doctor-patient-lung-cancer-treatment-compass-oncologyOut of the two primary types of lung cancer, non-small cell lung cancer (NSCLC) is the most common, accounting for 80 to 85 percent, while small cell lung cancer (SCLC) only accounts for 10 to 15 percent of cases. The type of cancer you have, as well as the size and stage of the tumor, will determine your treatment options. 

Once your oncologist has determined your lung cancer profile, they will present you with a personalized treatment plan based on your lung cancer. Many new treatments have been approved recently and used in combination with long-standing treatments, and for some types of lung cancer the new treatments even replace the first-line of treatment previously given. We also have clinical trials available to our patients who qualify.  

A clinical trial is a carefully monitored research study meant to help introduce new treatment or improve upon current treatment options. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment, which is what we are seeing with lung cancer in the past 5 years. Patients may want to consider taking part in a clinical trial, although some are open only to patients who have not started treatment.

Surgery to Remove Lung Cancer

Surgery is most commonly used to treat early stages of NSCLC. While it can be an option for some early-stage SCLC, it is rarely used as the primary treatment since SCLC has usually spread past the lungs at the time of diagnosis. Lung cancer surgery can involve removing a portion of the lung or the entire lung through procedures such as lobectomy, segmentectomy, wedge resection, and pneumonectomy. 

Even if the doctor removes all of the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that may remain. Treatment that is given after surgery to lower the risk of the cancer coming back is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. The way the chemotherapy is given depends upon the type and stage of the cancer being treated. 

  • When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). 
  • When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Radiation Therapy for Lung Cancer Treatment

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

There are two types of radiation therapies:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.​
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. This is usually done through a bronchoscope— a procedure called endobronchial brachytherapy— but it may also be done during surgery. Prophylactic cranial irradiation (radiation therapy to the brain to reduce the risk that cancer will spread to the brain) may also be given.

Lung Cancer Immunotherapy

Immunotherapy, also called biologic therapy, is designed to help your immune system fight cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

The immunotherapy currently available to treat NSCLC and some patients with advanced SCLC all belong to a class called checkpoint inhibitors. Immune checkpoints are molecules on the immune cells that can start or stop an immune response. Your body’s immune system uses these molecules to help determine what cells are foreign, or not normal. Cancer cells have found ways around this system by hiding from your body’s natural immune system or by weakening the immune system itself. Immunotherapy drugs allow the immune system to recognize and destroy the cancer cells.

Other types of immunotherapy that are being studied in clinical trials include cancer vaccines and adoptive T cell therapy.

Targeted Therapy Based on Biomarkers

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. This precision leaves healthy cells alone, reducing the side effects that often come with other types of treatment, such as chemotherapy and radiation therapy. Monoclonal antibodies, tyrosine kinase inhibitors, and mammalian target of rapamycin (mTOR) inhibitors are three types of targeted therapy being used to treat certain types of lung cancer. 

Non-small cell lung cancer patients may go through some testing for genetic mutations in the cancer cells, called biomarker testing or genomic testing. Biomarker testing looks for changes in the DNA that may have been caused by exposure to things in the environment known to harm the lungs. The type of genetic mutation that’s found will direct the first line of treatment that’s recommended. If no biomarkers are found, there is a different approach recommended. This cuts down on the time taken to try various therapies in hope of finding the one that works best for a particular patient. 

There are currently FDA-approved targeted therapies for NSCLC tumors showing the following genetic mutations:

  • EGFR
  • KRAS
  • ALK
  • ROS-1
  • NTRK
  • MET
  • RET
  • BRAF V600E

Patients who do not test positive for a biomarker with an approved targeted therapy are going to receive a different recommended treatment plan. They may also be eligible for a clinical trial that is identifying treatments based on other biomarkers found outside of those with an established targeted therapy. l that is looking at treatments for a number of other markers. 

Laser Therapy for Lung Cancer

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill the cancer cells. It is sometimes used to open up the airways of patients whose cancer is making it hard to breathe.

While you are under general anesthesia, the oncologist inserts the laser with a bronchoscope and then aims the beam at the tumor to burn it away. If needed, the treatment may be repeated. 

Endoscopic Stent Placement

An endoscope is a thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may be used to place a stent in a body structure to keep the structure open. Endoscopic stent placement can be used to open an airway blocked by abnormal tissue. Follow-up tests may be needed.

Follow-up Tests or Check-ups for Small Cell and Non-Small Cell Lung Cancer

Some of the tests that were done to diagnose the cancer or to find out the stage of the lung cancer may be repeated. Some tests will be performed again to see how well the treatment is working. Decisions about whether to continue, adjust or stop treatment may be based upon the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has returned. These tests are sometimes called follow-up tests or check-ups.

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