Treatment - What is Lung Cancer? - Cancer Council Victoria

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Wednesday 30 June, 2010

Reviewed by: Dr Nick Pavlakis, Medical Oncologist, Royal North Shore Hospital; Jocelyn McLean RN, MN (Res), Case Manager for Thoracic Surgery, Sydney South Western Area Health Service; Eileen Ryan, Consumer.

Your choice of treatment depends on the stage of the cancer, your general health and breathing capacity, and your wishes.

Non-small cell lung cancer can be treated with surgery, radiotherapy or chemotherapy.
Small cell lung cancer is usually treated with chemotherapy. Some people with cancer in one lung (limited disease) will have radiotherapy to the chest and brain (called preventive or prophylactic radiotherapy). Because it usually spreads early, surgery is not often used for this type of cancer.
Mesothelioma is rarely able to be removed by surgery. However, people commonly have other types of treatment, such as chemotherapy or thoracentesis, to slow down progression of the disease or to help manage symptoms.

Surgery

Surgical removal of a tumour offers the best chance of a cure for patients who have early-stage cancer. The multidisciplinary team will look at whether or not the cancer has spread beyond the lungs, your general well-being and fitness, and your breathing capacity. They will see if you would be fit enough for surgery and decide if it is an option for you.

There are several types of lung surgery

Wedge resection: only part of the lung, not a lobe, is removed
Lobectomy: a lobe of the lung is removed
Pneumonectomy: one whole lung is removed.

If the cancer has spread, or if you have mesothelioma in your abdomen, you may have another type of surgery.

After the operation

After major lung surgery you will have an intravenous (IV) drip for at least a few days (though you will be able to eat and drink the day after the operation). There will be one or two temporary tubes in your chest or abdomen to drain fluid and/or air from your chest cavity.

You will have some pain and discomfort but your medical team will work with you to reduce these effects. There is no need to suffer in silence - tell your doctor or nurse how you are feeling. This is important because if you are not in pain, you are more likely to move around and do exercises with the physiotherapist. Pain-relief may also help you clear phlegm from your chest and reduce your chances of developing a chest infection.

You will probably go home 4-10 days after the operation but you will still be recovering for about six weeks. The recovery time depends on the type of operation and your fitness.

Many patients who have part of their lung removed experience some breathlessness. If your lung function was poor before surgery, or if you have one whole lung removed (pneumonectomy), you may feel very breathless.

Your doctor, nurses and physiotherapist will talk to you about how to manage at home. For example, they might recommend you do regular light exercise, like walking, to speed your recovery. Some people go to rehabilitation to improve their breathing over time.

You will have regular chest x-rays to check your lung or lungs are working properly.

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells.

Chemotherapy is commonly given to patients whose cancer is large or has spread outside the lungs. It may be given:

before surgery, to try to shrink the cancer and make the operation easier
before radiotherapy or during radiotherapy (chemoradiation), to increase the chance of the radiotherapy working
after surgery, to reduce the chances of the cancer coming back
as palliative treatment, to reduce symptoms, improve your quality of life or extend your life.

Generally, chemotherapy is administered intravenously through a drip or a plastic catheter (tube) inserted into a vein in your arm, hand or chest. Some types of chemotherapy are given orally, in tablet form.

Chemotherapy is given in cycles that typically last three weeks each. Intravenous chemotherapy may be given for a few days. The rest of the time is a break from treatment. The number of treatments you have will depend on the type of lung cancer you have and how well your body is handling the side effects. You may be able to have treatment as an outpatient.

If you have tablet chemotherapy it will probably be given on a continuous basis.

Targeted therapies

Some types of chemotherapy called targeted therapies may be available. Targeted treatments aren't as harmful to healthy cells.

Your doctor will send a sample (biopsy) of your tumour to the lab to see what types of cells are there. If the cells have a specific gene mutation, your doctor may have to do another biopsy to get more tissue.

Some cancer cells have receptors on their surface. This means the cell wall is shaped in a certain way. Receptors can be a target for chemotherapy drugs. For example, a person with adenocarcinoma might have an epidermal growth factor receptor (EGFR) gene mutation, so the doctor may prescribe targeted therapies for EGFR.

You may be asked if you want to participate in a clinical trial to receive targeted therapy. Talk to your doctor for more information about new drug trials. Alternatively you can call our Cancer Helpline on 13 11 20 or see our Victorian Cancer Trials section.

Side effects of chemotherapy

Most drugs used in chemotherapy cause side effects. Different drugs have different side effects - your doctors and nurses will discuss this with you. The most common side effects include:

nausea, vomiting
mouth ulcers
fatigue
thinning or loss of hair
skin rashes.

Talk to your medical team if you have side effects - in most cases drugs can be prescribed to make any side effects you experience less severe.

