Lung Cancer Treatment

The type of treatment given for lung cancer depends primarily on two factors, the type of tumor, and the stage of the disease. Although there are many subdivisions within each category, most lung cancers are divided into small cell lung cancers, almost always caused by smoking (1), and non-small cell cancer that has numerous potential causes, including exposure to asbestos. The stage of cancer refers to how far advanced the cancer has gotten. By determining the stage, or the progression, of the disease, the doctor can determine available treatment techniques, as well as probable survival rates.

The cancer is first categorized using the TNM system in which the doctor evaluates the tumor size, whether the nodes are affected, and whether the cancer has metastasized (2). Each item is further subdivided according to the severity of the cancer. For example, a tumor smaller than 3 cm in diameter, and located in the lung is identified as a T1 tumor. By contrast, if the tumor is larger than 3 cm in diameter, and located in the lung, it is identified as a T2 tumor. There are seven main tumor categories (2). The same type of analysis is applied to the lymph nodes where there are 4 categories. Metastasis is simpler: it can’t be determined, it exists, or it doesn’t exist. After the TNM categories are identified the doctor can then give the cancer a stage I thru IV rating. The more progressed the cancer has gotten, the higher the stage rating. Stage I cancer is a relatively small tumor with no involvement of the lymph nodes, and no metastasis. Stage IV cancer is cancer that has metastasized.

Treatment for Stage I cancer will frequently involve surgery since the cancer has not grown large, and has not gotten into the lymph nodes. Part of a lung, or even an entire lung may be removed to try to get the cancer out before it progresses any further. Several clinical trials are still in progress to determine whether follow-up treatment with radiation or chemotherapy increase the long-term survival rate, currently 30-50% for people with cancer caught in this stage (3). Most people decide to take some form of follow up treatment or prevention therapy to give them the best chance for long-term survival.

Stage II cancer is where the disease has moved into the lymph nodes, but has not spread beyond the lungs. Doctors remove as much infected tissue as possible, and follow up treatment with chemotherapy, radiation, or both.

Stage III cancer has moved into the chest cavity, and is in the lymph nodes, but has not yet fully spread through the body. Treatment is much the same as with stage II cancer, but surgery may no longer help some patients where the cancer has gotten to spread out, or has moved into areas like the lining of the heart, that are not safely operated on or near. In some cases surgery may follow radiation and chemotherapy, or doctors may recommend preventive radiation therapy to the brain (3).

Stage IV cancer has metastasized. It has spread outside the chest cavity and can be anywhere, the kidneys, the liver, or even the brain. Stage IV cancer is treated with multiple drug chemotherapy to try to kill the cancer at any cost. Combinations of therapies, including surgery, in addition to radiation of the brain work in some circumstances. At this stage a primary goal is often to treat the symptoms as much as the disease (3). Most people, 70-90%, in stage IV lung cancer require significant pain relief. Radiotherapy, and even massage and other relaxation techniques help people deal with pain issues associated with stage IV cancer. For some people oxygen helps ease labored breathing and shortness of breath, and in other cases surgery or radiation to remove tumors pressing against the trachea help deal with these issues (4). Some pain and difficulty in breathing is caused from an accumulation of fluid in the lining of the lungs. When the fluid is removed, the pain eases and breathing becomes more manageable. Another frustrating symptom of advanced lung cancer can be paralysis of the vocal cords. This can lead not changes in a person’s voice or an inability to speak at all, but worse, can cause a person to choke on their own vocal cords. An injection into the area that makes the vocal cords thicker can prevent them from falling backward into the throat causing the person to choke (4).

Since we have no cure for lung cancer at this time, most doctors recommend participation in some sort of clinical trial. New developments make the news on an increasingly frequent basis. As recently as July 3, 2007, very good news was released about advanced treatment for inoperable lung cancer. In that trial patients got a very strong initial dose of chemotherapy, then backed down to a more normal scale of treatment. The goal was to kill cells that may have been almost ready to metastasize very quickly then focus on destroying the tumor through radiation or other standard chemotherapy. This trial found about a 20% reduction in metastasis with the new treatment over standard treatment (5).

On July 5, 2007 Medical News Today reported findings that men and women react differently to chemotherapy drugs used in treating advanced lung cancer. Women over the age of 60 have a much higher survival rate than men with the same degree of cancer involvement. Under the age of 60, the sex differences seem to largely disappear. The scientists are hypothesizing that estrogen plays a role in the change. If it can be identified and quantified it may open new treatment options for both men and women (6). While clinical trials offer no guarantees, they do offer the patient hope. They also give the knowledge that even if the worst happens, and the person does not survive the cancer, that person has still contributed to research that will hopefully cure cancer someday.

'Lung Cancer Treatment' Resources:
  1. Lung Cancer Types, The Oncology Channel, August 1999;
  2. Lung Cancer Staging, The Oncology Channel, August 1999;
  3. What’s the Treatment for Non-small Cell Cancer by Stage? Health-Cares.net, 2005;
  4. Palliative Care: Improving Quality of Life for Lung Cancer Patients, Lung Disease Focus, 2007;
  5. New Cancer Treatment Adds to Lung Cancer Survival Rates in Lung Cancer Patients, Science Daily, July 3, 2007;
  6. Sex Differences in Lung Cancer Treatment, Medical News Today, July 5, 2007;