“It is very important that everyone has hope from the moment they are diagnosed and there are new treatments coming along all the time. The treatment that I am on was not available three years ago and now it is ‘old school’, so do not give up hope.” (Tom, UK, individual with lung cancer)
There are several different types of lung cancer, requiring a range of different treatments.
Your treatment plan will be based on the type and stage of lung cancer you have, your general state of health, and your personal preferences.
Treatments may be focused on either curing your lung cancer (curative treatments), or on helping you live longer and with a better quality of life with lung cancer (palliative treatments).
In some European countries the decision to treat, and the type of treatment, is discussed among a panel of experts in the field, called a multidisciplinary team (MDT). An MDT usually includes:
- a surgeon,
- respiratory doctors (specialising in lung health),
- a pathologist (doctor who will examine your biopsy and decide your type of cancer),
- a radiologist (specialising in lung imaging),
- a palliative care physician (specialising in looking after patients in pain and disability due to their lung cancer),
- a psychologist,
- a nurse (specialising in lung cancer).
MDTs are becoming more common in the treatment of lung cancer however in some countries they would not include all the experts mentioned here. If you are managed by an MDT, you will normally have one or two healthcare professionals as your main points of contact, and you may visit other healthcare professionals for specific treatments.
However, there are still many countries where the decision to treat relies on a single doctor, usually a lung health specialist.
The European Respiratory Society is currently working closely with the ELF on recommendations for the use and structure of MDTs in treating people with lung cancer.
The main forms of treatment are surgery, chemotherapy, radiotherapy, immunotherapy and targeted treatments. Your options will be discussed with you as not all treatments may be suitable for your type of lung cancer.
If you are fit enough for surgery, you may be offered an operation to remove the tumour.
Surgery is mainly used to treat non-small cell lung cancer (NSCLC). However, if you are diagnosed with small cell lung cancer (SCLC) at a very early stage and it is very limited, some doctors may suggest surgery. If your cancer has spread then surgery is unlikely to be the right treatment for you.
The lungs are made up of different sections or ‘lobes,’ with three in the right lung and two in the left lung. The usual operation for lung cancer is called ‘lobectomy’. The surgeon will completely remove the part of the lung (lobe) which contains the cancer and the glands around the lung (lymph nodes) to which cancer can spread. Sometimes, it may be recommended that one lung is removed completely (pneumonectomy). Breathing tests before surgery will help to decide if this operation is right for you.
You will receive a general anaesthetic (medication to make you fall asleep) for the duration of these operations and given pain medication following the operation.
Before surgery, you may receive a type of chemotherapy that contains platinum in order to shrink the tumour as much as possible before the operation. This makes it easier to remove surgically.
New, less-invasive surgical techniques have been developed to try to remove the cancer. This means there is less damage to your tissue during surgery. This includes a type of keyhole surgery, known as video-assisted thoracic surgery (VATS), in which a small video camera and instruments are placed through small cuts into your chest to guide the surgeon during the operation. Recovery time for keyhole surgery is quicker so may be a possibility for more people.
Surgery is not always the best option for everyone – it could be better to tackle your lung cancer with chemotherapy, often depending on where the tumour is and what stage of cancer you have. Your healthcare professional will discuss your treatment options with you.
Chemotherapy (also called chemo) uses drugs to treat cancer. It works to slow down the growth of the cancer.
The drugs can be given over different lengths of time and either injected directly into a vein or through an intravenous drip or pump. You will usually receive the chemo as an outpatient at the hospital every 3 or 4 weeks.
Most chemotherapy drugs cause side effects and nausea and being sick are the most common. Anti-nausea drugs will be given to help with this. Other side effects may include hair loss (regrows after treatment has ended), feeling more tired than usual, losing your appetite or changes in your sense of taste.
Chemotherapy affects people in different ways so it is hard to say how you may be affected in advance. Many people are able to carry on with their normal activities during their treatment.
Just as patients with different types of lung cancer respond differently to surgery, it is possible to tailor chemotherapy depending on the type of tumour a person has.
Radiotherapy can be offered either as a standalone treatment, after surgery or in combination with chemotherapy.
If your tumour is at an early stage and you are not able to have surgery (if your lungs are not working as well as they should do or you have other significant diseases that increase the risk of surgery) you may be offered modern radiotherapy called SABR (stereotactic ablative radiotherapy). This is almost as effective as surgery and also reduces the damage caused to the areas surrounding the tumour.
Radiotherapy uses high energy X-rays to destroy the cancer cells. You typically receive this treatment every day, 5 days a week, for about 6 weeks.
You do not need an anaesthetic and receive the treatment lying on a table while a linear accelerator (the machine that delivers the radiation) moves around you at different angles. You do not feel the radiation. Short-term side-effects may include skin inflammation (swelling and soreness), sore throat and trouble swallowing, cough and breathlessness. Most people do not have any long-term side-effects, although some people can get swelling and soreness in their lungs (called radiation pneumonitis), which is treated with steroids.
If you have undergone surgery to remove your tumour, then you may also receive radiotherapy as an additional treatment after surgery to make sure any remaining cancer cells are killed.
Sometimes radiotherapy is also prescribed to help with symptoms, such as treating blockages in your windpipe to make it easier to breathe. This type of radiotherapy is the more usual type and is not as highly targeted as modern radiotherapy. It is usually offered as a standalone treatment or in combination with chemotherapy.
In some cases, you may be offered radiotherapy to treat areas outside your lungs, such as brain or bone, if the disease has spread.
PERSONALISED TREATMENT (BIOLOGICAL THERAPIES/TARGETED THERAPIES)
As experts have understood more about the biology of lung cancer, they have also been able to develop new drugs that target specific parts of the cancer. These are called biological therapies or targeted therapies.
Targeted therapies for specific types of lung cancer come in tablet form, e.g. EGFR (epidermal growth factor receptor) inhibitors, with the drugs erlotinib or gefitinib found to be particularly beneficial for people who are unable to have their tumour removed surgically. Also ALK (anaplastic lymphoma kinase), with the drug crizotinib found to be effective.
These drugs work to block the growth of cancer cells and can control this for a long time. You take the tablets at home, rather than having to travel to a clinic as you would for chemotherapy treatment. Targeted therapies tend to come with fewer side effects than other types of treatment.
Not everyone will benefit from targeted therapies as this depends on the type of tumour you have. Access to these drugs may also depend on your own country’s recommendations for lung cancer treatment and funding by national health care systems.
Immunotherapy (a type of biological therapy) is a new treatment approach which has shown some promising results among people with advanced-stage NSCLC. It works by encouraging our natural immune system processes to fight cancers.
Lots of research is going on in the field at the moment, and an immunotherapy treatment for people with a type of advanced-stage squamous lung cancer was recently approved by the European Medicines Agency.
To find out if your type of lung cancer could be treated with a targeted therapy, you will need a molecular diagnostic test. These tests look at biological markers in a tissue sample of your tumour and help to find out more information about whether a particular drug or targeted treatment would be likely to work for you.
This test could happen at the time you are diagnosed, or at a later stage in your treatment. Talk to your specialist to find out if molecular testing is an option for you.