What treatments are there for lung cancer?

The main treatments for lung cancer are surgery, radiation treatment and chemotherapy. The choice of treatment will depend on the type of lung cancer, whether the cancer has spread beyond the lung, on how well your lungs are functioning and on your general health.

The aim of treatment is to keep you as well and symptom-free as possible, even if your cancer cannot be cured.

Surgery for non-small cell lung cancer

Surgery is the first treatment considered for non-small cell lung cancer.

This is only possible if:

• the cancer has not spread beyond the lung and
• your health (apart from the cancer) is reasonably good and
• your breathing capacity is adequate.

The most common operation, called a lobectomy, removes the affected part of the lung. Occasionally, the whole lung needs to be removed and this is called a pneumonectomy.

In patients with reduced breathing, smaller parts of the lung may be removed to try to preserve breathing capacity.

After the operation

After having lung surgery, you will have an intravenous drip for a couple of days, until you can eat and drink again. You will have one or two tubes in your chest, to drain fluid or air away. Your health team will take regular x-rays to make sure your lung(s) are working properly.

This is major surgery and you will require painkilling drugs - often for many weeks and occasionally for much longer.

You will probably be in hospital for 5 to 10 days after the operation. While you are in hospital a physiotherapist will teach you exercises to help with your breathing.

Before you go home, your health team will discuss and organise support services, and give you information about managing at home. Recovery can take many weeks for some people.

Exercise will help you to recover. Your doctor or physiotherapist will tell you when you can start more vigorous exercise, such as walking or swimming, which will improve your strength and fitness.

If your breathing was not affected before the operation, you will probably find that you can breathe reasonably normally, even though you have had a lung or part of a lung removed. People who had breathing difficulties before the operation may find that they are more breathless afterwards.

Chemotherapy

Chemotherapy is the treatment of cancer using anti-cancer (cytotoxic) drugs. The aim of chemotherapy is to kill the cancer cells while doing as little damage as possible to normal cells. It is the main form of treatment for small cell lung cancer.

Chemotherapy is usually given in an outpatient clinic, and this treatment is spread over weeks and months. Although most chemotherapy is given as an intravenous (IV) infusion (drip), some types can be given by tablet.

Most chemotherapy drugs are available free through the hospital cancer services. A few newer drugs are not subsidised by the government and can be very expensive. Your oncologist should be able to advise you on your best options.

Side effects of chemotherapy

Most of the side effects of chemotherapy are temporary and go away after treatment or within a few months of stopping. A few people may manage to continue with their normal life at home and work throughout their chemotherapy.

Problems may include:

• infections – the drugs can lower your ability to fight infections.
• easy bruising or bleeding
• sore mouth
• diarrhoea or constipation
• feeling sick or vomiting
• tiredness
• loss of appetite or taste changes
• hair loss
• hearing loss
• pins and needles sensations  or numbness
• skin rash.

If you develop a fever (have a temperature of 38 degrees Celsius or over), or feel unwell, even with a normal temperature, do not wait to see what happens. Phone your cancer treatment centre, oncologist, oncology nurse or hospital immediately for advice.

You and your partner should use contraceptives during chemotherapy treatment, because the drugs can cause birth defects or miscarriage.

Also see chemotherapy side effects

Radiation treatment

Radiation treatment uses high-energy radiation to destroy cancer cells or prevent them from reproducing. Radiation treatment only affects the part of the body at which the beam(s) are aimed, so is very localised.

About half of all people with cancer need radiation treatment at some point in their illness. For some types of cancer this is the main treatment. It might be used in combination with surgery, chemotherapy or hormone therapy.

Radiation treatment may be given as a single one-off dose, or in a course of up to 30 to 35 treatments depending on individual circumstances. For longer courses, radiation is usually given daily for 4 or 5 days a week, but not usually over weekends.

Each treatment session usually lasts about 10 to 15 minutes. You will see a doctor once a week during treatment to check on your progress. Additional blood tests, x-rays or scans may be required to help with this.

Side effects of radiation treatment

Radiation treatment is not painful. There are side effects, which gradually develop during a long course of radiation treatment, or soon after a short course. These side effects can be temporary or permanent. It is important to discuss any side effects with your cancer treatment team, who can advise you on what to expect and how to manage these effects.

Side effects may include:

• tiredness
• skin irritation
• not wanting to eat
• nausea or vomiting
• sore throat
• difficulty swallowing
• breathlessness.

Radiation treatment may be used to treat many areas of the body apart from the chest. It is particularly useful at relieving pain if lung cancer has spread to affect the bones.

Also see radiation treatment side effects

Combined therapy

Increasingly, cancer specialists use combinations of surgery, chemotherapy and radiation treatment to treat lung cancer.

Treatment for symptoms that may occur

Breathlessness
Breathlessness can occur for many reasons, such as:

• lung surgery
• chest infection
• anaemia
• increase in the size of the cancer
• pleural effusion (see below)
• anxiety
• radiation treatment effects on the lung.

It is important to tell your doctor or cancer care nurse about breathlessness, as there are many ways they can relieve this symptom.

Pleural effusion
Sometimes, fluid builds up in the chest because of the spread of the cancer. Lung cancer can spread to the pleura (membranes which help protect the lungs). The cancer irritates the pleura and they then make too much fluid.

The fluid takes up space that the lung should occupy, so your lung can’t expand normally. This may make you feel breathless. If you have too much fluid between the pleura, this is called a pleural effusion. Your doctor can drain this fluid. They can also inject a drug which sticks together the membranes between the lung and the chest wall. This reduces the risk of it happening again.

Haemoptysis (blood in the sputum)
This may be caused by:

• severe coughing
• chest infection
• bleeding from a small blood vessel within the cancer.

Report this to your doctor - once the cause is identified, treatment will be given to relieve it.

Cough
This is very common in people with lung cancer and may be caused by:

• chest infection
• the cancer.

Depending on the cause, treatment may include antibiotics, codeine-based cough medicine, a low dose of oral morphine or radiation treatment. Sipping warm water or tea may be helpful.

Palliative care

The majority of people with lung cancer will not be cured. Palliative care is an approach to caring for people with advanced cancer and their family that focuses on improving their quality of life. It is not just about care at the end of life. This can be offered in a hospital, rest home, at home or by hospice.

Palliative care is coordinated care provided by specialist doctors, nurses, social workers and spiritual care workers.

Palliative care may be used during times when your illness is causing discomfort; for example, for:

• bothersome pain
• shortness of breath
• nausea and vomiting periods
• when your thoughts and feelings are distressing
• occasions when your illness may be affecting other aspects of your life, such as with your partner, children, family/whanau
• difficulties with work or perhaps financial affairs.

In general, palliative care services are free. There may be a charge for hire of some equipment for home care. Palliative care and hospice services are funded by both the government and voluntary donation.

You may also be faced with decisions and choices that are confusing or difficult to make during your illness. The palliative care team may be able to help explain things to you, and help you find answers.

Taking part in a clinical trial

Research into the causes of lung cancer and into ways to prevent, detect and treat it, is continuing. Your doctor may suggest that you consider taking part in a clinical trial. If you do not want to take part, your doctor will discuss the current treatment options with you.

Related topics

See What is lung cancer? ; Diagnosing lung cancer

See Questions to ask your doctor when you have cancer

Original material provided by the Cancer Society of New Zealand, 2010. Reviewed by everybody, July 2010.