Treatment for Lung Cancer

Surgery

For patients with non small cell lung cancer, surgery is often employed in cancers up to and including stage IIIA. The purpose of the surgery is to remove all of the cancer if possible. If the tumor is small and in a favorable location, or the patient has limited lung function, the surgeon may choose to remove the tumor with a small section of lung; this is called a wedge resection. Most times the surgeon will choose to remove the entire lobe of the involved lung; this is known as a lobectomy. On occasion, the surgeon must remove the entire lung affected by the cancer; and this is known a pneumonectomy. Not every patient can tolerate these surgeries. Patients with diminished lung function due to other diseases may not be able to survive after such a surgery, or they may be severely limited in their activities. Preoperative pulmonary function tests (PFT's) are used to help predict who is a good candidate for surgery. Sometimes a quantified ventilation perfusion scan will be ordered which shows the amount that each area of lung is currently working. These tests may help the surgeon to predict how much lung function will be lost based on the amount of lung that will need to be removed, and how well the patient will feel after surgery. Surgery is not generally recommended for small cell lung cancer of any stage. Small cell lung cancer is usually treated with chemotherapy and radiation therapy. There have been some studies on the use of surgery in small cell lung cancer for very early stage lesions; however, this is not generally considered a standard option for patients with small cell lung cancer.

Another potential use for surgery with lung cancer lies in treating solitary brain or spinal metastases. If a patient has a solitary lesion in the brain or spine, a neurosurgeon may elect to remove them surgically. Talk with your doctor about the different ways to approach treatment of your particular disease.

Chemotherapy

Despite the fact that the tumors are often removed by surgery, there is always a risk of recurrence because there may be microscopic cancer cells left that the surgeon cannot remove. Also, some patients are not candidates for surgery or choose not to have surgery. Chemotherapy is the use of anti-cancer drugs that go throughout the entire body. These drugs may be given through a vein or as pills by mouth. Chemotherapy is recommended after surgery for some stage I and stage II non-small cell lung cancer patients. Because current treatment of advanced stage non-small cell lung cancers (stage III) is often a combination of radiation and/or chemotherapy and/or surgery, the timing and use of chemotherapy may vary depending on the specifics of the case. It may be given at the same time as radiation, or before or after radiation. Chemotherapy is offered to many patients with stage IV disease.

Small cell lung cancer is very responsive to chemotherapy, and most patients with small cell lung cancer will be offered chemotherapy. Again, depending on the specifics of an individual case, it may be given during radiation, or before or after radiation is complete.

There are many different chemotherapy drugs, and they are often given in combinations. Patients will usually have to go to a clinic to get the chemotherapy because many of the drugs have to be given through a vein. Different chemotherapy regimens are used for different purposes. Some of the drugs used in lung cancer chemotherapy include: Etoposide (and Teniposide), Cisplatin (and Carboplatin), Ifosfamide, Cyclophosphamide, Vincristine, Doxorubicin, Paclitaxel, Docetaxel and Vinorelbine (Navelbine). There are advantages and disadvantages to each of the different regimens that your medical oncologist will discuss with you. Based on your own health, your personal values and wishes, and side effects you may wish to avoid, you can work with your doctors to come up with the best regimen for your cancer and your lifestyle.