Treatment and type of lung cancer

Treatment and type of lung cancer
The treatment for non small cell lung cancer is different from the treatment for small cell lung cancer.
Small cell lung cancer is mostly treated with chemotherapy. Surgery is only suitable if there is no sign that the cancer has spread to the lymph glands in the centre of the chest (the mediastinal lymph glands) and this is rare with small cell lung cancer. It has usually spread at the time of diagnosis. So chemotherapy is usually the main treatment. You may also have radiotherapy to treat this type of lung cancer. There is information below about the treatment of small cell lung cancer by stage.
Non small cell lung cancer can be treated with surgery, chemotherapy, radiotherapy or a combination of these, depending on the stage when the cancer is diagnosed. Some people with advanced lung cancer may have biological therapy. There is information below about the treatment of non small cell cancer by stage.
Treatment by stage for small cell lung cancer
If you have early stage small cell lung cancer you are most likely to have chemotherapy and then radiotherapy to the lung. People who are fairly fit may have chemotherapy and radiotherapy at the same time (chemoradiation). It is quite common for this type of cancer to spread to the brain. So doctors often recommend radiotherapy to the brain for people whose lung cancer shrinks with chemotherapy treatment. You usually have radiotherapy to the brain at the end of the chemotherapy treatment. It aims to try to kill any cancer cells that may have already spread to the brain but are too small to show up on scans. Doctors call this prophylactic cranial irradiation or PCI.
For very early stage small cell lung cancer that has not spread to the lymph nodes in the centre of the chest (the mediastinal lymph nodes), you may have surgery to remove the part of the lung containing the tumour (a lobectomy). The surgery is followed by chemotherapy and sometimes radiotherapy. But usually the cancer has already spread at the time of diagnosis and surgery is not then possible.
If you have small cell cancer that has spread to lymph nodes or other areas of the body you may have chemotherapy, radiotherapy or treatment to relieve symptoms. If chemotherapy works well to shrink the lung tumour down and you are fairly fit you may also have radiotherapy to the brain to kill any cancer cells that may have already spread there.
Treatment by stage for non small cell lung cancer
Stage 1
Stage 1 non small cell lung cancer is uncommon. You normally have surgery to remove part of the lung (a lobectomy) or all of the lung (a pneumonectomy). If you can’t have an operation for other health reasons, your doctor may suggest radiotherapy instead to try to cure the cancer. Another option for small tumours if you cannot have surgery is radio frequency ablation (RFA).
Stage 2
For stage 2 non small cell lung cancer, depending on the position of the tumour, you may be offered surgery to remove part of the lung (a lobectomy) or all of the lung (a pneumonectomy). If the cancer is completely removed, your specialist may suggest chemotherapy to try to lower the risk of the cancer coming back. They call this adjuvant chemotherapy. It is important that your doctor talks to you beforehand about the benefits and side effects of chemotherapy. If the surgeon could not remove all of the tumour you may have radiotherapy afterwards.
If you can’t have surgery due to other health concerns, your doctor may offer radiotherapy or combined radiotherapy and chemotherapy (chemoradiation). This treatment aims to try to get rid of the cancer completely.
Stage 3
For stage 3 non small cell lung cancer you may be able to have surgery, depending on where the cancer is in the lung. You may need to have the whole lung removed (a pneumonectomy). If the surgeon completely removes the cancer, you may then have chemotherapy to try to lower the risk of the cancer coming back. If the surgeon finds cancer cells in the lymph nodes during the surgery they are likely to advise you to have chemotherapy and possibly radiotherapy after the operation.
If you can’t have surgery due to other health concerns, your doctor may offer radiotherapy or combined radiotherapy and chemotherapy (chemoradiation). This treatment aims to try to get rid of the cancer completely.
