Treatment

Lung Cancer & Treatment Options

Lung cancer is the second most common type of cancer affecting both men and women and the leading cause of cancer deaths.  In 2008 an estimated 215,020 new cases of lung cancer were diagnosed and 161,840 individuals died from this disease.

Risk Factors

Certain practices increase the risk of developing cancer. Risk factors include:

• Smoking (most common known cause)
• Exposure to certain chemicals like second-hand smoke, asbestos, radon, arsenic, air pollution and some organic chemicals

Diagnosis

Lung cancer usually begins in one lung, but if not detected and treated it can spread to other parts of the chest including lymph nodes, the other lung and other parts of the body (called metastasis). When certain signs and symptoms occur, further evaluation for lung cancer is necessary. These may include:

• Persistent cough
• Shortness of breath
• Coughing blood
• Chest pain
• Hoarseness
• Bloody or rust-colored sputum
• Frequent episodes of bronchitis or pneumonia
• Unexplained weight loss, loss of appetite or fatigue

Your doctor may order a variety of tests including:

• Chest X-ray to determine the cause of your symptoms
• CT, MRI and PET scans can provide more detailed information. If small cell lung cancer is diagnosed, a CT or MRI of the brain will also be recommended as this is one of the first sites to which the disease will spread
• Bronchoscopy: a flexible tube is inserted into your nose or mouth to examine the airways leading to the lungs. Sometimes small pieces of tissue or secretions from the lung can be removed during this procedure for review under a microscope
• Mediastinoscopy or mediastinotomy: a lighted, hollow tube is inserted through a small incision in the neck or along the breastbone allowing your surgeon to remove lymph nodes from your chest to look at under the microscope
• Biopsy (removal of a small piece of tissue) which can be done during a bronchoscopy, mediastinoscopy or with a needle inserted through the skin directly into the abnormal area using CT guidance. This tissue is looked at under the microscope to determine if cancer is present and if so, the type and stage of the cancer

Types of Lung Cancer

• Non-small cell lung cancer (NSCLC) is the most common type of lung cancer accounting for 75 to 80% of all lung cancers. It grows more slowly than small cell lung cancer and spreads less rapidly. Non-small cell lung cancer is divided into three types according to the cell of origin: squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
• Small cell lung cancer is less common, tends to grow rapidly and has a greater likelihood to be more widespread at diagnosis. It accounts for 20 to 25% of all lung cancers and has a greater tendency to spread to other parts of the body.

Treatment

The management of lung cancer depends on several factors, including the type, stage, size and location of the tumor and your general health. Usually different treatments and combinations of treatments will be used to treat lung cancer.

Surgery

The type, extent and timing of surgery will depend on the location and stage of the tumor.  Non-small cell lung cancer (NSCLC) may first be treated with surgery possibly followed by chemotherapy and/or radiation therapy.

Chemotherapy

This involves the administration of anticancer drugs for certain types and stages of lung cancer.  It may be delivered after surgery when there is no evidence of cancer, but a chance it may come back or to help shrink a tumor before surgery.  Small cell lung cancer is frequently treated with chemotherapy and radiation therapy either together or one right after the other.

Radiation Therapy

When there is a diagnosis of small cell lung cancer, your doctor may recommend radiation therapy to the brain after completion of your treatment course to the lung. This is called prophylactic cranial irradiation (PCI) and is recommended only in certain situations.
There are several methods by which the radiation therapy treatments can be given: External beam radiation or Brachytherapy.

• External beam radiation therapy involves a series of painless, daily (Monday through Friday) outpatient treatments delivered over several weeks. It works by focusing a beam of ionizing radiation to the tumor while sparing the surrounding tissue. The two main techniques for delivering external beam radiation therapy are:
  • 3-dimensional conformal therapy (3-D conformal) refers to a method of treatment delivery that incorporates 3-dimensional computer planning and treatment systems to produce a high-dose area of radiation that conforms to the shape of the area to be treated. This technique allows the delivery of precise doses of radiation to the targeted area through multiple treatment fields while sparing surrounding tissues.
  • Intensity modulated radiation therapy (IMRT) which utilizes a more sophisticated system of shields within the machine allowing a higher dose of radiation to be delivered to the tumor from multiple angles while minimizing effects on surrounding tissue. This form of 3-D conformal radiotherapy allows a precise adjustment of radiation beams to the tissue within the target area. It continues to be studied for lung cancer especially in our departments where respiratory gating (synchronizing the delivery of radiation to the individual's own breathing cycle) is possible.
• Brachytherapy may be recommended for specialized circumstances. It is a form of internal radiation therapy
  • High-dose-rate brachytherapy (HDR): During this procedure a bronchoscopy is performed placing one or two thin plastic tubes or catheters into the airways leading to the lungs. These tubes are connected to a special machine. A small amount of radioactive material passes through these catheters allowing a high dose of radiation to be delivered to a small, precise area while sparing surrounding normal tissue. The radiation and catheters are removed at the end of each treatment.

Treatment Side Effects

Side effects of radiation for lung cancer may include tiredness, mild to moderate redness of the skin in the treatment area (similar to sunburn), temporary difficulty or pain with swallowing, cough and shortness of breath.