Page last updated: October 2024
The information on this webpage was adapted from Understanding Lung Cancer - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in October 2024.
Expert content reviewers:
This information was developed based on Australian and international clinical practice guidelines, and with the help of a range of health professionals and people affected by lung cancer:
- Dr Malinda Itchins, Thoracic Medical Oncologist, Royal North Shore Hospital and Chris O’Brien Lifehouse, NSW
- Dr Cynleen Kai, Radiation Oncologist, GenesisCare, VIC
- Dr Naveed Alam, Thoracic Surgeon, St Vincent’s Hospital, Epworth Richmond, and Monash Medical Centre, VIC
- Helen Benny, Consumer
- Dr Rachael Dodd, Senior Research Fellow, The Daffodil Centre, NSW
- Kim Greco, Specialist Lung Cancer Nurse Consultant, Flinders Medical Centre, SA
- Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA
- Marco Salvador, Consumer
- Janene Shelton, Lung Foundation Australia – Specialist Lung Cancer Nurse, Darling Downs Health, QLD
- Prof Emily Stone, Respiratory Physician, Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital Sydney, NSW
- A/Prof Marianne Weber, Stream Lead, Lung Cancer Policy and Evaluation, The Daffodil Centre, NSW.
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.
All treatments chosen for you will be expected to be safe and effective.
Understanding the aim of treatment
For early or locally advanced non-small cell lung cancer (stages 1-3 NSCLC) or limited-stage small cell lung cancer (stages 1-3 SCLC), treatment may be given with the aim of making all signs and symptoms of the cancer go away (curative treatment).
Because lung cancer causes vague symptoms or even no symptoms in the early stages, most people are diagnosed when the cancer is advanced. This means the cancer has spread outside the lung to other parts of the body.
When the cancer is advanced, the aim of treatment is often to maintain quality of life by controlling the cancer, slowing down its spread and managing any symptoms. This is called palliative treatment.
Sometimes palliative treatment can significantly shrink or control the cancer, helping people to live as fully and as comfortably as possible for many months or years.
NSCLC and SCLC are treated in different ways. Treatments to improve breathing are covered in the managing symptoms section.
Treatment options by type and stage
Non-small cell lung cancer (NSCLC)
- Early (stage 1 or 2) – usually treated with surgery, and for stage one, a type of high-dose targeted radiation therapy called stereotactic body radiation therapy (SBRT). Stage two is sometimes treated with chemotherapy or immunotherapy before or after the surgery.
- Locally advanced (stage 3) – can be treated with surgery and chemotherapy, or with radiation therapy and chemotherapy (without surgery). Immunotherapy may also be used. With some gene mutations, targeted therapy is starting to be used. Treatment will depend on where the cancer is in the lung, the number and location of lymph nodes with cancer and whether a surgeon can safely remove all of the visible cancer.
- Advanced (stage 4) – depending on the symptoms, palliative drug treatment (targeted therapy, chemotherapy or immunotherapy), palliative radiation therapy, SBRT, or a combination of treatments may be used. This depends on the cancer cell type, how much the cancer has spread, the symptoms and the molecular test results.
Small cell lung cancer (SCLC)
- Limited disease (stages 1 to 3) – usually treated with chemotherapy and radiation therapy (called chemoradiation). Sometimes, surgery may be used for stage one disease.
- Extensive disease (stage 4) – mainly treated with palliative chemotherapy, with or without immunotherapy. Palliative radiation therapy may also be given to the primary cancer in the lung and to other parts of the body where the cancer has spread to help control symptoms such as pain.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for lung cancer can help you make sense of what should happen.
It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Surgery for lung cancer
People with early NSCLC (stage one or two) will generally be offered surgery to remove the tumour. How much of the lung is removed depends on:
- the location and size of the cancer
- your general wellbeing and fitness, and
- how your lungs are working (lung function).
Surgery is not suitable for most people with advanced lung cancer. If there is fluid in the pleural cavity (called pleural effusion) that keeps coming back, you may have surgery (pleurodesis) to control this, or need to insert a catheter.
Preparing for treatment
Stop smoking
If you smoke or vape, you will be advised to stop before you start treatment for lung cancer. Stopping smoking can improve how treatments work and reduce the impact of side effects such as breathlessness.
Research shows that stopping smoking before surgery also reduces the chance of complications and can help you recover faster. To work out a plan for stopping, talk to your doctor, your nurse specialist, or call Quitline on 13 7848 (13 QUIT).
