Lung Cancer Treatment

This treatment option depends on the size and location of the tumour. Your tumour may be resectable, meaning it can be completely removed with surgery, or unresectable, meaning it cannot be completely removed with surgery.

The two commonly used approaches are thoracotomy and minimally invasive surgery. Thoracotomy involves making an incision on the side of the chest and dividing some of the chest wall muscles to access the lung. Minimally invasive surgery, on the other hand, uses small incisions and special instruments, including a camera, to perform the surgery. This method is also known as thoracoscopy or video-assisted thoracoscopic surgery (VATS) and can be done with the help of a surgical robot. The choice of approach depends on factors such as the location, size, and stage of the tumor, as well as the surgeon’s expertise.

During surgery, all or part of the tumor as well as a portion of healthy tissue is removed. Surgery is done under a general anesthetic, and you will stay in the hospital for a few days following the surgery.

Surgery is most used for non-small cell cancer, or for small cell lung cancer if it is found at an early stage. There are several types of surgical procedures that can be done such as:

1. Wedge resection- the removal of a small, wedge-shaped part of the lung tissue surrounding the tumor.
2. Segmental resection or segmentectomy- the removal (resection) of the one of the five lobes of the lung affected by lung cancer.
3. Lobectomy- the removal (resection) of the one of the five lobes of the lung affected by lung cancer.
4. Pneumonectomy- the removal (resection) of the one of the five lobes of the lung affected by lung cancer.

Sometimes lymph nodes in the chest will be removed as well.

It takes time to recover after surgery. Side effects can include pain or discomfort and the collection of air or fluid in the chest. You can also expect some shortness of breath right after your surgery. These side effects are temporary and can be managed. You will likely need to perform coughing and breathing exercises several times a day.

Radiation therapy uses intense beams of energy to kill cancer cells. Many people with lung cancer receive radiation therapy. Radiation therapy may be given before surgery to shrink tumors (induction or neoadjuvant therapy) or after surgery to help destroy cancer cells that may remain in your body (adjuvant therapy). Radiation therapy may be used if your cancer can’t be surgically removed – either because of your overall health, your level of heart or lung function, or how close the cancer is to your vital organs. When radiation is combined with chemotherapy, this is called chemoradiation.

Radiation therapy treatments are given at a cancer centre that has the radiation equipment. They are provided on a daily basis (for the duration of the treatment course). Most people live at home during the treatment and travel to the clinic each day. Those who live too far away from the cancer centre for daily commuting may have to seek accommodation near the cancer centre for the duration of their treatment regimen. Some cancer centres have accommodations available. The length of your radiation therapy treatment can vary. For large tumours or those that have spread to the lymph nodes, radiation therapy can take place in daily doses that span several weeks.

Since radiation damages the cells in its path – healthy cells as well as tumour cells – there are some side effects. Fatigue and shortness of breath are the most common. Remember to talk to your cancer care team about any side effects you experience, as they can often be managed.

External beam radiation treatment uses a large machine to direct an external beam of radiation directly at the tumor. Treatment times are short and painless, though you’ll be required to lay down and be very still. Some types of external radiation therapy include 3D conformal radiation therapy, intensity-modulated radiation therapy, and stereotactic body radiotherapy.

Stereotactic body radiotherapy is an option for those with small lung cancers. This form of radiation aims many beams of radiation from different angles at the lung cancer. Stereotactic body radiotherapy treatment is typically completed in one or a few treatments. In certain cases, it may be used in place of surgery for small tumors.

Internal beam radiation or brachytherapy is provided by placing the radioactive material (i.e., seeds, needles, or catheters) directly into or near the tumor. This technique uses internal radiation. It may be done during surgery. It can be used to shrink tumours in your airway, which can relieve symptoms.

Chemotherapy is the use of anticancer drugs which destroy cancer cells. Chemotherapy may be given for different reasons. You may have chemotherapy before surgery to shrink tumors (induction or neoadjuvant therapy) or after surgery to help destroy cancer cells that may remain in your body (adjuvant therapy). You may also receive chemotherapy as the main treatment if the cancer cannot be removed with surgery.

