Lung Cancer Treatment

Your treatment team will consider a number of factors when choosing treatments that will fight your cancer most effectively. They will consider your overall health, age, and personal situation. They will also consider the unique features of your particular cancer including the cancer type, tumour location, and whether it has spread to other parts of your body. 

Your treatment team should also consider your wishes for your treatment. You are an important part of your lung cancer treatment team, so don’t be afraid to ask questions about your treatment, or ask to explore other available treatment options.

In this section:

  • What’s the goal of my treatment?
  • Boost your results by quitting smoking!
  • Lung cancer treatment options
  • Managing side effects of lung cancer treatment
  • Clinical trials

Need one-on-one advice? Talk to a Certified Respiratory Educator through our Lung Health Line. We’re available Monday – Friday, 8:30 a.m. to 4:30 p.m. EST. Chat live at lunghealth.ca, email us, or call us toll-free at 1-888-344-LUNG (5864).

What’s the goal of my treatment?

The goals of cancer treatment may be different for different individuals. If there is a chance for cure, you will be offered curative treatments. The goal of these treatments is to make the cancer disappear.

If the cancer cannot be cured, then treatments will be given to help you feel more comfortable and manage your symptoms. These are called palliative treatments.

Local or systemic treatment – which is right for me?

Local treatments are directed at one part of the body such as the lungs. A local treatment is given when the cancer is limited to a specific area. Radiation and surgery are both local treatments.

Systemic treatments can affect your whole body and are given when cancer is found in several parts of the body or to reduce the chance of cancer coming back. Chemotherapy is treatment with drugs and is a systemic treatment. Targeted therapy is another form of systemic treatment.

Boost your results by quitting smoking!

It’s never “too late” to quit smoking!  In fact, if you smoke, getting you the help you need to quit is an important part of your treatment plan. That’s because there is evidence that continuing to smoke could make your treatments less effective, and increase your risk of experiencing treatment complications (especially when it comes to surgery).

Quitting isn’t always easy, but we can help. You can get non-judgemental, one-on-one guidance from Certified Smoking Cessation Counselor through our Lung Health Line. We’re available Monday – Friday, 8:30 a.m. to 4:30 p.m. EST. Chat live at lunghealth.ca, email us, or call us toll-free at 1-888-344-LUNG (5864).

You can do this. View our list of practical quit tips here.

Lung Cancer Treatment Options

Chemotherapy 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). 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.

This treatment option depends on the size and location of the tumor. During an operation, 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 require a stay in hospital for a few days following the surgery.

Surgery is most commonly used for non-small cell cancer, or for small cell lung cancer if it is found at an early stage. There are a number of types of surgery that can be done (e.g., wedge resection, segmental resection, lobectomy, segmentectomy, pneumonectomy) depending on the nature of your tumor. Sometimes lymph nodes in the chest will be removed as well. There are some surgical risks including bleeding and infection.

It will take some time to recover after the 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. 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.

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. 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 that you should know about. 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. Internal beam radiation or brachytherapy is provided by placing the radioactive material (i.e., seeds, needles, or catheters) directly into or near the tumor.

Endobronchial radiation therapy (brachytherapy), on the other hand, uses internal radiation. It may be done during surgery. It can be used to shrink tumours in your airway, which can relieve symptoms.

For people with lung cancers that are very small, one option may be stereotactic body radiotherapy. 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.

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 for the threat they are. To your immune system, they may just looks like normal cells. That’s where immunotherapy comes in.

Immunotherapy is a 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. 

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. 

Traditional lung cancer therapy (like chemotherapy) kills cancer cells, but it can also affect healthy cells throughout the body. This can mean big-time side effects.  

A new class of precision lung cancer drugs – targeted therapies based on your unique genetics – help reduce damage to healthy cells. Instead they interrupt the growth and function of cancerous cells by attacking specific targets on or inside of them. This can reduce side effects while providing other quality of life and cancer-fighting benefits.

Some of the more common targeted lung cancer therapies include:

  • Epidermal growth factor receptor (EGFR) inhibitors
  • Anaplastic lymphoma kinase (ALK) inhibitors
  •  Immune checkpoint inhibitors

The first step of connecting patients with the right targeted therapies is molecular (“biomarker”) testing of a tissue sample from the patient’s tumor. Your access to this test may depend on where you live.

 

Managing Side Effects of Lung Cancer Treatment

Cancer treatments have side effects such as fatigue, loss of hair or nausea. However, treatments affect each person somewhat differently. It is hard to predict exactly what your experience with side effects will be. The important thing to remember is that side effects can be managed effectively. Talk with your cancer care team about what you are experiencing and seek their advice about managing the side effects. Below are tips for managing a few of the most common ones individuals experience. Some you can manage yourself while others will need the assistance of the health care team members.

Lung cancer can cause bleeding in the airway and cause you to cough up blood (called hemoptysis). Sometimes bleeding can become severe. Treatments are available to control bleeding. Contact your health care team about this issue and what ought to be done.

