Lung Cancer treatment

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Having diagnosed the lung cancer, a multidisciplinary team evaluates each case on an individual basis so they may prepare a course of treatment that offers the best chance of curing the patient.

The team comprises all of the healthcare professionals directly involved in the diagnostic and therapeutic process, such as pulmonologists, radiologists, nuclear medicine specialists, pathologists, radiotherapists, oncologists, thoracic surgeons and nursing staff.

Once the team reach a collective decision, the doctor in charge will inform the patient and explain the treatment.

The type of treatment is determined according to the following factors:

There are several types of therapeutic approach to lung cancer that can be carried out individually or in combination depending on the degree of extension and biological characteristics of the tumour:

  • Surgical treatment
  • Non-surgical treatment: chemotherapy and radiotherapy
  • New therapies
  • Palliative treatment

Surgical procedures aim to completely eliminate all tumour cells and cure the disease. The location and size of the tumour determine the extent of surgery required. Depending on the case, surgery is complemented with chemotherapy and/or radiotherapy.

Surgery offers the best chance of cure and is indicated for patients with early stage lung cancer who have good overall health. Around 30% of patients with lung cancer can benefit from surgical treatment.

After selecting this approach, the type of surgery to be carried out is assessed:

Lobectomy

Lobectomy. Surgical procedure involving removal of the lobe of the lung containing the tumour. The right lung is divided into three lobes (upper, middle and lower), while the left comprises two lobes (upper and lower). A lobectomy, accompanied by removal of the lymph nodes, is the standard treatment for early stage lung cancer.

Pneumonectomy

Pneumonectomy. Surgery to remove an entire lung. This operation is performed on tumours located in the bronchi, the lung’s main airways, or when the tumour affects more than one lobe.

Segmentectomy

Segmentectomy. Each lobe is in turn composed of several segments. When the tumour is small and located in a peripheral area of the lung, then just the affected segment can be removed and the rest of the lobe preserved. Segmentectomies are carried out in patients with benign or low malignancy tumours, in cases of lung metastasis due to a cancer originating in another organ, or in those patients who would not tolerate a broader lung resection given their overall condition.

sublobar resections

Atypical sublobar resection. This involves removing a portion of the affected lung lobe. As with segmentectomies, they are carried out in patients with benign or low malignancy tumours, in cases of lung metastasis due to a cancer originating in another organ, or in those patients who would not tolerate a broader lung resection given their overall condition. not tolerate a broader lung resection given their overall condition.

As with any other surgery, that of lung cancer involves risks and complications. Some of the most common are:

  • Infection
  • Accumulation of air between the lung and the chest wall (pleural cavity) that can cause a collapse of the lung (tension pneumothorax)
  • Bleeding (haemorrhage)
  • Tube opening between a bronchiole and the pleural cavity that leads to the filtration of air or fluid into the surgical area (broncho-pleural fistula)
  • Accumulation of pus in the chest cavity (empyema)

There may be other risks, depending on the state of health of the individual. It is important to consult the medical team of any doubts before this procedure.

Chemotherapy

Chemotherapy is the treatment most commonly applied to lung cancer. It is generally administered intravenously, but in some cases it may be taken orally.

Chemotherapy inhibits the growth of cells in the process of division. It affects both tumour and healthy cells which is what causes the symptoms associated with the treatment, known as adverse effects or side effects.

Chemotherapy may be administered as a two-drug combination or a monotherapy (one drug). Some of the most used medications include platinum-based compounds (cisplatin and carboplatin), antifolates (pemetrexed), taxanes (paclitaxel and docetaxel), vinorelbine, gemcitabine and etoposide.

The number of cycles depends on the characteristics and staging of each tumour, but patients generally receive 4–6 treatment cycles. Different tests are conducted throughout the treatment to evaluate its effectiveness.

Radiotherapy

Radiation therapy or radiotherapy uses high-energy X-rays to destroy cancer cells. It has many applications in lung cancer and can be administered alone or in combination with chemotherapy in order to reduce the size of the tumour prior to surgery, eliminate remaining cancer cells after surgery or to treat lung cancer that has spread to other parts of the body outside the lungs, such as the brain or bones.

Depending on the specific type of chemotherapy administered, each treatment will cause different side effects. It is very important that your doctor tells you about them before starting treatment.

Some of the symptoms that may appear are: tiredness (asthenia), changes in dietary preferences, nausea, vomiting, hair loss, inflammation of the mouth’s mucous membrane, fever, constipation/diarrhoea, abdominal and muscular pain, hives and nail lesions. If in doubt you should talk with your doctor.

Radiotherapy can be associated with skin irritation, inflammation of the oesophageal mucous membrane (oesophagitis, difficulty swallowing), tiredness and pneumonitis (i.e., inflammation of lung tissue which usually appears months after completing treatment).

Lung cancer treatment has witnessed some very significant advances in recent years with the incorporation of new biological drugs aimed at specific targets within tumour cells. Examples include medicines that focus on the epidermal growth factor receptor (EGFR), the anaplastic lymphoma kinase receptor (ALK) or the vascular endothelium growth factor (VEGF).

In contrast to most chemotherapies, several of these treatments are administered orally and are better tolerated by patients. To discover if you can be treated with one of these biological treatments, a molecular study is performed on a tumour sample to determine whether you are likely to respond to treatment.

Immunotherapy is a new treatment strategy that has proven to be effective in lung cancer. It involves the intravenous administration of a biological therapy that enhances the immune system’s own capacity to recognise and destroy the tumour.

There are currently several clinical studies into immunotherapy underway, which could, in the future, be used to treat lung cancer.

Cancer is associated with a wide range of physical problems but it also entails emotional ones. Lung cancer treatment must focus on all of these aspects.

Various studies have shown that palliative treatment not only improves the quality of life in patients with advanced lung cancer but it can also help them live longer.

Palliative care helps alleviate physical symptoms, such as pain, while also addressing the emotional and spiritual anxiety felt by patients and their families.

Substantiated information by:

Ramon Mª Marrades
Laureano Molins
Noemí Reguart
Mari Carmen Rodríguez
David Sánchez
Núria Viñolas

Published: 20 February 2018
Updated: 20 February 2018

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