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Lung Cancer

Lung Cancer

What Is Lung Cancer?

Cancer is a disease in which cells in the body grow uncontrollably. When cancer starts in the lungs, it is called lung cancer.

Lung cancer starts in the lungs and can spread to lymph nodes or other parts of the body, such as the brain. Cancer from other organs can also spread to the lungs. When cancer cells spread from one organ to another, they are called metastases.

 

What types of Lung Cancer are there?

 

Lung cancers are usually divided into two main types - small cell and non-small cell (including adenocarcinoma and squamous cell carcinoma). These types of lung cancer grow differently and are treated differently. Non-small cell lung cancer is more common than small cell lung cancer.  Smoking causes most types of lung cancer, but lung cancer can also occur in non-smokers.

What Are the Risk Factors for Lung Cancer?

Research has found several risk factors that may increase your chances of getting lung cancer.

  • Smoking

Cigarette smoking is the number one risk factor for lung cancer.

People who smoke are 15-30 times more likely to get or die from lung cancer than non-smokers. Even smoking a few cigarettes a day or occasional smoking increases the risk of developing lung cancer. The more years a person has smoked and the more cigarettes he or she smokes every day, the greater the risk.

People who quit smoking have a lower risk of developing lung cancer than if they had continued to smoke, but their risk is higher than for people who have never smoked. Stopping smoking at any age can reduce your risk of developing lung cancer.

Smoking cigarettes can cause cancer in almost any part of the body. Cigarette smoking causes cancer of the mouth and throat, oesophagus, stomach, colon, rectum, liver, pancreas, voice box (larynx), trachea, bronchi, kidneys and renal pelvis, bladder and cervix, and causes acute myeloid leukaemia.

 

  • Second-hand smoke

Smoke from other people's cigarettes, pipes or cigars (passive smoking) also causes lung cancer. When a person inhales second-hand smoke, it is as if they are smoking.

 

  • The impact of radon

Radon is a naturally occurring radioactive gas formed by the decay of uranium in soil and rocks. It cannot be seen, tasted or smelt. Radon is the main cause of illness among people who do not smoke.

Outdoors, there is so little radon that it is not dangerous. But indoors, radon can be more concentrated. When it is inhaled, your lungs are exposed to small amounts of radiation. This can increase the risk of developing lung cancer.

 

  • Exposure to asbestos

People who work with asbestos (e.g. in mines, mills, textile factories, places where insulation is used and shipyards) are several times more likely to die from lung cancer. The risk of lung cancer is much higher in workers who are exposed to asbestos and who also smoke. It is unclear how low-level or short-term exposure to asbestos may increase the risk of developing lung cancer.

People exposed to large amounts of asbestos also have an increased risk of developing mesothelioma, a type of cancer that starts in the pleura (the lining surrounding the lungs).

  • Exposure to other cancer-causing agents in the workplace

Other carcinogens (cancer-causing agents) found in some workplaces that may increase the risk of lung cancer include:

Radioactive ores, such as uranium

Inhaled chemicals such as arsenic, beryllium, cadmium, silica, vinyl chloride, nickel compounds, chromium compounds, coal products, mustard gas and chloromethyl ethers

Diesel engine exhaust fumes

 If you work near these substances, try to limit your exposure as much as possible.

 

What are the factors with uncertain or unproven effects on Lung Cancer risk?

 

Marijuana smoking

There is evidence to suggest that smoking marijuana may increase your risk of developing lung cancer.

 

E-cigarettes

E-cigarettes are a type of electronic nicotine delivery system. They do not contain tobacco, but the Food and Drug Administration (FDA) classifies them as "tobacco" products. E-cigarettes are fairly recent, and more research is needed to find out what their long-term effects might be, including the risk of developing lung cancer.

 

Talc and talcum powder

Talc is a mineral that, in its natural form, may contain asbestos. Some studies suggest that talc miners and people working in talc factories may have an increased risk of developing lung cancer and other respiratory diseases due to exposure to industrially produced talc. However, other studies have found no increase in the incidence of lung cancer.

Talc powder is manufactured from talcum powder. The use of cosmetic talcum powder has not resulted in an increased risk of lung cancer.

