Treatment for lung cancer depends upon a variety of factors. The most important factors are the histopathologic (diseased tissue) type of lung cancer and the stage of the cancer.
Once the stage of the lung cancer has been determined, the oncology team and the patient work together to develop a treatment plan. It is important for lung cancer patients to discuss the value of different forms of therapy with their oncologist.
Characteristics of the lung tumor are used to help separate patients into two groups: patients who are at low risk for cancer recurrence and patients who are at high risk for cancer recurrence. Specific prognostic—disease-forecasting—factors are used to place patients in either of these groups.
Surgical resection (cutting away) of the tumor generally is indicated for cancer that has not spread beyond the lung. Surgery for lung cancer may be conducted using a variety of techniques. Thoracotomy, which is performed throught the chest wall, and median sternotomy, which is performed by cutting through the breastbone, are standard methods used for lung cancer surgery.
Alternative approaches include anterior limited thoractomy (ALT), which is performed on the frontal chest using a small incision; anterioraxillary thoracotomy (AAT), which is performed on the frontal chest near the underarm; and posterolateral thoracotomy (PLT), which is performed on the back/side region of the trunk.
Recently, surgeons have developed other less invasive procedures for the removal of cancerous lung tissue. For example, video-assisted thoracoscopy (VAT), also known as video-assisted thoracic surgery (VATS), involves using a video camera to help visualize and operate on the lung within the chest cavity. The surgical incisions made during VAT are much smaller than those required for thoracotomy or sternotomy.
However, some physicians caution that VAT does not allow complete lung examination to identify and remove metastases that are not detected by preoperative chest x-ray. VAT is perhaps most appropriate for Stage 1 and Stage 2 cancers that require lobectomy (surgical removal of a lung lobule) with lymphadenectomy (removal of one or more lymph nodes) and for peripheral (outer edge) lung tumors that can be removed by wedge resection. In such cases, follow-up is required to establish a long-term prognosis.
Photodynamic therapy (PDT) often is used to treat inoperable lung cancer. Photodynamic therapy involves the injection of a light-activated drug (e.g., photofrin/polyhaematoporphyrin, lumin). Then, during bronchoscopy (examination of the airways using a flexible scope), the lung tumor is illuminated by a laser fiber that transmits light of a specific wavelength. At that time, the laser light is used to destroy the sensitized tumor tissue. Skin photosensitivity (light sensitivity) is a side effect of PDT.
The curative potential of PDT is the most exciting aspect of this therapy in lung cancer patients whose tumors are occult (hidden, unseen) on chest x-ray. The tissue-sparing effects of PDT may be particularly important for patients who have limited lung function.
Electrosurgery is surgery performed using a needle, bulb, or disk electrode. Nd-YAG laser therapy (neodymium-yttrium/argon laser that concentrates high-energy electromagnetic radiation to destroy tissue), cryotherapy (destruction of tissue using extreme cold), and brachytherapy (treatment with ionizing radiation) are additional tumor debulking, or size-reducing, techniques that may be performed during bronchoscopy. These methods are especially useful for obstructive, inner cavity (intraluminal) lung tumors.
Radiotherapy, also known as radiation therapy, is a treatment method that uses high-energy, ionizing radiation (e.g., gamma rays) to kill cancer cells. Radiotherapy may be applied to shrink a tumor that is later removed by surgery, to relieve symptoms, or to destroy malignant cells in a tumor that cannot be removed surgically.
Because cancer cells usually multiply faster than most normal body tissues, they are especially affected by radiation, which prevents cell division and the formation of DNA (deoxyribonucleic acid; human genetic material). Other bodily tissues that divide rapidly, such as hair and skin, are also particularly vulnerable to radiotherapy.
Radiosurgery, also called stereotactic radiosurgery or radiation surgery, is a type of external radiation therapy that may be used to treat inoperable lung cancer. In this treatment, a single large dose of radiation is administered precisely to the tumor, causing little damage to healthy tissue.