Treatment for early lung cancer

Tuesday 1 November, 2016

Download PDF Order FREE booklet

On this page: Surgery | Thermal ablation | Radiotherapy | Chemotherapy | Key points


Treatment for lung cancer will depend on the type of lung cancer you have, the stage of the cancer, your breathing capacity and your general health. NSCLC and SCLC are treated in different ways.

Treatment options by type and stage
Non-small cell lung cancer (NSCLC)

Early stage – Usually treated with surgery, including removal of nearby lymph nodes. If surgery is not an option, radiotherapy is offered. Sometimes, chemotherapy may be given after surgery or with radiotherapy.

Locally advanced Stage III cancer can be treated with surgery and chemotherapy or with radiotherapy and chemotherapy. Treatment will depend on the number and location of lymph nodes with cancer.

Advanced – Palliative chemotherapy and/or palliative radiotherapy may be offered depending on symptoms. New targeted therapy drugs may also be an option.

Small cell lung cancer (SCLC)

Stages I–III Chemotherapy and radiotherapy are the main treatments. Surgery is not used.

Stage IV – Palliative chemotherapy is the main treatment. Palliative radiotherapy may also be given to the brain, spine, bone or other parts of the body where the cancer has spread.

Surgery

People with early stage NSCLC (stage I and stage II) will generally have surgery to remove the tumour. How much of the lung is removed depends on the location of the cancer, its size, your general wellbeing and fitness, as well as your lung function. See below for an illustration of the types of surgery.

Removing lymph nodes

During surgery, nearby lymph nodes will also be removed to see whether the cancer has spread. Knowing if the cancer has spread to the lymph nodes also helps the doctors decide whether you need further treatment with chemotherapy or radiotherapy.

How the surgery is done

The surgery can be done in different ways. If a cut is made between the ribs in the side of the chest, the operation is called a thoracotomy. You will need to stay in hospital for 3–7 days.

It’s becoming more common for surgery to be done with a keyhole approach. This is known as video-assisted thoracoscopic surgery (VATS). It involves making three to four cuts in the chest wall, known as ports, and inserting a small video camera and operating instruments that allow the surgeon to perform the operation from outside the chest. A keyhole approach usually means a shorter hospital stay, faster recovery and fewer side effects.

See more information about surgery or call Cancer Council 13 11 20.

Types of lung surgery

There are several types of lung surgery.

Lobectomy - A lobe of the lung is removed
Lobectomy

A lobe of the lung is removed.

Pneumonectomy - One whole lung is removed

 

Pneumonectomy

One whole lung is removed.

 

Wedge resection - Only part of the lobe is removed

 

Wedge resection

Only part of the lobe is removed.

 

What to expect before surgery

If you smoke, your medical team will advise you to stop before you have surgery. If you continue to smoke during treatment, you may not respond to treatment as well as people who don’t smoke. Also, the side effects may be worse. See your doctor or call the Quitline on 13 7848 (13 QUIT) to find out about quitting products.

What to expect after surgery
Tubes and drips

You will have several tubes in place, which will be removed as you recover. A drip inserted into a vein in your arm (intravenous drip) will give you fluid, medicines and pain relief. There may be one or two temporary tubes in your chest to drain fluid and/or air from your chest cavity.

Pain

This is common after surgery, but can be controlled. Managing the pain will help you to recover and move around more quickly, and allow you to do your breathing exercises. Pain relief may also help clear phlegm from your chest.

Recovery time

You will probably go home 3–7 days after the operation. It may take 6–12 weeks to resume your usual routine and activities. The recovery time depends on the type of surgery and your fitness. Your doctor, nurses and physiotherapist will talk to you about how to manage at home. Walking will improve your fitness, clear your lungs and speed up recovery.

Breathlessness

This is common if you’ve had part of your lung removed, especially if your lung function was poor before surgery, or if you have had a whole lung removed (pneumonectomy). Gentle exercises as part of a pulmonary rehabilitation program will help improve breathlessness and reduce the risk of developing a chest infection. To find a pulmonary rehabilitation program, ask your surgeon for details or visit the Lung Foundation website.