 

Can Lung Cancer be detected at an early stage? 

Screening is the use of tests or examinations to detect disease in people who have no symptoms.

Regular chest X-rays have been studied as a screening test for people at increased risk of developing lung cancer, but they have not been shown to help most people live longer and are therefore not recommended for lung cancer screening.

In recent years, a test known as low-dose computed tomography (LDCT) has been studied in people at increased risk of lung cancer (mainly because they smoke or have smoked before). LDCT scans can help detect abnormal areas in the lungs that may be cancerous. Research has shown that, unlike a chest X-ray, an annual LDCT scan for people at high risk of lung cancer can be life-saving. For these people, having an annual LDCT scan before symptoms appear can help reduce the risk of dying from lung cancer.

If lung cancer is detected at an early stage, when it is small and has not yet spread, it is more likely to be treated successfully.

Lung cancer screening is recommended for some people who smoke or have smoked before, but who have no signs or symptoms. If a person has lung cancer but no symptoms, this usually means that there is a chance of detecting the disease at an early stage.

Symptoms of lung cancer usually only appear when the disease is already at an advanced stage. Even when lung cancer causes symptoms, many people may mistake them for other problems, such as an infection or the long-term effects of smoking. This can delay diagnosis. If you have symptoms that could be caused by lung cancer, see your doctor straight away. (People who already have symptoms that may be related to lung cancer may need tests such as a CT scan to find the cause, which in some cases may be cancer. But such examinations are for diagnostic purposes and are not screening).

What is a nodule in the lung?

 

A nodule (or mass) in the lung is a small, abnormal area that is sometimes found during a chest CT scan. These scans are done for a variety of reasons, such as as as part of lung cancer screening or to check the lungs if you have symptoms.

Most lung nodules found on a CT scan are not cancerous. They are most often the result of old infections, scar tissue or other causes. But tests are often needed to be sure that the nodules are not cancerous.

If you have a lump in your lung

Most often the next step is a repeat CT scan to see if the lump is growing over time. The interval between scans can be from a few months to a year, depending on how likely your doctor thinks the lump may be cancerous. This depends on the size, shape and location of the node, and whether it is solid or filled with fluid. If follow-up scans show that the node has grown, your doctor may want to carry out another type of imaging test - a positron emission tomography (PET) scan, which often helps to determine whether it is cancerous.

If subsequent scans show that the node has grown, or if the node has other signs of concern, your doctor will want to take a sample of it to check it for cancer cells. This is called a biopsy. It can be carried out in different ways.

 

 

 

 

How is a lung nodule biopsy carried out?

 

The doctor may take a long thin tube (called a bronchoscope) through the throat and airways of the lung to reach the nodule. Using small forceps at the end of the bronchoscope, a sample of the nodule can be taken.

If the nodule is in the outer part of the lung, the doctor can pass a thin, hollow needle through the skin of the chest wall (using a CT scan) and insert it into the nodule to take a sample.

If there is a strong chance that the node is cancerous (or if the node cannot be reached with a needle or bronchoscope), surgery may be carried out to remove the node and some of the surrounding lung tissue. Sometimes large parts of the lung may also be removed.

 

 

What happens after a lung nodule biopsy?

 

After the biopsy, the tissue sample is carefully examined in the laboratory by a pathologist. The pathologist will check the biopsy for cancer, infection, scar tissue and other lung problems. If cancer is found, special tests will be done to find out what kind of cancer it is. If something other than cancer is found, further action will depend on the diagnosis. Some nodules will be followed up with a repeat CT scan after 6-12 months for several years to make sure they have not changed. If a lung nodule biopsy shows an infection, you may be referred to a specialist - an infectious disease specialist - for further investigation. Your doctor will decide how to proceed depending on the results of the biopsy.

 

What are the signs and symptoms of Lung Cancer?