Eat well and exercise
Your health care team may also suggest that you eat healthy foods and exercise before starting lung cancer treatment.
Preparing for treatment in this way is called prehabilitation. It can help you to cope with cancer treatment, recover more quickly and improve your quality of life.
A dietitian, exercise physiologist or physiotherapist can support you to make lifestyle changes. Ask your doctor for a referral.
Types of lung surgery
Removing lymph nodes
During surgery, nearby lymph nodes near the cancer 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.
How the surgery is done
There are two main ways to perform surgery for lung cancer, and both require a general anaesthetic. Each type of surgery has advantages in particular situations – talk to your surgeon about the best option for you.
- VATS – lung cancer surgery can often be done using a keyhole approach. This is known as video-assisted thoracoscopic surgery (VATS). The surgeon will make a few small cuts (incisions) in the chest wall. A tiny video camera and operating instruments are passed through the cuts, and the surgeon performs the operation from outside the chest. A keyhole approach usually means a shorter hospital stay, faster recovery and fewer side effects.
- Thoracotomy – if a long cut is made between the ribs in the side of the chest, the operation is called a thoracotomy. This may also be called open surgery. You will need to stay in hospital for 3–7 days.
Sometimes the surgeon may need to change from a VATs approach to a thoracotomy during the surgery.
Many hospitals in Australia have programs to reduce the stress of surgery and improve your recovery. Called enhanced recovery after surgery (ERAS) or fast-track surgical (FTS) programs, they provide information about what to expect each day after surgery.
What to expect after surgery
- Exercises for breathlessness – A pulmonary rehabilitation program can help improve breathlessness and reduce the risk of a chest infection. A physiotherapist will show you how to do exercises. To continue rehabilitation after you leave hospital, talk to your surgeon or visit Lung Foundation Australia to find a program near you.
- Pain – You may have some pain after surgery but this can be controlled. Ask for pain relief as needed. Managing the pain will allow you to do breathing exercises and help you to recover. Pain will improve when tubes are removed from the chest.
- Recovery time – You will probably go home after 3–7 days. It may take 4–8 weeks after VATS or 6–12 weeks after thoracotomy to get back to your usual activities. Walking can help clear your lungs and speed up recovery.
- Tubes and drips – Several tubes will be in place after surgery. They will be removed as you recover. A drip in a vein in your arm (intravenous drip) can provide fluid and medicines. Tubes in your chest drain fluid and help your lungs expand; and a tube in your bladder may check how much urine you pass.
Radiation therapy
Also known as radiotherapy, radiation therapy uses radiation to target and kill cancer cells.
This reduces the risk of the cancer growing or spreading. It uses advanced technology to focus the radiation on the cancer and avoid the normal parts of the body.
You may be given radiation therapy on its own, or after surgery or chemotherapy, or at the same time as chemotherapy (called chemoradiation). When you have it depends on the stage of the cancer.
Radiation therapy may be recommended to treat the primary tumour in the lung:
- if you are unable to have surgery for stage one lung cancer
- if you chose not to have surgery
- where a surgery is not able to be safely done to treat locally advanced (stage three) NSCLC, or to treat limited-disease SCLC
- after surgery, if there is a risk of microscopic cancer cells left behind.
You may be offered radiation therapy as palliative treatment, to control the primary tumour in the lung or areas where the tumour has spread to, with the aim of relieving pain, breathlessness or other symptoms.
For lung cancer, radiation is usually delivered in the form of x-ray beams from a machine outside the body called a linear accelerator.
This is known as external beam radiation therapy (EBRT) and can be done as standard EBRT or stereotactic radiation therapy.
Standard external beam radiation therapy (EBRT)
This is usually given Monday to Friday over several weeks. For NSCLC, treatment aimed at making the signs and symptoms of cancer go away (curative course) may involve 20–30 radiation therapy sessions over 4–6 weeks.
Palliative radiation therapy may involve up to about 10 treatments. For SCLC, treatment may be given twice a day for three weeks (about 30 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, early-stage NSCLC.
How radiation is done
Planning radiation therapy
Before treatment starts, you will have a planning session at the radiation therapy centre to work out the dose and position of the beams.
During this session, you will have a CT scan to determine the area to be treated, and small marks will be put on your skin so the radiation therapists ensure your body is in the same position for every treatment.
You may have a 4-dimensional CT scan to record any movement of the cancer as you breathe. You may also be shown some breathing exercises to help your breathing stay as regular as possible.
