4 Lung Cancer Treatment Options, Explained By Doctors
It's a scary diagnosis, but you still have choices.
In some cases, when lung cancer is diagnosed early, doctors can surgically remove the tumor or tumors, and cure patients of the disease. In more advanced cases, they can often shrink existing tumors, prevent the cancer from spreading further, or help manage symptoms and improve life expectancy. Here’s a look at some of the ways lung cancer is treated at various stages.
Tumors in the lungs can be very difficult to remove, says Prasad Adusumilli, MD, deputy chief of thoracic service at Memorial Sloan Kettering Cancer Center—especially if they’re not diagnosed until they’ve grown quite large or spread to other organs, which is often the case. But if a cancer is caught early enough, doctors may be able to remove it surgically.
The goal of lung cancer surgery is to cut out the tumor as well as a margin of healthy cells around it. This margin reduces the risk of cancer cells being left behind and continuing to spread.
In the early stages of lung cancer, a minimally invasive surgery technique, such as video-assisted or robot-assisted thoracoscopic surgery (known as VATS and RATS), may be used. For these procedures, doctors don’t cut the chest open all the way. Instead, they make a few small incisions through which they insert surgical tools and a camera that helps them see what’s going on beneath the surface of the skin.
“A decade ago, we used to do minimally invasive surgery on maybe four out of 10 lung cancer patients,” says Dr. Adusumilli. “Now, we’ve gotten a lot better at it and almost eight or nine out of 10 patients who need surgery get the minimally invasive kind.”
Removing just a small section of lung tissue is called a wedge resection, while removing a larger portion (but not an entire lobe) is called a segmental resection. The removal of an entire lobe (which can still be done with minimally invasive surgery) is called a lobectomy. Sometimes, patients will need an entire lung removed. This procedure is called a pneumonectomy.
For larger or harder-to-access tumors, an open surgery—with a six- to eight-inch incision between two ribs—may be needed. No matter what type of surgery a lung cancer patient has, says Dr. Adusumilli, it usually takes at least a month for them to feel “back to normal.”
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Chemotherapy and/or radiation
While surgery is the most common way to treat early-stage lung cancer, doctors may also recommend chemotherapy or radiation to shrink a tumor before a patient is operated on. Chemotherapy or radiation may also be used after surgery to kill any rogue cancer cells that may have been left behind.
If a person’s lung cancer is inoperable—because it takes up too much of the lungs, for example, or it’s spread to other parts of the body—radiation may help control pain and keep the tumor (or tumors) from growing larger and spreading farther.
Chemotherapy and radiation are also the primary treatment for small cell lung cancer—a type of lung cancer that makes up about 15% of cases. Because this cancer tends to grow quickly and spread faster than non-small cell lung cancer (the most common type), surgery is usually not recommended.
Chemotherapy for lung cancer is usually administered intravenously, in a doctor’s office or clinic. Radiation is also delivered in an office or clinic, with a device similar to an X-ray machine.
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Immunotherapy is a newer type of lung cancer treatment, and one that’s shown promise in treating advanced forms of disease. Immunotherapy drugs manipulate the body’s own immune system to fight cancer. For example, one class of drugs—known as checkpoint inhibitors—provide fuel to white blood cells so they can go on to kill tumor cells.
“Mother Nature gives our immune system breaks so that it doesn’t work too hard,” says Dr. Adusumilli. “What these drugs do is take off those breaks, so the immune cells can keep going and keep attacking the cancer.
Immunotherapy drugs, which are usually administered intravenously, can be a good option for patients whose cancers have stopped responding to chemotherapy, according to the American Cancer Society.
In a small 2018 study published in The Lancet Oncology, researchers found that combining a checkpoint inhibitor with a new immune-stimulation drug, called ALT-803, was even more effective at controlling the spread of cancer than using a checkpoint inhibitor alone. Together, researchers say, the drugs give patients new hope at a longer life.
"People don't talk about 'curing' patients with metastatic lung cancer,” said co-author John Wrangle, MD, an immunologist with the Hollings Cancer Center at the Medical University of South Carolina in a press release. “We now get to flirt with the idea for certain patients using immunotherapy. And at the very least we have a significant proportion of patients enjoying prolonged survival even if we can't call them ‘cured.’"
Targeted therapy is a term used for drugs that attack and kill cancer cells, without harming nearby healthy cells. This makes targeted therapy an appealing option for patients with late-stage lung cancer, with fewer side effects than treatments that damage both unhealthy and healthy cells, like chemotherapy and radiation.
In order to develop these drugs, which are taken as pills or capsules, scientist have had to find specific things about cancer cells that make them different from other cells. Certain types cancer cells, for example, have genetic mutations that healthy cells do not.
If doctors are able to identify one of these mutations, they can prescribe a drug that will act directly on those molecular pathways. “Right now it’s only about 15% to 20% of patients that have some type of mutation that we have a drug for,” says Dr. Adusumilli. “But with more research, we hope there will be a lot more in the future.”
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