- Posted by jdavis on August 24, 2011
Treatments for lung cancer are based on “staging.” Stage refers to the extent to which the disease has spread, the lower the stage, the less spread.
Stage 1 and Stage 2:
Surgical removal of the tumor is the principle form of treatment for individuals with Stage 1 or Stage 2 lung cancer. If the surgical margins are found to be close to or involved with the tumor, the physician may recommend additional treatment in the form of radiation therapy. Radiotherapy is given to reduce the rate of tumor re-growth in the area of the original tumor. If a patient cannot medically withstand tumor resection, radiotherapy alone may be administered to destroy the tumor tissue.
Cases of Stage 3 lung cancer are typically evaluated for treatment by putting them into one of three groups:
- Patients with abnormal, enlarged lymph nodes as seen on chest x-ray or CT scan. These patients have a high probability of cancer in those nodes. These patients are not considered primary surgical candidates, but they may benefit from a combination treatment plan involving both radiation and chemotherapy. Some research suggests that concurrent treatment produces better response rates than sequential (one at a time) treatment. However, patients report more side effects with combined, concurrent radiotherapy and chemotherapy. It is unclear whether or not disease-free or overall survival is improved when surgery is performed after concurrent combination therapy.
- Patients with normal-appearing but cancerous lymph nodes that are identified during examination of the chest cavity with a scope. These patients may proceed to surgery for tumor resection. In many patients, examination will reveal that the lymph nodes are actually cancerous. That was my case. Another option is to have preoperative chemotherapy or chemo-radiotherapy and, if a response is seen, to undergo follow-up surgery. Preoperative therapy should be given if available. Clinical trials may provide helpful forms or therapy for these patients, so the availability of research protocols should be discussed.
- Patients with tumors of any size and cancerous lymph nodes within the mid-chest area, the trachea, the point of entry/exit of vessels within the lungs, upper ribs, or upper collarbone region. These patients are not surgical candidates. A combination treatment plan with chemo-radiotherapy should be considered for those who have non-cancerous fluid that is free of cancer cells. Both patient and doctor should decide on the timing of therapy—concurrent or sequential. Individuals who have cancerous fluid will typically be asked to consider the benefits of chemotherapy alone versus no therapy with comfort care.
Stage 4 or Recurrent Lung Cancer:
As with Stage 3b patients, individuals with Stage 4 or recurrent lung cancer have the options of chemotherapy alone versus no therapy with comfort care. Some clinical findings indicate that treatment of Stage 4 patients can improve overall survival when compared with comfort care only. In addition, chemotherapy may help to relieve symptoms in patients who experience significant symptoms from their disease.
Limited-Stage Small Cell Lung Cancer (SCLC):
The treatment of limited-stage SCLC is very physically demanding. Therefore, the physician will assess each patient’s ability to tolerate whole-body therapy (e.g., with chemotherapeutic agents) and locol/regional therapy with radiation or surgery. If an individual is unable to walk at least 50% of the time, and if he or she does not have good function of the liver, kidney, and cardiopulmonary (heart/lung) system, it is unlikely that aggressive treatment can be tolerated. Patients who have localized disease and are in relatively good health are felt to be good candidates for aggressive combination therapy. Combination therapy may consist of one of several treatment options, including:
- surgery followed by chemotherapy
- chemotherapy followed by radiotherapy (sequential therapy)
- chemotherapy plus radiotherapy (concurrent therapy)
- chemotherapy alternating with radiotherapy
Although conventionally-trained oncologists tend to agree that chemo-radiotherapy is preferred over one therapy alone, many issues—such as the sequencing and timing of therapy—remain unanswered. Participation in a clinical trial is often recommended.
Although controversial, cranial (head) radiation therapy is sometimes recommended for lung cancer patients with limited-stage disease. Some experts believe that prophylactic, or disease-preventing, cranial radiation is helpful, whereas others maintain that a “watch and wait” approach is more practical. Studies that have tried to answer this question have not shown significant improvements in survival. Cranial radiation can decrease the risk of developing brain metastases in SCLC patients.
Extensive-Stage Small Cell Lung Cancer (SCLC):
If an individual with extensive-stage disease is not medically stable or has poor health, typically comfort care will be recommended. For all other extensive-stage SCLC patients, chemotherapy is a suitable treatment strategy, since it can prolong survival. Yet the choice of chemotherapy should take into account a number of factors, such as (1) lengthened survival; (2) side effects; (3) need for frequent physician visits; and (4) other quality of life issues.