This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Choosing a treatment plan

If you have lung cancer, your treatment choices may include:

• surgery
• radiation therapy
• chemotherapy
• targeted therapy

More than one kind of treatment may be used, depending on the stage of your cancer and other factors.

Your doctor will talk to you about treatment choices. Give yourself time to take in the information you have learned. The most important things to think about include the stage of the cancer, your overall health, the likely side effects of the treatment, and the chance of curing the cancer or helping you live longer. Age alone should not keep you from having treatment. Older people can benefit from treatment as much as younger people as long as their general health is good.

It is often a good idea to get a second opinion. A second opinion may give you more information and help you feel good about the treatment plan you choose. Your doctor should not mind your doing this. If your first doctor has done tests, the results can be sent to the second doctor so that you will not have to have them done again.

Types of treatment for non-small cell lung cancer

Surgery

Surgery is usually done, often along with other treatments, for early stage lung cancers. If surgery can be done, it offers the best chance of curing non-small cell lung cancer (NSCLC).

Several different operations can be used to treat (and maybe cure) NSCLC:

• pneumonectomy: an entire lung is removed in this surgery
• lobectomy: a section (lobe) of the lung is removed in this surgery
• segmentectomy or wedge resection: part of a lobe is removed in this surgery

A type of operation, known as a sleeve resection, may be used to treat some cancers in large airways in the lungs. If you think of the large airway with a tumor like the sleeve of a shirt with a stain an inch or 2 above the wrist, the sleeve resection would be like cutting across the sleeve above and below the stain and sewing the cuff back onto the shortened sleeve. A surgeon may be able to do this operation instead of a pneumonectomy to keep more lung function.

With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer.

The type of operation your doctor suggests depends on the size and place of the tumor and on how well your lungs are working. In some cases, doctors may want to do a bigger operation (for instance, a lobectomy instead of a segmentectomy) if a person's lungs are healthy enough, as it may provide a better chance to cure the cancer.

After the surgery

Operations are done with the patient asleep (under anesthesia). A hospital stay of 5 to 7 days is often needed. There will be some pain after the surgery because the surgeon has to cut through the ribs to get to the lungs. Other possible problems include bleeding, wound infections, and pneumonia.

People whose lungs are in good condition (other than the cancer) can often return to normal activities after a lobe or even an whole lung is removed. But if they also have problems such as emphysema or chronic bronchitis (common among heavy smokers), they may have long-term shortness of breath.

There is a new kind of surgery for people with early stage lung cancer. It is called video-assisted thoracic surgery (VATS). A tiny camera can be placed through a small hole in the chest to help the surgeon see the tumor. One or 2 other small holes are made in the skin, and long instruments passed though these holes are used to remove the tumor. Only small cuts (incisions) are needed, so there is less pain after surgery. This approach is most often used for tumors smaller than about 1½ inches. The cure rate seems to be the same as for standard surgery. The doctor who does this surgery should have experience because it takes a great deal of skill.

Surgery for lung cancers with limited spread to other organs

If the lung cancer has spread to the brain or adrenal gland and there is only one tumor, you might have the metastasis removed. This surgery would be done only if the tumor in the lung can also be completely removed. Even then, not all lung cancer experts agree with this approach, especially if the tumor is in the adrenal gland.

For tumors in the brain, the surgery is done through a hole in the skull (craniotomy). It should only be done if the tumor can be removed without harming vital areas of the brain that control movement, feeling, and speech.

For people who can't have the usual surgery because of lung disease or other medical problems, or because the cancer is widespread, other types of surgery (for example, laser surgery) may be done to relieve symptoms.

Sometimes fluid collects in the chest and makes it hard to breathe. This fluid can be taken out through a small tube placed in the chest. Then either talc or some type of drug is placed into the chest. This will start a reaction that will help seal the space and prevent future fluid build-up.

For more information about surgery, please see our document, Surgery.

Radiation treatment

Radiation treatment is the use of high-energy rays (like x-rays) to kill cancer cells or shrink tumors. The radiation may come from outside the body (external radiation) or from radioactive seeds placed into or next to the tumor (brachytherapy). External radiation is the type most often used to treat lung cancer.

External beam radiation

In this method, radiation is focused from outside the body on the cancer. This is the type of radiation most often used to treat a primary lung cancer or its spread to other organs.