 

Common symptoms of lung cancer are:

 

  • Cough that does not go away or gets worse
  • coughing up blood or rust coloured sputum (saliva or phlegm)
  • chest pain, which often increases when you breathe deeply, cough or laugh
  • Wheezing
  • Loss of appetite
  • Unexplained weight loss
  • Shortness of breath
  • Feeling tired or weak
  • Infections, such as bronchitis and pneumonia, that do not go away or keep coming back
  • New onset of wheezing

 

If lung cancer spreads to other parts of the body, it may cause

 

  • Bone pain (eg back or hip pain)
  • Changes in the nervous system (e.g. headache, weakness or numbness in the arm or leg, dizziness, balance problems or seizures) caused by the cancer spreading to the brain
  • Yellowing of the skin and eyes (jaundice), if the cancer has spread to the liver
  • Swelling of the lymph nodes (accumulation of immune system cells), e.g. in the neck or above the collarbone.

 

  • Horner syndrome

Cancers of the upper lung are sometimes called Pancost tumours. These tumours are more often non-small cell lung cancer (NSCLC) than small cell lung cancer (SCLC).

 

Pancost tumours can affect certain nerves in the eyes and parts of the face, causing a group of symptoms called Horner's syndrome:

  • Drooping or weakness of one upper eyelid
  • Reduced pupil (the dark part in the centre of the eye) in the same eye
  • Faint or no sweating on the same side of the face
  • Pancoast tumours may also sometimes cause severe pain in the shoulder.

 

  • Superior vena cava syndrome

The superior vena cava (AV) is a large vein that carries blood from the head and arms down to the heart. It runs near the top of the right lung and lymph nodes inside the chest. Tumours in this area can put pressure on the SVC, which can cause blood to flow back into the veins. This can lead to swelling of the face, neck, arms and upper chest (sometimes with bluish red skin). It can also cause headaches, dizziness and altered consciousness if the brain is affected. Although SVC syndrome can develop gradually over time, in some cases it can become life-threatening and requires immediate treatment.

 

  • Paraneoplastic syndromes
  • Some lung cancers produce hormone-like substances that enter the bloodstream and cause problems in distant tissues and organs, even if the cancer has not spread to these places. Such problems are called paraneoplastic syndromes. Sometimes these syndromes can be the first symptoms of lung cancer. Because these symptoms affect other organs, you may first suspect that they are caused by a disease other than lung cancer.

 

  • Paraneoplastic syndromes can occur in any lung cancer, but are most commonly associated with SCLC. Some common syndromes include:

 

  • SIADH (inadequate antidiuretic hormone syndrome): In this condition, cancer cells produce ADH, a hormone that causes the kidneys to retain water. This lowers salt levels in the blood. Symptoms of SIADH may include fatigue, loss of appetite, muscle weakness or cramps, nausea, vomiting, restlessness and confusion. Without treatment, severe cases can lead to seizures and coma.
  • Cushing's syndrome: In this condition, cancer cells produce ACTH, a hormone that causes the adrenal glands to produce cortisol. This can lead to symptoms such as weight gain, mild bruising, weakness, drowsiness and fluid retention. Cushing's syndrome can also cause high blood pressure, high blood sugar or even diabetes.
  • Nervous system problems: Sometimes SCLC can cause the body's immune system to attack parts of the nervous system, which can lead to problems. One example is a muscle disorder called Lambert-Eaton syndrome. In this syndrome, the muscles around the hips become weak. One of the first signs may be difficulty getting up from a sitting position. Later, the muscles around the shoulder may become weak. A less common problem is paraneoplastic cerebellar degeneration, which can cause loss of balance and instability of movement in the arms and legs as well as problems with speech and swallowing. SCLC can also cause other problems with the nervous system, such as muscle weakness, changes in sensation, vision problems or even changes in behaviour.
  • High blood calcium levels (hypercalcaemia), which can cause frequent urination, thirst, constipation, nausea, vomiting, abdominal pain, weakness, fatigue, dizziness and confusion.
  • Blood clots
  • Again, many of these symptoms are probably caused by something other than lung cancer. However, if you have any of these problems, it is important to see your doctor straight away to find the cause and treat if necessary.

 

How to detect Lung Cancer?

 

Some lung cancers can be detected by screening, but most lung cancers are detected because they cause problems. The actual diagnosis of lung cancer is made when a sample of lung cells is tested in a laboratory. If you have any possible signs or symptoms of lung cancer, see your doctor.

