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Dec 22 2017

Lung Cancer – Non-Small Cell: Treatment Options

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ON THIS PAGE. You will learn about the different ways doctors use to treat people with NSCLC. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Patients should have a sense that their doctors have a coordinated plan of care and are working effectively with one another. If patients do not feel that the members of their health care team are communicating effectively with them or each other about the goals of treatment and the plan of care, patients should discuss this with their doctors or seek additional medical opinions before treatment.

There are 5 basic ways to treat NSCLC:

Each treatment option is described below, followed by an outline of common treatment plans by the stage of NSCLC. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions .

Surgery

A surgical oncologist is a doctor who specializes in treating cancer using surgery. For lung cancer, a thoracic surgeon is specially trained to perform lung cancer surgery. The goal of surgery is the complete removal of the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surrounding border or margin of healthy lung tissue. A “negative margin” means that when the pathologist examines the lung, or piece of lung that has been removed by the surgeon, no cancer was found in the healthy tissue surrounding the tumor.

The following types of surgery may be used for NSCLC:

Lobectomy. The lungs have 5 lobes, 3 in the right lung and 2 in the left lung. The removal of an entire lobe of the lung in a procedure called a lobectomy is currently thought to be the most effective type of surgery, even when the lung tumor is very small.

A wedge resection. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of healthy lung.

Segmentectomy. This is another way to remove the cancer when an entire lobe of the lung cannot be removed. In a segmentectomy, the surgeon removes the portion of the lung where the cancer developed.

Pneumonectomy. If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung.

The time it takes to recover from lung surgery depends on how much of the lung is removed and the health of the patient before surgery. Talk with your health care team about what to expect before your surgery, including recovery time and possible side effects. Learn more about the basics of cancer surgery .

Adjuvant therapy

Adjuvant therapy is treatment that is given after surgery to lower the risk of the lung cancer returning. Adjuvant therapy may include radiation therapy, chemotherapy, targeted therapy, or immunotherapy. Each therapy is described below. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. It also can decrease the risk of recurrence, though there is always some risk that the cancer will come back.

Along with staging, other tools can help determine prognosis and help you and your doctor make decisions about whether adjuvant therapy would be helpful in your treatment. The website Adjuvant! Online (www.adjuvantonline.com ) is a tool that your doctor can access to interpret a variety of factors that are important for making treatment decisions. This website should only be used with the help of your doctor.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. If you need radiation therapy, you will be asked to see a specialist called a radiation oncologist, a doctor who specializes in giving radiation therapy to treat cancer. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to several weeks.

Like surgery, radiation therapy cannot be used to treat widespread cancer. Radiation only destroys cancer cells directly in the path of the radiation beam. It also damages the healthy cells in its path; for this reason, it cannot be used to treat large areas of the body.

Sometimes, CT scans (see Diagnosis ) are used to plan out exactly where to direct the radiation to lower the risk of damaging healthy parts of the body. This is called intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). It is not an option for all patients, but it may be used for patients with early disease and small tumors when surgery is not an option.

Side effects of radiation therapy

Patients with lung cancer who receive radiation therapy often experience fatigue and loss of appetite. If radiation therapy is given to the neck or center of the chest, patients may also develop a sore throat and have difficulty swallowing. Patients may also notice skin irritation, similar to sunburn, where the radiation was directed. Most side effects go away soon after treatment is finished.

If the radiation therapy irritates or inflames the lung, patients may develop a cough, fever, or shortness of breath months and sometimes years after the radiation therapy ends. About 15% of patients develop this condition, called radiation pneumonitis. If it is mild, radiation pneumonitis does not need treatment and goes away on its own. If it is severe, a patient may need treatment for radiation pneumonitis with steroid medications, such as prednisone (multiple brand names). Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. Typically, the scarring does not cause symptoms. However, severe scarring can cause a permanent cough and shortness of breath. For this reason, radiation oncologists carefully plan the treatments using CT scans of the chest to lessen the amount of healthy lung tissue exposed to radiation (see above).

Learn more about the basics of radiation therapy .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. It has been shown to improve both the length and quality of life for people with lung cancer of all stages. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). Most chemotherapy used for lung cancer is given by IV injection.

A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. The type of lung cancer you have, such as adenocarcinoma or squamous cell carcinoma, affects which drugs are used for chemotherapy.

Common drugs used to treat lung cancer include either 2 or 3 drugs together or 1 drug by itself. Most therapies cause side effects that can generally be managed by the health care team.

Some common drugs include:

Carboplatin (Paraplatin) or cisplatin (Platinol)

Docetaxel (Docefrez, Taxotere)


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