Treatment for lung cancer will depend on the type of lung cancer you have, the stage of the cancer, how well you can breathe (your lung function) and your general health. If you are a smoker, your doctor will advise you to stop smoking before you start treatment.

Treatment options by type and stage

Non-small cell lung cancer (NSCLC)

• Early (stage 1 or 2) – usually treated with surgery to remove the cancer and nearby lymph nodes. If surgery is not an option or you choose not to have surgery, you may have radiation therapy. Sometimes, chemotherapy may be given after surgery to reduce the risk of the cancer returning. 
• Locally advanced (stage 3) – can be treated with surgery and chemotherapy, or with radiation therapy and chemotherapy. Immunotherapy drugs may also be used. Treatment will depend on where the cancer is in the lung and the number and location of lymph nodes with cancer. In some cases, targeted therapy may be used to slow the spread of the cancer.
• Advanced (stage 4) – depending on the symptoms, palliative drug treatment (targeted therapy, immunotherapy or chemotherapy), palliative radiation therapy or both may be used.

Small cell lung cancer (SCLC)

• Early or locally advanced (stages 1 to 3) – usually treated with chemotherapy and radiation therapy. Surgery is not used.
• Advanced (stage 4) – mainly treated with palliative chemotherapy, with or without immunotherapy. Palliative radiation therapy may also be given.

Understanding the aim of treatment

For early or locally advanced non-small cell lung cancer or limited-stage small cell lung cancer, treatment may be given with the aim of making all signs and symptoms of the cancer go away. This is called curative treatment.

Because lung cancer causes vague symptoms in the early stages, many people are diagnosed when the cancer is advanced. This means the cancer has spread outside the lung to other parts of the body. The goal of treatment is to maintain quality of life by controlling the cancer, slowing down its spread and managing any symptoms, which is called palliative treatment.  

Surgery

People with early non-small cell lung cancer will generally be offered 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.

Lung cancer is usually diagnosed at a later stage once it has caused symptoms, so most people with lung cancer will not have surgery.

Types of lung 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 radiation therapy.

Radiation therapy

Also known as radiotherapy, radiation therapy is the use of targeted radiation to kill or damage cancer cells so they cannot grow, multiply or spread.  Radiation therapy may be offered on its own or in combination with surgery or chemotherapy, and may be recommended:

• to treat an early lung cancer if you are unable or choose not to have surgery
• to treat locally advanced NSCLC or limited-stage SCLC
• after surgery if tests show cancer in the mediastinal lymph nodes, to reduce the risk of the cancer coming back in the mediastinum
• as palliative treatment to improve quality of life by relieving pain or other symptoms.

For lung cancer, the radiation is usually in the form of x-ray beams that come from a machine outside the body. This is called external beam radiation therapy (EBRT) and it can be delivered in different ways:

Standard external beam radiation therapy (EBRT)

• This is usually given every weekday over several weeks
• Treatment aimed at making the signs and symptoms of cancer go away (curative course) may involve 20–33 treatments over 4–6 weeks
• Palliative radiation therapy usually involves 1–15 treatments.

Stereotactic body radiation therapy (SBRT)

• This is also called stereotactic ablative body radiation (SABR). It is a way of giving a very precise high dose of radiation therapy to small NSCLCs. It is sometimes used instead of surgery
• SBRT is often given as 3–4 treatment sessions over a couple of weeks
• It is suitable only for tumours that are not close to major airways or major blood vessels

Side effects of radiation therapy can include difficulty swallowing and heartburn, fatigue, skin changes, shortness of breath and coughing. 

Chemotherapy

Chemotherapy is the treatment of cancer with drugs that kill cancer cells or slow their growth. It can be used at different times, including:

• before surgery to try to shrink the cancer and make the operation easier (neoadjuvant chemotherapy)
• before or during radiation therapy to make radiation therapy more effective (chemoradiation)
• after surgery to reduce the risk of the cancer returning (adjuvant chemotherapy)
• when cancer is advanced to reduce symptoms and improve quality of life (palliative chemotherapy).

Sides effects of chemotherapy can include anaemia (low red blood cell count), mouth ulcers, hair loss, nausea or vomiting and a higher risk of infection.

Targeted therapy

Targeted therapy is a type of drug treatment that attacks specific features of cancer cells, known as molecular targets, to stop the cancer growing and spreading. The molecular targets are found in or on the surface of cancer cells (for example, they may be genes or proteins).

Targeted therapy can often be given by mouth as tablets or capsules. These drugs can be highly effective, but they will only work if the cancer contains the particular gene or protein and, even then, they do not work for everyone. Targeted therapy is currently available for people with NSCLC whose tumours have specific genetic changes (mutations) when the cancer is advanced or has come back after initial surgery or radiation therapy.

Although targeted therapy may cause less harm to healthy cells, it can still have side effects, which commonly include skin changes such as acne-like rashes, tiredness, diarrhoea, nausea or vomiting. 

Immunotherapy

Immunotherapy is a type of drug treatment that uses the body’s own immune system to fight cancer. Immunotherapy drugs, known as checkpoint inhibitors block proteins, stop immune cells from recognising and destroying the cancer cells. Once the proteins are blocked, the immune cells can recognise and attack the cancer.

Several checkpoint inhibitors have been approved for most types of advanced NSCLC. One has also been approved for extensive-stage SCLC when it is used together with chemotherapy. Several others are currently being tested in clinical trials for lung cancer. 

Side effects of immunotherapy drugs are different to those caused by chemotherapy or targeted therapy. Immunotherapy can cause inflammation of any body organ, which may lead to side effects including fatigue, rashes, painful joints and diarrhoea. Most people have mild side effects that can be treated easily and usually improve.