Thermal ablation

Ablation treatment may be offered for localised lung cancer when surgery or radiotherapy are considered unsuitable. This involves inserting needles or probes into the cancer to destroy the cancer cells by heating them. Only one treatment is needed. A CT scan is used to guide the needle into the right position. Thermal ablation is not painful, but you may have a general anaesthetic to make you more comfortable during the procedure.

Radiotherapy

Radiotherapy uses x-rays to kill or damage cancer cells. It can be used to treat all types of lung cancer. It may be offered on its own or in combination with surgery or chemotherapy.

Radiotherapy can be used:

  • to treat an early stage lung cancer if you are unable to have surgery
  • to treat locally advanced (stage III) NSCLC or stages I–III SCLC
  • after surgery if the mediastinal lymph nodes contained cancer, to reduce the risk of the cancer coming back in the mediastinum
  • as palliative treatment to treat cancer that has spread to other organs, such as the brain or bones, and is causing symptoms
  • as palliative treatment to relieve pain and improve quality of life or extend your life.

Before treatment starts, the radiation oncology team will plan your treatment, and will explain the treatment schedule and the possible side effects. These are briefly described below.

During treatment, you will lie on an examination table, and a radiotherapy machine will be aimed at the chest area. The radiation therapist will place you and the machine in the correct position and then leave the room. You will not feel anything during the treatment, but may hear a buzzing sound from the machine. The treatment itself takes only a few minutes, but the full session may last for about 10–20 minutes.

See more information about radiotherapy and its side effects, talk to your doctor and nurses, or call Cancer Council 13 11 20.

Types of external radiotherapy

Radiotherapy may be delivered in different ways depending on the type of lung cancer. It is usually given as daily treatment over a number of weeks. Palliative radiotherapy usually involves 1–10 treatments. A course of curative radiotherapy usually involves between 20–33 treatments over 4–6 weeks. Treatment is generally given during the weekdays with a rest over the weekend.

Stereotactic ablative body radiotherapy (SABR)

This is a way of giving highly focused radiotherapy to small NSCLC tumours while the surrounding tissue receives a low dose. SABR is delivered from multiple beams that meet at the tumour. You may have 1–5 treatment sessions, 1–2 days apart for a couple of weeks. SABR is only suitable for tumours not close to major airways, blood vessels or the spinal cord.

Hyperfractionated radiotherapy

This means having more than one treatment of radiotherapy a day. Each treatment will be at least six hours apart to allow time for the healthy cells to repair themselves.

The whole dose of radiation is about the same as you would have for standard radiotherapy. This form of treatment is usually considered for SCLC.

Side effects of radiotherapy

The side effects of radiotherapy vary depending on the dose of radiation and the number of treatments.

Difficulty swallowing and heartburn

This may occur during treatment and continue for up to 3–4 weeks after treatment ends. You may need to change to a soft food diet and avoid hot drinks, such as tea and coffee, until these side effects improve.

Skin changes

The skin on your chest and back may become red or dry, like sunburn. Moisturising cream, such as sorbolene, should be applied to the skin when treatment starts – talk to your medical team about other products they recommend.

Fatigue

Feeling tired is common after radiotherapy. Plan your daily activities so you can rest regularly. It may also help to talk to your family, friends or employer about how they can help you.

Shortness of breath and cough

Radiotherapy may cause inflammation of the lungs, known as radiation pneumonitis. This may cause shortness of breath or a cough, sometimes during treatment but more likely one to six months after treatment ends. Radiation pneumonitis is usually temporary and can be treated with steroid (cortisone) tablets.

Side effects can change from one period of radiotherapy to the next and may build up over time. Let the radiation oncologist, radiation therapist or nurse know of any side effects you experience, as they can usually be managed.