Everyone who has cancer pain will feel it differently. Only you know how much pain you are feeling and how it affects you. Getting relief from pain is important because it can interfere with getting a good sleep, eating well, enjoying your time with family and friends, and doing your work or hobbies.

You do not have to accept pain as a normal part of living with cancer. Tell your health care team about what you are feeling.

Pain will feel different when it comes from different parts of your body.

Bone pain can be felt as a deep throbbing pain that can be sharp at times. It may get worse as you move around.

Neuropathic pain is from damage to your nerves. This pain can be burning, shooting or feel l like ‘pins and needles’. It can hurt when things touch your skin (i.e., clothing, water, wind)

Visceral pain is from the organs inside your body. It can be dull, deep or squeezing pain. Sometimes it is hard to tell where it is coming from.

If you are taking medication regularly for pain, you may experience breakthrough pain between doses. It can happen suddenly.

Discuss your pain experience with your doctor and the health care team. There are different medications for different types of pain. Sometimes it takes some adjusting to find the right dose and time to take your medications. Your doctor may prescribe more than one type of pain medication. It is important to work together to find the right plan for your situation.

 

Lung cancer can cause fluid to accumulate in the space that surrounds the affected lung in the chest cavity (pleural space). This accumulation of fluid can result in shortness of breath and pain. Treatment are available to drain this fluid from your chest and reduce the risk that the pleural effusion will occur again. Contact your health care team about this issue.

Anemia is caused by a low level of healthy red blood cells. Cancer and its treatment can decrease the amount of red blood cells and the hemoglobin level in the blood. Symptoms can include:

  • Fatigue
  • Pale skin, especially noticeable around the lips and nail beds
  • Dizziness
  • Weakness
  • Shortness of breath
  • Low blood pressure
  • Feeling cold
  • Headache
  • Difficulty concentrating
 

Constipation is when the stool is hard and difficult to pass. It can be caused by chemotherapy and radiation, as well as some pain relievers or anti-nausea drugs. Symptoms can include:

  • Bloating or feeling full
  • Cramping or pain
  • Gas
  • Belching
  • Loss of appetite
  • No regular bowel movement for two or more days
  • Straining to have a bowel movement

Diarrhea is the frequent passing of loose, watery stool and can be caused by cancer treatment. Symptoms of diarrhea can include:

  • Gas
  • Cramping
  • Bloating
  • Weight loss
  • Rectal pain or bleeding
  • Dehydration

Difficulty breathing is feeling like you can’t get enough air. This can be caused by a tumour blocking, narrowing or putting pressure on an airway, radiation therapy to the lungs or lung surgery. Symptoms can include:

  • Trouble catching your breath
  • Working hard to breathe
  • Fast breathing or heartbeat, or both
  • Wheezing
  • Coughing
 

Some types of cancer treatments can make it hard to swallow. Symptoms can include:

  • Feeling like food is stuck in the throat
  • Difficulty starting to swallow
  • Trouble moving food from the mouth to the throat
  • Food getting stuck in the cheeks
  • Coughing, choking or gagging when swallowing

Disseminated intravascular coagulation (DIC) is a condition where the blood clots too much. Blood clots in the bloodstream block small blood vessels in organs or limbs. When these blood clotting factors are low, it can cause excessive bleeding. DIC can be caused by tumours in the lung. Symptoms can include:

  • Bleeding and bruising easily
  • Shortness of breath
  • Pain or swelling in the arms and legs
  • Jaundice, which includes yellow skin and whites of the eyes
  • Low blood pressure
  • Low blood oxygen level
  • Bleeding at an intravenous site or in the gums, skin, muscles, digestive tract or abdominal cavity
 

Chemotherapy or radiation can cause hair loss. Some biological therapies can dry or thin hair. Hair loss is a common side effect of chemotherapy, but not all drugs cause hair loss. In most cases, hair loss is temporary. Radiation can cause hair loss in the area where the radiation was given. The amount of hair loss and whether it will grow back depends on the dose of radiation. Hair loss often begins two to three weeks after chemotherapy or radiation starts.

Hypercalcemia is when too much calcium is in the blood. It develops when the bones release too much calcium or the kidneys cannot get rid of enough calcium. It can be caused by advanced stages of lung cancer. Symptoms can include:

  • Nausea and vomiting
  • Loss of appetite
  • Constipation
  • Muscle weakness
  • Increased thirst
  • Frequent urination
  • Dark yellow urine
  • Little or no sweating
  • Confusion and difficulty concentrating
  • Bone pain or bone fracture

Infections happen because cancer treatment lowers the number of white blood cells in the body, which play a major role in defending the body against viruses and bacteria. With lung cancer, recurring bronchitis or pneumonia may occur. 