Having radiation therapy
Each treatment day, a radiation therapist will help you lie in the position decided at the planning session. You will have an x-ray to check that the correct area is being treated.
When the treatment is being delivered, you will be alone in the room, but the radiation therapists will be able to hear you and talk to you from the monitoring area as there are speakers and a microphone in the room.
The radiation treatment itself takes only a few minutes, but a session may last about 20 minutes, depending on how complex the set-up process is.
Side effects of radiation therapy
Radiation therapy itself is painless, but it can affect some tissues and organs of the body. You may experience some side effects during or after radiation therapy, depending on the dose, the number of treatments and the part of the chest treated.
Most side effects are temporary and improve a few weeks after treatment.
- Fatigue – Feeling tired is common after radiation therapy. You may need more rest or sleep, but gentle exercise and being physically active, if you are able to, is encouraged.
- Discomfort when swallowing and heartburn – If the cancer is in the centre of the chest and near the oesophagus, you may find swallowing uncomfortable, and develop heartburn. You may need to eat softer food and avoid hot drinks until you feel better. You may also be prescribed medicine by your radiation oncologist to control the pain until these side effects resolve.
- Skin changes – Skin may become red and inflamed if the tumour is very close to the skin, but this is rare. Applying a moisturising cream and sun protection daily can help protect your skin.
- Lung inflammation (pneumonitis) – Radiation therapy may cause inflammation of the lungs, called radiation pneumonitis. This may happen 2–12 months after the radiation has finished and usually doesn’t need any treatment. Occasionally, it can cause shortness of breath and/or a cough which may require treatment with steroids. Tell your radiation oncology team about any side effects you are concerned about, as most can be managed.
Clinical trials
The area of cancer treatment is changing rapidly, and it's likely that new gene changes and targeted therapy drugs will continue to be discovered.
Talk to your oncologist about any clinical trials that may be suitable for you, and see Victorian Clinical Trials Link for cancer clinical trials being conducted in Victoria.
Visit VCTL
Drug therapies
Sometimes called systemic therapies, drug therapies can travel throughout the body to treat cancer cells wherever they may be. This can be helpful for cancer that has spread (metastatic cancer).
The main types of drug therapies used to treat lung cancer are chemotherapy, immunotherapy and targeted therapy.
Some drug therapies are given through a vein (intravenously). You will probably have drug therapies as an outpatient, which means you go to a treatment centre, but not stay overnight.
Some types of targeted therapy come as tablets and can be taken by mouth (orally) at home.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells or slow their growth. Chemotherapy can be used at different times:
- before surgery to try to shrink the cancer and make it easier to remove (neoadjuvant chemotherapy)
- before, or in combination with, radiation therapy to make radiation therapy more effective (chemoradiation); or in combination with immunotherapy
- after surgery to reduce the risk of the cancer returning (adjuvant chemotherapy)
- when cancer is advanced – to reduce symptoms and improve quality of life.
Chemotherapy given to treat lung cancer is usually one, two or three drugs together or one by itself. Drugs are commonly given as a period of treatment followed by a break to allow your body to recover. This is called a cycle.
The number of cycles will depend on the type of lung cancer and any side effects you have.
Side effects of chemotherapy
Chemotherapy works on cells that are dividing rapidly. Cancer cells divide rapidly, as do some healthy cells such as the cells in your blood, mouth, digestive system and hair follicles.
Side effects occur when these normal cells are damaged. As the body constantly makes new cells, most side effects are temporary. Some side effects are listed below.
- Anaemia – A low red blood cell count is called anaemia. This can make you feel tired, breathless or dizzy. Your treatment team will monitor your red blood cell levels and suggest treatment if necessary.
- Risk of infections – Chemotherapy drugs can lower the number of white blood cells that fight infections caused by bacteria. This means if you get an infection caused by a virus, such as a cold, flu or COVID-19, the risk of getting a bacterial infection is further increased. Talk to your doctor about being vaccinated against flu and COVID-19. Keeping your hands and mouth clean and social distancing can also help prevent the risk of infection. If you feel unwell or have a temperature above 38°C, call your doctor immediately or go to the hospital emergency department.
- Mouth ulcers – Some chemotherapy drugs cause mouth sores, ulcers and thickened saliva, making swallowing difficult. Your treatment team will explain how to prevent these issues and take care of your mouth.
- Hair loss – You may lose hair from your head, chest and other areas, depending on the chemotherapy drugs you receive. The hair will grow back after treatment is completed, but the colour and texture may change.