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim is to destroy cancer cells while causing the least possible damage to normal, healthy cells. Chemotherapy can be used at different times, including:

  • before surgery (neo-adjuvant chemotherapy), to try to shrink the cancer and make the operation easier
  • before radiotherapy or during radiotherapy (chemoradiotherapy or chemoradiation), to make radiotherapy more effective
  • after surgery (adjuvant chemotherapy), to reduce the risk of the cancer returning
  • as palliative treatment, to reduce symptoms, improve your quality of life or extend your life.

Chemotherapy is usually delivered through an intravenous drip. Each chemotherapy treatment is called a cycle and is followed by a rest period to give your body time to recover. The number of treatments you have will depend on the type of lung cancer you have and how well your body is coping with the side effects. You will probably have chemotherapy as an outpatient, which means you won’t have to stay in hospital overnight. Ask your doctor about the treatment plan recommended for you.

Some types of chemotherapy can be taken by mouth (orally) in tablet form, and are generally used on a continuous basis.

See more information about chemotherapy or call Cancer Council 13 11 20.

Side effects of chemotherapy

Chemotherapy can affect the healthy cells in the body and cause side effects. Everyone reacts differently to chemotherapy, and effects will vary according to the drugs you are given. Often side effects are temporary. Talk to your medical team about what to expect.

Anaemia

A low red blood cell count is called anaemia. This can make you feel tired or breathless. Your treatment team will monitor your red blood cell levels and suggest treatment if necessary.

Risk of infections

Chemotherapy drugs lower the number of white blood cells that fight infections. This can make you more likely to develop colds or the flu. If you feel unwell or have a temperature higher than 38°C, call your doctor immediately or go to the hospital emergency department.

Mouth ulcers

Some chemotherapy drugs cause mouth sores, ulcers or thickened saliva, which make it difficult to swallow. See more information on mouth health and cancer treatment or call Cancer Council 13 11 20.

Hair loss

You may lose hair from your head and chest, depending on the chemotherapy drugs you receive. The hair will grow back after treatment is completed, but the colour and texture may change.

Nausea or vomiting

It is common to feel sick (nauseated) or vomit. Let your treatment team know if you feel nauseated.

Key points

  • Treatment will depend on the type of cancer, its stage, and your general fitness and suitability for the treatment.
  • If you have surgery, you may have a whole lung, a lobe or part of a lobe removed. If you are a smoker, you will be encouraged to stop smoking before surgery.
  • Effective pain management, gentle breathing exercises as part of a pulmonary rehabilitation program, and being active will help your recovery after surgery.
  • Radiotherapy uses radiation such as x-rays to damage or kill cancer cells. It can be used to treat all types of lung cancer. It may be offered on its own or together with surgery or chemotherapy. Side effects may include difficulty swallowing and heartburn, red or dry skin, or shortness of breath or cough.
  • Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. Most chemotherapy drugs can cause side effects such as anaemia, risk of infections, mouth ulcers, hair loss and nausea or vomiting.
  • If the cancer has spread outside the lung and to other parts of the body, this is considered advanced lung cancer. The goal of treatment is to slow the spread and manage symptoms.
  • Treatment to target specific mutations within cancer cells is called targeted therapy. Some targeted therapy drugs may be available only through a clinical trial.
  • Palliative treatment aims to improve people’s quality of life by relieving symptoms of cancer without trying to cure the disease. It is part of palliative care.

Reviewed by: Dr Dishan Herath, Medical Oncologist, Royal Melbourne Hospital, VIC; Sue Lilley, 13 11 20 Consultant, Cancer Council SA; Nev Middleton, Consumer; A/Prof Matthew Peters, Professor of Respiratory Medicine, Faculty of Medicine and Health Sciences, Macquarie University, and Senior Staff Specialist, Department of Respiratory Medicine, Concord Hospital, NSW; Dr Shawgi Sukumaran, Medical Oncologist, Flinders Medical Centre, SA; and A/Prof Shalini Vinod, Radiation Oncologist, Liverpool Hospital, NSW.