases.
Chemotherapy may be given as pills, as an intravenous infusion, or as a
combination of the two.
Chemotherapy treatments are usually given in an outpatient setting. A
combination of drugs is given in a series of treatments, called cycles, over a
period of weeks to months, with breaks in between cycles. Unfortunately, the
drugs used in chemotherapy also kill normally-dividing cells in the body,
resulting in unpleasant side effects. Damage to blood cells can result in
increased susceptibility to infections and difficulties with blood clotting
(bleeding or bruising easily). Other side effects include fatigue, weight loss,
hair loss, nausea, vomiting, diarrhea, and mouth sores. The side effects of
chemotherapy vary according to the dosage and combination of drugs used and may
also vary from individual to individual. Medications have been developed that
can treat or prevent many of the side effects of chemotherapy. The side effects
generally disappear during the recovery phase of the treatment or after its
completion.
Brain prophylactic radiation – SCLC often spreads to the brain. Sometimes people
with SCLC that is responding well to treatment are treated with radiation
therapy to the head to treat very early spread to the brain (called
micrometastasis) that is not yet detectable with CT or MRI scans and has not yet
produced symptoms. Brain radiation therapy can cause short-term memory problems,
fatigue, nausea and other side effects.
Treatment of recurrence – Lung cancer that has returned following treatment with
surgery, chemotherapy, and/or radiation therapy is called recurrent or relapsed.
If a recurrent cancer is confined to one site in the lung, it may be treated
with surgery. Relapsed tumors generally do not respond to the chemotherapeutic
drugs that were previously administered. Since platinum-based drugs are
generally used in initial chemotherapy of lung cancers, these agents are not
useful in most cases of recurrence. A type of chemotherapy referred to as
second-line chemotherapy is used to treat recurrent cancers that have previously
been treated with chemotherapy, and a number of second-line chemotherapeutic
regimens have been proved effective at prolonging survival. People with
recurrent lung cancer who are well enough to tolerate therapy are also good
candidates for experimental therapies (see below) including clinical trials.
Experimental therapies - Since no therapy is currently available that is
absolutely effective in treating lung cancer, patients may be offered a number
of new therapies that are still in the experimental stage, meaning that doctors
do not yet have enough information to decide whether these therapies should
become accepted forms of treatment for lung cancer. New drugs or new
combinations of drugs are tested in so-called clinical trials, studies that
evaluate the effectiveness of new medications in comparison with those
treatments already in widespread use. Experimental treatments known as
immunotherapies may involve the use of vaccine-related therapies or other
therapies that attempt to utilize the body’s immune system to fight cancer
cells. One kind of experimental therapy used for recurrent SCLC is photodynamic
therapy. This treatment is now being tested in recurrent SCLC that is causing a
type of airway obstruction (endobronchial obstruction, or obstruction of a
bronchus from within). In photodynamic treatment, a photosynthesizing agent (such
as a porphyrin, a naturally-occurring substance in the body) is injected into
the bloodstream a few hours prior to surgery. During this time, the agent
deposits itself selectively in rapidly growing cells such as cancer cells. A
surgical procedure then follows in which the physician applies a certain
wavelength of light through a hand held wand directly to the site of the cancer
and surrounding tissues. The energy from the light activates the
photosensitizing agent, causing the production of a toxin that destroys the
tumor cells.
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