If your scans showed that there are cancer cells in the middle area of the chest (the mediastinum), your doctor may suggest radiotherapy instead of surgery. The cancer may be too close to your heart to operate safely. Or your doctor may advise that you have a course of chemotherapy followed by radiotherapy. Some people who are fairly fit and have small tumours have radiotherapy at the same time as chemotherapy (concomitant chemoradiotherapy). Chemoradiotherapy causes more side effects than the treatments given alone so you need to be well enough to cope with the side effects.
If scans show signs of cancer in the lymph nodes on the opposite side of your chest, surgery is not possible but you may have a course of chemotherapy. After the chemotherapy you might need further treatment with radiotherapy. If you are fairly fit you may have radiotherapy at the same time as chemotherapy.
Stage 4
Treatment for stage 4 non small cell lung cancer aims to control the cancer for as long as possible and to shrink the tumour down to reduce symptoms. Many trials have used chemotherapy in this situation and we know that it can help people to live longer as well as relieving symptoms. People whose cancer cells have particular proteins (receptors) may have treatment with biological therapy drugs called erlotinib (Tarceva), gefitinib (Iressa) or crizotinib (Xalkori).
If you have had chemotherapy and it is no longer controlling the cancer, you may have further chemotherapy if you are well enough. If your cancer has EGFR receptors your doctor may offer erlotinib treatment. Or you may choose to have no further treatment but to control your symptoms with medicines.
You may also have radiotherapy to control symptoms such as pain or a cough. As well as radiotherapy, other treatments can relieve a blockage and reduce symptoms if you have a tumour in one of the main airways (the left or right bronchus). These treatments include internal radiotherapy (brachytherapy), laser treatment, freezing the tumour (cryotherapy), using a rigid tube (a stent) to keep the airway open, and light therapy (photodynamic therapy – PDT). There is detailed information about treatments to relieve an airway blockage in the advanced lung cancer treatment section.
Being cared for by a multidisciplinary team
NHS guidelines state that everyone diagnosed with lung cancer should be under the care of a multi disciplinary team (MDT). This is a team of health professionals who work together to discuss your case and how best to manage your treatment and care. The team includes
Specialist surgeons
Doctors who specialise in using drugs to treat cancer (medical oncologists)
Doctors who specialise in chest conditions
Doctors who specialist in symptom control
Doctors who specialist in radiotherapy and chemotherapy treatment (clinical oncologists)
Specialist lung cancer nurses
Doctors specialising in diagnosis from tissue specimens (histopathologists)
Physiotherapists
Occupational therapists
Psychologists
Social workers
Dieticians
Other health professionals or specialists
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Discussing things with your doctor
It’s important that you feel OK about the treatment your specialist recommends. Most people feel more comfortable about this if they understand why a particular treatment decision has been made. This can be even more important if you’ve been told that a particular treatment isn’t suitable for you. These days, most doctors expect patients to want to ask questions and they appreciate that you need things explained in a way you can understand.
Your doctor won’t give any treatment without your permission (consent). In some situations you may feel that
you don’t want to have treatment, for example if the treatment has only a small chance of helping you and may cause bad side effects. Your doctor can explain what will happen if you don’t have the treatment and they will go along with your wishes.
An appointment where you are given your diagnosis and told about your treatment options is very important. You are likely to be shocked and might find it hard to take in information or make decisions. When you go to see the doctor it often helps to write down a list of questions you want to ask.
You could take a close friend or relative with you to the appointment. They can help you to remember what is said. If you feel that you need more time to think things through or discuss the options, you can ask your specialist to see you again to discuss things more fully before you make a decision. There are also lung cancer specialist nurses you can talk to who can answer questions about your cancer and its treatment.
Some people feel they would like to get an opinion from a second doctor before they decide on their treatment. Most doctors are happy to refer you to another specialist for a second opinion if you would find this helpful. You should discuss this with your GP or cancer specialist who can make the referral for you.
Our lung cancer organisations page gives details of people who can provide information about your choice of treatment. Some organisations can put you in touch with a cancer support group. You can find details of counselling organisations in our counselling section. Our lung cancer reading list has information about books and leaflets on lung cancer treatments.

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