 

  • Computed tomography (CT) scan.

A CT scan uses X-rays to take detailed cross-sectional images of your body. Instead of taking 1-2 pictures like a normal X-ray, a CT scan takes many pictures and the computer then combines them to show a cross-section of the part of your body being examined.

A CT scan is more likely to show lung tumours than a normal chest X-ray. It can also show the size, shape and location of any lung tumours and help detect enlarged lymph nodes where the cancer may have spread. This test can also be used to look for masses in the adrenal glands, liver, brain and other organs that may be caused by the spread of lung cancer.

CT-guided needle biopsy: If a suspected area of cancer is deep in your body, a CT scan can be used to guide a biopsy needle into the area to take a tissue sample to check for cancer.

 

  • Magnetic resonance imaging (MRI)

Like a CT scan, an MRI shows detailed images of the soft tissue in the body. But MRI uses radio waves and strong magnets instead of X-rays. MRI is most often used to look for possible spread of lung cancer to the brain or spinal cord.

  • Positron emission tomography (PET)In a PET scan, a slightly radioactive formof sugar (known as FDG) is injected into the bloodstream and accumulates mainly in cancer cells.

PET/CT scan: Often a PET scan is combined with a CT scan using a special machine that can do both at the same time. This allows the doctor to compare areas of increased radioactivity on the PET scan with a more detailed image on the CT scan. This is the type of PET scan most often used for patients with lung cancer.

 

  • Bone scans

With a bone scan, small amounts of low-level radioactive material are injected into the bloodstream and accumulate mainly in abnormal areas of the bone. A bone scan can help show whether cancer has spread to the bone. But this test is not often needed, as PET scans usually show whether the cancer has spread to the bone.

 

 

What tests should be done to diagnose Lung Cancer?

 

The real diagnosis is made by looking at lung cells in a laboratory.

 

The cells can be taken from lung secretions (mucus you cough up from your lungs), fluid removed from the area around your lung (thoracentesis), or from a suspicious area with a needle or surgery (biopsy). The choice of one or another test(s) depends on the situation.

 

  • Sputum cytology

A sputum sample (the mucus you cough up from your lungs) is tested in a laboratory to see if it contains cancer cells. It is best to take a sample early in the morning on 3 consecutive days. This test is more likely to help find cancers that start in the main airways of the lungs, such as squamous cell lung cancer. It may not be as useful for detecting other types of lung cancer.

 

  • Thoracentesis

If there is fluid built up around the lungs (called a pleural effusion), doctors may remove some of the fluid to see if it is caused by cancer that has spread to the tissue lining the lungs (pleura).

During a thoracentesis the skin is anaesthetised and a hollow needle is inserted between the ribs to drain the fluid. The fluid is tested in a laboratory for the presence of cancer cells. Other fluid tests can also sometimes help distinguish a malignant (cancerous) pleural effusion from a non-cancerous effusion.

 

  • Needle biopsy

Doctors often use a hollow needle to take a small sample from a suspicious area (mass). The advantage of needle biopsy is that it does not require a surgical incision. The disadvantage is that it only removes a small amount of tissue and in some cases the amount of tissue removed may not be enough both to make a diagnosis and to carry out additional tests on the cancer cells, which may help doctors choose anti-cancer drugs.

 

  • Fine needle aspiration (FNA) biopsy

A doctor uses a syringe with a very thin, hollow needle to take (aspirate) cells and small pieces of tissue. An FNA biopsy can be done to check for cancer in the lymph nodes between the lungs.

 

A transtracheal FNA or transbronchial FNA is performed by passing a needle through the wall of the trachea (windpipe) or bronchi (large airways leading to the lungs) during a bronchoscopy or endobronchial ultrasound scan (described below).

 

In some patients, an FNA biopsy is performed during an endoscopic ultrasound of the esophagus (described below) by passing a needle through the esophageal wall.

 

  • Core biopsy

A larger needle is used to take one or more small tissue cores. Samples obtained by core biopsy are often preferred as they are larger than those from FNA biopsy.

