Lung Cancer Treatment Options

It’s helpful to understand all possible treatments for lung cancer. The following are overviews of the most common treatments. Reading these should help you know what to expect, what the potential side effects are, and what the advantages are to each.

Here are the common treatments for lung cancer:

  • Surgery
  • Chemotherapy
  • Radiation
  • Targeted Therapy

There are many different specialists who treat lung cancer. Typically, they work as a team. Often a lung cancer team includes:

  • Thoracic (chest) surgeon
  • Medical oncologist
  • Radiation oncologist
  • Pulmonologist (lung specialist)
  • Respiratory therapist
  • Oncology nurse
  • Registered dietitian
  • Psychologist
  • Supportive Care Specialist
  • Thoracic Nurse Navigator

The type of treatment you get depends on the type of lung cancer and its stage. Your doctor may recommend that you have surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of several of these.

Treatment of lung cancer is either local therapy or systemic therapy:

  • Local therapy: Local therapies remove or destroy cancer. Surgery and radiation are examples of local therapies. If lung cancer has spread to another part of your body, your doctor may recommend local therapy to control the disease there. For example, if lung cancer has spread to the liver, it may be treated with radiation to the liver.
  • Systemic therapy: Systemic medications enter your bloodstream. They can destroy cancer throughout your body. Chemotherapy and targeted therapy are examples of systemic therapies.

Surgery for lung cancer removes the tissue with the tumor in it. Your surgeon also removes nearby lymph nodes.

The surgeon removes either part or all of the lung:

  • Wedge resection or segmentectomy: In this procedure the surgeon removes the tumor and a small part of your lung.
  • Lobectomy or sleeve lobectomy: In this procedure the surgeon removes a lobe of your lung. This is the most common surgery for lung cancer.
  • Pneumonectomy: The surgeon removes your entire lung.

What to Expect

Once surgery is over, air and fluid collect in your chest. You will need a chest tube to let the fluid drain out. A nurse or respiratory therapist will teach you coughing and breathing exercises. You’ll need to do these exercises several times a day. These exercises will do several things:

  • Keep your lung(s) inflated
  • Help move fluid out of your lungs
  • Help prevent pneumonia

You may be in the hospital for a week or longer after surgery. It will probably take several weeks before you can return to normal activities.

Your doctor will give you a prescription for pain medicine after surgery. It’s important to get this prescription filled before you go home—in case you need it.

You may want to ask your doctor these questions before having surgery:

  • What kind of surgery do you suggest for me?
  • How will I feel after surgery?
  • If I have pain, how will it be controlled?
  • How long will I be in the hospital?
  • Will I have any lasting side effects?
  • When can I get back to my normal activities?

Chemotherapy (usually called chemo) uses anticancer drugs to destroy cancer cells. These drugs are given through a vein in your arm or a special IV port inserted in your chest. There are some chemotherapy drugs that can be taken by mouth. The chemotherapy drugs damage cancer cells all over your body.

Chemotherapy is not just one drug. There are many types of chemotherapy drugs. Your doctor may give you more than one chemotherapy drug.

Chemotherapy is given in cycles. You have a period of rest after each treatment. The length of the rest period and the number of cycles depend on what anticancer drugs are used.

You may have your treatment in a clinic, at the doctor's office, or at home. You may need to stay in the hospital for treatment.

What to Expect

The side effects of chemotherapy depend on which drugs are given and how much of the drugs are given. You may feel side effects from chemotherapy drugs because those drugs can harm normal cells as they destroy cancer cells. Possible side effects of chemotherapy to watch out for include:

  • Fatigue
  • Hair loss
  • Poor appetite
  • Nausea and/or vomiting
  • Mouth sores
  • Hearing loss
  • Pain in your joints
  • Tingling or numbness in your hands and feet (peripheral neuropathy)

These side effects usually go away once treatment ends. Make sure you report any side effects. There are many medications and therapies that can make the side effects more bearable.

You may want to ask your doctor these questions before having chemotherapy:

  • What are the benefits of chemotherapy?
  • What are the risks and possible short and long term side effects?
  • What will my treatment schedule be?
  • Will I receive one drug or a combination?
  • Will I need someone to come with me to treatment?
  • How will I know if the treatment is working?

Radiation therapy (also called radiotherapy or radiation) uses high-energy x-rays to destroy cancer cells. Radiation damages cells only in the cancerous area and is a type of local therapy.

Radiation comes from a large machine outside your body. It is administered at a hospital of cancer clinic.

External Radiation side effects may include:

  • Damage to the esophagus, causing problems with swallowing
  • Fatigue
  • Red, dry, tender skin in the area that has received radiation

Internal radiation (also called brachytherapy) is another option. The radiation comes from a wire, seed, or device put inside your body. Internal radiation is not commonly used for lung cancer.

You may want to ask your doctor these questions before having radiation therapy:

  • Why do I need this treatment?
  • What kind of radiation therapy do you suggest for me?
  • When will the treatments begin? When will they end?
  • How will I feel during treatment?
  • How will we know if the radiation treatment is working?
  • Are there any lasting side effects?

Targeted therapy uses drugs to block the growth and spread of cancer cells. The drugs enter your bloodstream. They can then travel throughout your body and damage cancer cells.

Although this sounds like chemotherapy, targeted therapies work differently. They target specific biomarkers that help tumors grow and divide. They do not attack normal cells, like chemotherapy drugs do. Your oncologist will conduct molecular testing to find out which targeted therapy may be right for you.

What are biomarkers?

Biomarkers are molecules that are signs of a condition or disease. Many newer cancer treatments can target these biomarkers to destroy cancer cells or stop cell growth. Here are some of the common lung cancer biomarkers:

  • EGFR (epidermal growth factor receptor): A protein found on the surface of cells which causes cells to divide and multiply.
  • ALK (anaplastic lymphoma kinase) gene: If this gene is mutated, it may increase cancer cell growth.
  • ROS1 (c-ros oncogene 1): When this gene is mutated, it causes cancer to grow.
  • KRAS (Kristen RNA Associated Rat Sarcoma 2 Virus Gene): This gene makes the KRAS protein. This protein controls cell signaling pathways, cell growth, and cell death.

Not all lung cancers are the same. Your tumor may not test positive for these biomarkers, but your doctor can use the information to personalize your treatment plan.

Currently, there are only targeted therapies approved for non-small cell lung cancer. There are two kinds of targeted therapy for lung cancer:

  • Intravenous: This type is given through an IV in your vein. It’s given at the same time as chemotherapy. It may be given at your doctor's office, hospital, or clinic. Side effects can include bleeding, coughing up blood, rash, high blood pressure, stomach pain, vomiting, or diarrhea.
  • Oral: This type is taken by mouth. It is not given at the same time as chemotherapy. Side effects can include rash, diarrhea, and shortness of breath.

Targeted therapy is usually recommended for people with non-small cell lung cancer that has spread.

You may want to ask your doctor these questions before having targeted therapy:

  • What drugs will I have? What are the expected benefits?
  • When will treatment start? When will it end? How often will I have treatments?
  • Where will I go for treatment?
  • What can I do to take care of myself during treatment?
  • How will we know the treatment is working?
  • Will there be lasting side effects?
  • What side effects should I tell you about? Can I prevent or treat any of these side effects?