- Nausea, vomiting or constipation – You will usually be prescribed anti-nausea medicine with your chemotherapy drugs, but some people still feel sick (nauseous) or vomit. Constipation is also a common side effect of some types of anti-nausea medicines. Let your treatment team know if you have these side effects, as they may be able to give you extra medicines.
Get support
When you call the Cancer Council support line on 13 11 20, you’ll talk to a cancer nurse and get the support you need.
It’s free, confidential, and available for anyone affected by cancer who has a question – those diagnosed as well as their family, friends, and carers.
Support groups also provide an opportunity for people affected by cancer to meet in an emotionally supportive environment.
Explore support groups
Immunotherapy
Immunotherapy is a type of drug treatment that uses the body’s own immune system to fight cancer.
Immunotherapy drugs, also known as immune checkpoint inhibitors, block proteins, such as PD-L1, that stop immune cells from recognising and destroying the cancer cells.
Once the proteins are blocked, the immune cells can potentially recognise and attack the lung cancer. Several checkpoint inhibitors have been approved for most types of advanced NSCLC and for SCLC when it is used together with chemotherapy.
Several other checkpoint inhibitors are being tested in clinical trials for lung cancer, including using a combination of these drugs. Checkpoint inhibitors do not work for all types of lung cancer, but some people have good results.
Ask your oncologist about molecular testing and whether immunotherapy may be right for you. Immunotherapy may be used alone, or with chemotherapy as a palliative treatment, or after chemoradiation.
Immunotherapy is now being used for some people with stage two NSCLC, either before or after surgery. Tell your medical team if you have an autoimmune disease as this might mean this treatment is not suitable.
Side effects of immunotherapy
Immunotherapy can cause an inflammatory response in various parts of the body, which leads to different side effects depending on which part of the body becomes inflamed.
Common side effects include fatigue, rash, diarrhoea and joint pain. Most people have mild side effects that can be treated easily and usually improve.
Let your treatment team know if you have new or worsening side effects. If left untreated, some side effects can become serious and may even be life-threatening.
"A lot of the people I’ve met with lung cancer, say they’re guarded about their diagnosis. One carer said she didn’t tell anyone for three years that her spouse had lung cancer for fear of being stigmatised. There needs to be a lot more compassion." Lillian
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 usually particular protein changes that are found in or on the surface of the cancer cells as a result of abnormal genes.
Targeted therapies are currently mostly available for people with NSCLC whose tumours have specific gene changes when the cancer is advanced or has come back after initial surgery or radiation therapy.
These drugs will only work if the cancer contains the particular gene targeted and, even then, they do not work for everyone. Ask your oncologist about molecular testing and whether targeted therapy is an option for you.
For some abnormal genes, targeted therapy can be given as tablets or capsules. This area of cancer treatment is changing rapidly, and it is likely that new gene changes and targeted therapy drugs will continue to be discovered.
Talk to your medical oncologist about any clinical trials that may be suitable for you.
Cancer cells often become resistant to targeted therapy drugs over time. If the first-line treatment stops working, your oncologist may suggest trying another targeted therapy drug or another systemic treatment. This is known as second-line treatment.
Side effects of targeted therapy
Although targeted therapy drugs may cause less harm to healthy cells than chemotherapy, they can still have side effects. These side effects vary depending on the type of targeted therapy drugs used.
Common side effects include a rash, fatigue, diarrhoea, nausea, body aches or swelling. Vomiting is a rare side effect. In rare cases, targeted therapy may also cause pneumonitis (inflammation of the lung tissue), which can lead to breathing problems.
It is important to report any new or worsening side effects to your treatment team. If left untreated, some side effects can become serious and may even be life-threatening.
Palliative and supportive care
If the cancer is advanced when it is first diagnosed or comes back after treatment (recurrence), your doctor will discuss palliative treatment for any symptoms caused by the cancer (supportive care).
They may refer you to a palliative care specialist. Palliative treatment aims to manage symptoms without trying to cure the disease.
It can be used at any stage of advanced lung cancer to improve quality of life and does not mean giving up hope.
In fact, palliative treatment can help some people with advanced lung cancer to live well and with few symptoms for many months or years. Ways that symptoms may be relieved include:
- having palliative drug therapies (chemotherapy, immunotherapy and targeted therapy), radiation therapy and surgery to slow the spread of cancer and control symptoms such as pain or breathlessness
- draining any fluid to help prevent it building up again.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, spiritual and social needs and those of your family or carer.
Learn more