Symptoms of infection can vary, depending on what part of the body is affected. Having a fever is the most common sign of infection. But sometimes you can have an infection without a fever. Symptoms can include:

  • Chills or shivering
  • Unusual sweating
  • Redness, heat, swelling or discomfort from a wound, surgical cut or area around an intravenous line or vascular access device site
  • Sore throat
  • Cough, which may produce phlegm
  • Shortness of breath or rapid breathing
  • Diarrhea
  • Vomiting
  • Weakness
  • Sinus pain

Cancer treatment can affect the way food tastes or make you not feel like eating. Symptoms can include:

  • Feeling like food tastes “funny”
  • Being put off by certain food odours
  • Not liking a food that was once a favourite
  • Eating only one or two types of foods
  • Feeling full sooner than expected

Low blood cell counts happen when bone marrow doesn’t produce the normal number of blood cells. Chemotherapy and radiation can affect the bone marrow and cause low blood cell counts. A low red blood cell count is called anemia. Symptoms can include:

  • Fatigue
  • Pale skin or lips
  • Increased heart rate
  • Tiring easily with exertion
  • Dizziness
A low white blood cell count is called neutropenia or leukopenia. It puts you at greater risk of infection.

Platelets are made in the bone marrow and help the blood to clot. Chemotherapy, biological therapies or other drugs can cause platelet levels to drop. Symptoms can include:

  • Easy bruising
  • Bleeding from the nose, gums or mouth
  • Tiny red spots on the skin
  • Blood in the urine
  • Dark or black bowel movements

Nausea and vomiting are common side effects of cancer treatment and often occur together. Causes include chemotherapy and radiation or pain medication.

Radiation pneumonitis is inflammation of the lung caused by radiation to the chest. It most commonly develops one to three months after treatment. Radiation pneumonitis is more likely to happen with high doses of radiation or when a large area of the lung is treated. Some chemotherapy drugs can also increase the risk of developing radiation pneumonitis if given along with radiation therapy. Symptoms can include:

  • Cough
  • Chest congestion or pain
  • Shortness of breath

Cancer or its treatments can alter your usual sleep patterns. Sleep problems can be caused by anxiety or depression or by symptoms of cancer or side effects of treatment, such as pain, nausea or shortness of breath. You may have trouble falling asleep or staying asleep, not feel refreshed after sleep or you may sleep too much.

The superior vena cava is the large vein that carries blood from the head, neck, arms and chest to the heart. Superior vena cava syndrome is a group of symptoms that occur when there is pressure on the superior vena cava or it is partially blocked and blood can’t flow back to the heart properly. This causes more pressure in the veins and face, which leads to a buildup of fluid or swelling. Symptoms can include:

  • Shortness of breath, especially when bending over or lying down
  • Feeling of fullness in the head
  • Swelling in the face, neck, upper body or arms
  • Hoarseness
  • Chest pain
  • Bluish colour on the lips and skin

A sore mouth and throat can be side effects of chemotherapy and radiation. Sores and inflammation can develop in the mouth, back of the throat and the lips.

Syndrome of inappropriate antidiuretic hormone develops when there is too much antidiuretic hormone (ADH) in the body. ADH helps regulate the balance of fluids in the body by decreasing the amount of urine the body makes and increasing the amount of water the kidneys take up. Too much ADH leads to water retention, electrolyte imbalances and a low level of sodium in the blood. This syndrome can be caused by lung cancer or by some cancer treatments or pain medications. Symptoms can include:

  • Fatigue
  • Headache
  • Nausea and vomiting
  • Muscle cramps
  • Lethargy
  • Agitation
  • Confusion
  • Delirium
  • Disorientation
  • Hallucinations

Clinical trials

You may be offered an opportunity to participate in a clinical trial as part of your treatment plan. This decision is one to talk carefully about 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 part of an important concept called 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 from those you can count on.

What is a clinical trial?

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 brand new treatment, or for an existing treatment that’s being used in a new way.

What are some of the potential benefits?
A clinical trial could help you gain early access to a treatment that you wouldn’t otherwise be able to access (or afford). It also gives you access to a wider care team.

What about the drawbacks?

Depending on the trial, you may not get to access new treatment. This is a possibility because many cancer clinical trials are designed to compare new treatments to more established/approved treatments. Another drawback is side effects. In newer treatments, the side effects may not be as well known. It’s important to communicate with your clinical trial investigators about any side effects you experience.

What happens before a clinical trial?

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

Source: Clinical Trials and Drug Safety, Health Canada.

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.

Lung Cancer Screening

Lung Cancer Screening

“Screening” means checking for cancer before symptoms develop, even if you feel healthy. Screening can help detect cancer in its earliest stages.

Middle aged man hugs his adult son. He looks supported.

Diagnosis and Staging

Being diagnosed with lung cancer is often life-changing, and emotional distress is common. Understanding the steps and procedures can help you feel more in control, prepare you to advocate for yourself during your treatment.

Navigating Your Lung Cancer Care

The cancer care system can seem overwhelming at first, but we’re here to help you navigate it in a way that makes you feel empowered and supported. 

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Questions and Answers About Coping with Lung Cancer

The questions we list here are the top coping questions reported by people with lung cancer. Our answers provide some basic information, but we encourage you to discuss any concerns or questions with your oncologist and other members of your cancer care team.

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