Lung Foundation Australia is pleased by the announcement that Atezolizumab will be listed on the Pharmaceutical Benefits Scheme (PBS) for the treatment of locally advanced or metastatic non-small…
The treatment recommended for you will depend on your lung cancer type, stage, general health and breathing capacity, as well as your personal wishes. One, several, or all options may be used, depending on your specific condition, staging and overall health.
Lung cancer treatments aim to:
- Shrink the tumour size
- Relieve symptoms
- Improve the ability to live comfortably from day to day
- Prolong life
As with most types of cancers, the best results of treatment are seen the earlier the cancer is found. It is important that you discuss with your doctor what your prognosis (expected outcome) is so that you can make an informed decision.
Depending on your needs and wishes, at different times throughout your lung cancer experience you will be cared for by a range of health professionals, each of whom specialises in a different aspect of your treatment and care. You may have different types of doctors, for example, a medical oncologist and a radiation oncologist, and a specialist lung cancer nurse, a physiotherapist, a social worker and a palliative care physician, to name a few. In some hospital settings, these health professionals work together in a formal arrangement called a multidisciplinary team, or MDT. Having your treatment and care provided by a formally arranged MDT is what is considered in Australia as a gold standard approach to the management of lung cancer.
Ask your doctor about the arrangements of your treatment and care. If the hospital where you are attending does not have an MDT to manage your treatment and care, ask your doctor about how you can be linked with other health professionals that can assist with your supportive care needs, for example, a specialist lung cancer nurse or physiotherapist. Alternatively, a list of the locations and details of lung cancer MDTs in Australia can be found here:
Find an MDT team, here.
Treatment for non-small cell lung cancer
Treatment for non-small cell lung cancer (NSCLC) depends on:
- Sub-type and stage of NSCLC
- If certain biomarkers are present
- How well your lungs are working
- Other health problems which may increase the toxicity of therapy
- Your ability to perform activities of daily living without assistance, like eating, bathing and dressing.
Treatment options can include one or more of the following:
Surgery for lung cancer can include, but not limited to:
- SUB-LOBAR RESECTIONS: Removal of the tumour and surrounding lung tissue without removing the whole lobe of the lung. Types include wedge resection and segmentectomy.
- LOBECTOMY: Removal of an entire lobe of the lung.
- PNEUMONECTOMY: Removal of an entire lung.
- COMPLEX RESECTIONS: Removal of part or all of a lung and surrounding structures, such as ribs, part of the chest wall or windpipe (trachea and bronchus structures) when the cancer has spread to these areas.
All surgeries should include testing of the lymph nodes associated with the affected part of the lung.
Surgical approaches for lung cancer can include:
- Thoracotomy: An incision is made between the ribs to allow removal of the cancer.
- Minimally invasive surgery: A small incision is made in the chest to allow the insertion of a video camera along with small instruments to remove cancerous tissue. This is called a video-assisted thorascopic surgery (VATS).
Surgery is most often used in people with non-small cell lung cancer.
Radiation therapy is a treatment that uses high energy x-rays, gamma rays or particles (protons, neutrons, electrons) to kill or shrink cancer cells, to manage pain or to prevent the cancer from spreading. It can be used to eliminate tumours entirely and to eradicate residual disease after surgery. At times it might be helpful to reduce the size of tumours with radiation before surgery.
There are two main types of radiation therapy for use in non-small cell lung cancer:
- External beam radiation therapy, which includes types such as stereotactic body radiation therapy, stereotactic radiosurgery, and intensity modulated radiation therapy.
- Brachytherapy (internal radiation therapy), which includes the delivery of a small source of radioactive material placed directly into the cancer by a doctor or surgeon.
Chemotherapy is a treatment that kills cancer’s rapidly growing and dividing cells. In NSCLC, chemotherapy can be given as a single drug or as multiple drugs at the same time, depending on the sub-type and stage of NSCLC and on the overall health of the patient.