Chemotherapy may be given as an injection or an oral therapy, depending on the actual drug that is required. Chemotherapy interferes with the ability of the cancer cells to grow and spread, but it can also damage your healthy cells as well. Healthy cells recover over time, but you can experience a range of side effects. You may experience nausea, vomiting, loss of appetite, fatigue, lung problems, hair loss, and increased risk of infection, to name a few.

Chemotherapy by injection is usually given at the cancer centre. There are a variety of protocols for various drugs and you may have to travel to the cancer centre at various time intervals depending on the drug you are receiving.

More and more oral chemotherapy drugs are becoming available. Being able to take your medication on your own at home can mean less visits to your cancer centre and can save you time and energy, but it means that you will have to monitor and manage your own symptoms. It is important to talk with the cancer care team about when you should call the cancer centre if you are experiencing changes in your side effects.

Your immune system defends your body from infection and disease. When things are working properly, your body will sense threats and get rid of them. However, your body’s immune system can’t always recognize cancer cells as a threat. To your immune system, they may just look like normal cells.

Immunotherapy is medicine that stimulates your own immune system to recognize and destroy cancer cells. It can be given alone or with other treatments like chemotherapy. Immunotherapy may be given by needle into a vein (IV), or as a pill or capsule you swallow.

The most commonly used immunotherapy for lung cancer is a treatment called immune checkpoint inhibitors (ICIs). The body produces proteins that prevent the immune system from destroying its own cells. ICIs work by blocking these proteins, allowing the body’s T-cells to attack cancer cells.

Like chemotherapy, the goals of immunotherapy treatment vary depending on personal factors. You may be prescribed immunotherapy to stop or slow growth of your cancer, or to control symptoms.

Immunotherapy is often well tolerated, but there are some side effects that you should know about. The most common are fatigue, skin reactions, and flu-like symptoms. Other possible side effects include muscle pain, shortness of breath, leg swelling, sinus congestion, headaches, weight gain, diarrhea, hormone changes, and cough. Remember to talk to your cancer care team about any side effects you experience, as they can often be managed.

Targeted therapies are treatments that are personalized to the specific biomarkers for your cancer.

Targeted therapies work to exploit a particular weakness of your cancer. By identifying the unique molecular features of your cancer, doctors can use therapies that have a better chance of working. Additionally, targeted therapies may have fewer or less intense side effects when compared to general treatments like chemotherapy.

Previously, targeted therapies were only available for non-small cell lung cancer, but now, some forms of small cell lung cancer may qualify for targeted therapies.

It’s important to ask about biomarker testing and targeted therapies to ensure you are receiving the best available treatment for your cancer.

Some of the more common biomarkers and their targeted lung cancer therapies include:

For small cell lung cancer:

You may be offered an opportunity to participate in a clinical trial as part of your treatment plan. A clinical trial is a carefully controlled research study that determines how well a treatment works and how safe it is. A clinical trial may be performed for a new treatment, or for an existing treatment that’s being used in a new way.

If you are thinking about participating in a clinical trial, it’s a good idea to discuss this carefully with your doctor. Your doctor must make sure that you understand what’s involved in participating in the trial, how your safety will be protected, and what the potential risks are. This is all part of informed consent.

Once you have discussed the opportunity with your doctor, consider talking it over with your family and others in your support system. Participating in a clinical trial can involve some travel, tests and occasional hospital stays, and you may need more support and assistance.

The choice to participate in a clinical trial or not is yours. You don’t have to participate if you don’t want to.

There are many steps that a treatment has to go through before it gets to the clinical trial stage. This includes extensive laboratory tests using cells, tissue samples, and animals.

Before the trial begins, the person or organization testing the treatment must apply to Health Canada. Health Canada’s scientists will review the application to make sure:

• Drugs are used in the right way for the patients being studied
• Any risks in using the drug are lowered as much as possible
• The best interests of the people taking part in the trial have been considered
• The goals of the trial can be met

There are very strict rules in place for clinical trials in Canada. All trials must:

• Protect the health of the people in the trial
• Be well designed and conducted by trained professionals
• Be monitored and side effects reported
• Be reviewed by a Research Ethics Board

Finding clinical trials for lung cancer

The Canadian Partnership Against Cancer maintains a searchable database of ongoing clinical trials. You can filter by location and create email alerts for any new trials that begin in your area. Your Oncologist can also help you find clinical trials.