Before your treatments start, careful measurements will be taken to find the best angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is stronger. It does not hurt. Each treatment lasts only a few minutes, although the setup time -- getting you into place for treatment -- usually takes longer. Most often, radiation treatments are given 5 days a week for 5 to 8 weeks.

This type of radiation is used much less often than in the past. There are newer methods that may offer better chances of increasing the success rate with fewer side effects. For instance, a special kind of radiation (called the Gamma Knife^®) can sometimes be used instead of surgery for single tumors that have spread to the brain. In this method, many beams of radiation are focused on the tumor over the span of a few minutes to hours. The head is held in place with a rigid frame. Though it is called Gamma Knife, there is no cutting -- the treatment is radiation.

Brachytherapy (internal radiation therapy)

Brachytherapy is used most often to shrink tumors to relieve symptoms caused by the cancer. But in some cases it may be part of a larger treatment plan to attempt to cure the cancer. For this type of treatment, the doctor places a small source of radioactive material (often in the form of seeds or pellets) right into the cancer or into the airway next to the cancer. This is usually done through a bronchoscope, although it may also be done during surgery. The pellets are usually removed after a short time. Less often, small radioactive seeds are left in place, and the radiation gets weaker over several weeks.

When is radiation therapy used?

Radiation is sometimes used as the main treatment of lung cancer. It might be used for people who are not healthy enough to have surgery. For other patients, radiation might be used after surgery to kill small areas of cancer that can't be seen and removed during surgery. Radiation can also be used to relieve symptoms such as pain, bleeding, trouble swallowing, or problems caused by the cancer spreading to the brain.

Possible side effects

Side effects of radiation could include skin problems, nausea, vomiting, and tiredness. These can be treated and often go away after treatment. Chest radiation may cause lung damage and trouble breathing or swallowing.

Side effects of radiation therapy to the brain usually become most serious 1 or 2 years after treatment. These side effects could include memory loss, headaches, trouble with thinking, and less sexual desire. These side effects, though, are minor compared to those caused by lung cancer that has spread to the brain.

For more information about radiation therapy, please see our document, Understanding Radiation Therapy: A Guide for Patients and Families.

Other treatments

At times, treatments other than surgery or radiation may be used to destroy lung cancer cells in certain places.

Radiofrequency ablation (RFA)

This method is being studied for small lung tumors that are near the outer edge the lungs, especially in people who can't have or don't want surgery. It uses high-energy radio waves to heat the tumor. A thin, needle-like probe is placed through the skin and advanced until the end is in the tumor. Once it is in place, an electric current is passed through the probe. It heats the tumor and destroys the cancer cells. RFA is usually done as an outpatient procedure, using numbing medicine (local anesthesia) where the probe is put in. You may also be given medicine to help you relax.

Photodynamic therapy (PDT)

Photodynamic therapy is sometimes used to treat smaller lung cancers near airways when other treatments aren't a good choice. It may also be used to help open up airways blocked by tumors so a person can breathe better.

To do PDT, a light-activated drug called Photofrin is put into a vein. Over the next couple of days, the drug collects in cancer cells. A bronchoscope (a thin, flexible, lighted tube) is passed down the throat and into the lung. A special red light on the end of the bronchoscope is aimed at the tumor. The light turns on the drug which causes the cells to die. PDT may be done by numbing the throat (local anesthesia) or by putting the patient in a deep sleep (general anesthesia). The dead cells are then taken out a few days later during a bronchoscopy. This process can be repeated if needed. For more information about this treatment, please see our document, Photodynamic Therapy.

Laser treatment

Lasers can sometimes be used to treat very small lung cancers in the linings of airways. They can also be used to help open up airways blocked by larger tumors to help people breathe better.

You are usually asleep (under general anesthesia) for this type of treatment. The laser is on the end of a bronchoscope, which is passed down the throat and next to the tumor. The doctor then aims the laser beam at the tumor to burn it away. This treatment can usually be done more than once, if needed.

Stent placement

Lung tumors that have grown into an airway can sometimes cause trouble breathing or other problems. To help keep the airway open (often after other treatments such as photodynamic therapy or laser therapy), a stent may be placed in the airway. Stents are hard rubber or metal tubes that can be put in with a bronchoscope. They keep the airway open.