Radiotherapy

Radiotherapy treats cancer by using x-ray beams to kill cancer cells. It can be given to treat lung cancer that hasn't spread outside the chest or to treat a tumour that is too large for surgery. Radiotherapy can also be used to treat cancer that has spread to the lymph nodes. This may stop the cancer from spreading further or from returning later.

It can also be given:

after surgery, to reduce the chances of the cancer coming back and to treat cancer that has spread
before surgery, to shrink a tumour
as palliative treatment, to reduce symptoms, improve your quality of life or extend your life.

To plan radiotherapy treatment, your doctor will take an x-ray or CT scan of the treatment area. To ensure that the same area is treated each time, the radiation therapist will make a few small marks on your skin.

During treatment, you will lay on a treatment table. A machine that delivers the radiation will be positioned around you. The treatment session itself will take about 10-15 minutes. Radiotherapy treatment is painless and the person giving you the treatment will make you as comfortable as possible.

Side effects of radiotherapy

The side effects from radiotherapy depend on the area of your body being treated and the dose of radiation.

People who have radiotherapy to the chest for a primary lung cancer may experience tiredness and a mild burn on the skin, like a sunburn. Some patients who have a long course of radiotherapy (several weeks) may have temporary difficulty and pain in swallowing (oesophagitis).

Any radiotherapy to the lungs will cause some scarring, which can be seen on x-rays or CT scans after treatment. Some patients experience shortness of breath for months or years after the radiotherapy has finished. This often happens to people who have a large tumour or another condition like emphysema.

Talk to your health care team for more information about side effects, or call the Cancer Council Helpline on 13 11 20.

Complementary therapies

Complementary therapies are treatments that may help you cope better with side effects such as pain. They may also increase your sense of control over what is happening to you, decrease your stress and anxiety, and improve your mood.

There are many types of complementary therapies, including acupuncture, massage, hypnotherapy, relaxation, meditation, yoga, herbal medicine and nutrition. While some cancer treatment centres offer complementary therapies as part of their services, you may have to go to a private practitioner. Ask what's available at your hospital. Self-help CDs or DVDs can also guide you through some different techniques.

Let your doctor know about any complementary therapies you are using or thinking about trying. Some therapies may not be appropriate, depending on your conventional treatment. For example, herbs and nutritional supplements may interact with your medication. Massage and exercise therapies may also need to be modified. Call the Cancer Helpline on 13 11 20 for more information about complementary therapies.

Thoracentesis (pleural tap)

When fluid builds up in the area between the lung and the chest wall (pleural space), you may have symptoms like breathlessness, tiredness and pain. Your doctor can relieve the symptoms by performing a procedure called thoracentesis (pleural tap).

In this procedure your doctor inserts a hollow needle between your ribs to drain the fluid out. This will take about 30-60 minutes. A pleural tap is performed under a local anaesthetic and it is usually done on an outpatient basis.

Pleurodesis

Fluid between your lungs and chest wall may re-accumulate after you have a pleural tap. Your surgeons may perform another thoracentesis, but if the fluid continues to build up you may have pleurodesis.

In pleurodesis, you will have an injection of talcum powder between the layers of your lung tissue (pleura). The powder will inflame the membranes and make them stick together. This closes the space between the pleura, preventing the fluid from coming back. You will have a general anaesthetic during the pleurodesis, and you will probably stay in hospital for about three days.

Prognosis

As in most types of cancer, the results of treatment are best when the cancer is detected and treated early. People who have surgery in the early stages of lung cancer have a very good chance of cure.

In many people, lung cancer is not found while it can still be operated upon. In people with advanced cancer, palliative treatment with radiotherapy can effectively treat many symptoms.

People who continue to smoke after lung cancer treatment are at risk of further disease. If you need help quitting smoking, speak to your doctor or nurses or contact the Quitline on 13 7848.

If you would like information about your own prognosis, speak to a doctor who knows your medical history.

When cancer can't be cured

Palliative care helps to improve people's quality of life by alleviating symptoms of cancer without trying to cure the disease.

Palliative care often involves pain relief, stopping the spread of cancer and symptom management. Treatment may include radiotherapy, chemotherapy or other medication. It also involves the management of other physical and emotional symptoms and practical problems. This may include counselling, respite care, physiotherapy and modifications to your house (e.g. installing a ramp).

Although palliative care is particularly important for people with advanced cancer, it is not just for people who are about to die. Palliative care can be used at different stages of cancer.

General practitioners, specialists and palliative care teams in hospitals all play important roles in helping people with cancer. For further information, contact the Cancer Council Helpline on 13 11 20 or Palliative Care Victoria on 9662 9644. You may also like to read about when cancer won't go away.