Targeted therapies are aimed at a particular “target” in a tumour cell with the goal of stopping the cancer from growing. Your molecular testing results will identify if you are a good candidate for targeted therapy. The most common “targets” in NSCLC are gene changes in EGFR, ALK and ROS1.
Immunotherapy is a new type of treatment that helps the body’s own immune system ﬁght the cancer. A class of immunotherapy drugs called “checkpoint inhibitors” are approved for use in NSCLC.
Sometimes using more than one type of therapy may produce better results, for example, chemotherapy might be combined with radiation, or radiation might be used before and/or after surgery. In view of your diagnosis, your doctor will discuss with you the appropriateness of having a single approach therapy or combination therapy.
A drug may be given as an “adjuvant” or additional therapy along with surgery or radiation, for example, following the surgical removal of lung cancer, adjuvant therapy is sometimes recommended. In this case, the goal of adjuvant therapy is to increase the cure rate compared to surgery alone.
Sometimes a drug may be given prior to surgery, often to shrink the tumour. This is known as neo-adjuvant therapy.
Some drug therapies may be used after the initial therapy regimen has ended. Maintenance therapy can be used for as long as recommended by your doctor.
Treatment for small-cell lung cancer
Treatment for small-cell lung cancer (SCLC) depends on:
- The stage and the extent of the cancer
- How well your lungs are working
- Other health concerns like the presence of diabetes, heart disease or high blood pressure
- Your ability to perform activities of daily living, like eating, bathing and dressing, without assistance
Treatment options can include one or more of the following:
Chemotherapy is a treatment that kills cancer’s rapidly growing and dividing cells. It is typically a combination of drugs given at the same time. In newly diagnosed SCLC, first line treatment is most often a combination of chemotherapy drugs.
Radiation therapy is a treatment that uses high energy x-rays, gamma rays or particles (protons, neutrons, electrons) to kill or shrink cancer cells, to manage pain or to prevent cancer from spreading. SCLC is usually treated with general external beam radiation, which uses carefully aimed doses of radiation to specific sections of the lungs or surrounding areas.
Prophylactic cranial irradiation (PCI)
As the nature of SCLC often spreads (metastasizes) to the brain, the goal of PCI is to prevent it from spreading and growing in the brain by killing any cells that might be too small to be seen during diagnostic imaging tests.
PCI usually starts three to four weeks after chemotherapy ends. It is given five times a week for two to three weeks (10 to 15 sessions). The procedure only lasts three to four minutes, though a visit can take 30 to 40 minutes. Studies show that, after successful treatment with chemotherapy, PCI can reduce the chance that SCLC will spread to the brain by 30 to 50%.
The idea of radiation to the brain can be scary, especially when no cancer has been found there. Ask your doctor about the risks and benefits of PCI. Be sure to ask questions and discuss any concerns you have.
A combination approach of chemotherapy and radiation at the same time is often used to treat SCLC. Your healthcare team will decide if combination therapy is best for your situation.
Surgery is not commonly used to treat SCLC. For a small number of patients, if the cancer is found very early, is small and has not spread to lymph nodes; or the tumour is a mixture of SCLC and NSCLC (non-small cell lung cancer), surgery may be an option.
Clinical trials are research studies to determine whether new approaches to therapy are safe and effective, as well as to determine how they compare to existing treatments. Clinical trials in lung cancer may involve new ways of giving radiation, new chemotherapy drugs or new drugs which target speciﬁc molecular abnormalities in the cancer. Clinical trials in lung cancer may also involve the comparison of supportive care treatments, such as the comparison of a walking program and a swimming program on the experience of fatigue. Having molecular testing may could help your treatment team identify an appropriate clinical trial for you that is more precisely targeted to your cancer. Talk to your healthcare team about whether a clinical trial is right for you.
By Ismini Dandanis, Director/Senior Exercise Physiologist, InForm Health & Exercise A diagnosis of lung cancer brings challenges, emotions, time away from work and family, a…