Chemotherapy

Chemotherapy (often called just "chemo") is treatment with anti-cancer drugs that are put into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment useful for cancer that has spread (metastasized) to organs beyond the lung. Doctors give chemo in cycles, with each round of treatment followed by a break to allow the body time to recover. Chemo cycles generally last about 3 to 4 weeks, and the first round of treatments may involve 4 to 6 cycles.

When is chemo used?

• Chemo (sometimes along with radiation) may be used to try to shrink a tumor before surgery.

• Chemo (sometimes along with radiation) may be given after surgery to try to kill any cancer cells that may have been left behind.

• Chemo may be given as the main treatment (sometimes along with radiation) for more advanced cancers or for some people who aren't healthy enough for surgery.

Possible side effects of chemo

Chemo drugs kill cancer cells but they also damage some normal cells, causing side effects. These side effects depend on the type of drugs used, the amount given, and the length of treatment. You could have some of these short-term side effects:

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• increased chance of infections (due to low white blood cell counts)
• easy bruising or bleeding (due to low blood platelet counts)
• feeling tired all the time, called fatigue (due to low red blood cell counts)

Most of these side effects go away when treatment is over. If you have any problems with side effects, be sure to tell your doctor or nurse, as there are often ways to help.

Some chemo drugs can damage nerves. This can cause numbness in the fingers and toes, and sometimes the arms and legs may feel weak. You should report this, as well as any other side effects or changes you notice while getting chemo so that they can be treated right away. For more information about chemo, please see our document, Understanding Chemotherapy: A Guide for Patients and Families.

Targeted therapies

As researchers have learned more about the changes in cells that cause cancer, they have been able to develop newer drugs that target these changes. These targeted drugs work differently from standard chemo drugs. They often have different (and less severe) side effects. At this time, they are most often used either along with chemo or in cases where chemo is no longer working.

Drugs that target tumor blood vessel growth (angiogenesis)

For cancer cells to grow, they must form new blood vessels to feed the tumor. There is a drug (called Avastin^®) which can keep new blood vessels from forming. It has been shown to help people with advanced lung cancer live longer when it was given along with chemo. But it causes bleeding, so it can't be used for patients who are coughing up blood or whose cancer has spread to the brain. Other possible side effects include high blood pressure, loss of appetite, slow wound healing, and an increased risk of blood clots.

Drugs that target EGFR

Epidermal growth factor receptor (EGFR) is a protein found on the surface of cells. It normally gets signals telling the cells to grow and divide. Some lung cancer cells have too many copies of EGFR, which help them grow faster.

There are drugs such as Tarceva^® and Erbitux^® that block EGFR from telling the cell to grow. They have been shown to help keep some lung tumors under control, especially in women and in people who never smoked. They are most often used for advanced lung cancers if the first treatment of chemo is no longer working.

These drugs can have side effects such as an acne-like rash on the face and chest, diarrhea, loss of appetite, and feeling tired. A rare but serious side effect of Erbitux is an allergic reaction during the first infusion, which could cause problems with breathing and low blood pressure.

Treating cancer that keeps growing or comes back after treatment

If cancer keeps on growing during treatment or comes back, further treatment will depend on the extent of the cancer, what treatments have been used, and a person's health and desire for further treatment. You should know the goal of any further treatment -- if it is to try to cure the cancer, to slow its growth, or to help relieve symptoms -- as well as the benefits and risks.

At some point, it may become clear that standard treatments are no longer working. If you want to continue treatment, you might think about taking part in a clinical trial of newer lung cancer treatments. While these are not always the best option for every person, they may help you as well as future patients.

Even if you have lung cancer that cannot be cured, you should be as free of symptoms as possible. Treatment can often relieve symptoms and may even slow the spread of the disease. Symptoms caused by cancer in the lung airways, such as shortness of breath or coughing up blood, can often be treated with radiation therapy, brachytherapy, laser therapy, photodynamic therapy, stent placement, or even surgery if needed. Radiation can be used to help control cancer spread in the brain or relieve pain if cancer has spread.

Many people with lung cancer worry about pain. As the cancer grows near certain nerves it can sometimes cause pain, but this can almost always be treated with pain medicines. Sometimes radiation will help, too. It is important that you talk to your doctor and use these treatments to ease any pain.

Deciding on the right time to stop treatment aimed at curing the cancer and focus on care that relieves symptoms is never easy. Good communication with doctors, nurses, family, friends, and clergy can often help people facing this situation.

Last Medical Review: 11/03/2009
Last Revised: 11/03/2009