 

  • Transthoracic needle biopsy

If the suspected tumour is in the outer part of the lung, the biopsy needle can be inserted through the skin on the chest wall. The area where the needle will be inserted may first be anaesthetised with a local anaesthetic. The doctor will then guide the needle into the area, while examining the lungs with an X-ray (this is similar to an X-ray) or a CT scan.

 

  • Bronchoscopy

A bronchoscopy can help your doctor to find some lumps or blockages in the large airways of the lungs, which can often be biopsied during the procedure.

 

  • Blood tests

Blood tests are not used to diagnose lung cancer, but they can help give you an idea of a person's general state of health. For example, they can be used to determine whether a person is healthy enough to undergo surgery.

 

Biochemical blood tests can help detect abnormalities in certain organs such as the liver or kidneys. For example, if cancer has spread to the bones, this can lead to higher than normal levels of calcium and alkaline phosphatase.

 

 

What is robotic thoracic surgery?

Robotic thoracic surgery is a type of minimally invasive surgery used in thoracic procedures for some lung cancer cases. Also called robotic-assisted thoracic surgery, it can be used to remove diseased lung tissue and possibly surrounding lymph nodes. In robotic surgery, a surgeon will sit at a console next to the patient in the operating room and control the instruments on the robotic surgical system. First, a small 3D high-definition camera is placed through one of the cuts (incisions) to provide a view of the inside of the chest cavity. Then robotic instruments are placed through the other small incisions made in between the ribs. The robotic instruments are completely controlled by the doctor’s hands at the console. The surgeon removes lung tissue through one of the incisions. The magnified view and wristed instruments allow the surgeon to make precise, controlled movements to remove lung tissue without having to make larger incisions to open up the chest or spread the ribs. The robotic technique can be used for other types of chest procedures involving the lungs, esophagus, thymus, and certain cardiac procedures, besides lung cancer surgery.

What to expect from Robotic Surgery in the treatment of Lung Cancer ?

  • Your doctor will discuss with you what you need to do to prepare for surgery.
  • Your surgery will begin with you being placed under general anesthesia.
  • Once you are asleep, a breathing tube is placed into your airway to allow each lung to be separately inflated during surgery.
  • You are then positioned on your side.
  • The surgeon will typically make four small cuts (incisions) between your ribs so they can access your thoracic (chest) area using the robot.
  • The surgical assistant will place the instruments and cameras attached to the “arms” of the robot into the incisions.
  • The surgeon sits at a control console nearby where they can see magnified, clear images of the surgical area.
  • The robot responds in real-time to the surgeon’s hand movements as the surgeon removes the diseased part of the lung and possibly lymph nodes.
  • At the end of the surgery, the surgeon will insert a chest tube through one of the small incisions to drain fluid or air leaking into the chest cavity and help your lungs re-inflate. This tube will be removed by your care team as you recover.
  • Minimally invasive surgery often means a shorter recovery time and patients are usually discharged from the hospital sooner
  • Follow any post-operative instructions from your doctor.

It is important to give yourself time to rest when you go home. Gradually you will get stronger and feel like yourself.

What are the treatment options for Lung cancer ?

Treatment for lung cancer is managed by a team of specialists from different departments who work together to provide the best possible treatment.

This team includes the health professionals required to make a diagnosis, to stage your cancer and to plan the best treatment. If you want to know more, ask your doctor or nurse about this.

The type of treatment you receive for lung cancer depends on several factors, including:

  • the type of lung cancer you have (non-small-cell or small-cell mutations on the cancer)
  • the size and position of the cancer
  • how advanced your cancer is (the stage)
  • your overall health

Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

The most common treatment options include surgery, radiotherapychemotherapy and immunotherapy. Depending on the type of cancer and the stage, you may receive a combination of these treatments.

 

Surgery

There are 3 types of lung cancer surgery:

  • lobectomy – where one or more large parts of the lung (called lobes) are removed. Your doctors will suggest this operation if the cancer is just in 1 section of 1 lung.
  • pneumonectomy – where the entire lung is removed. This is used when the cancer is located in the middle of the lung or has spread throughout the lung.
  • wedge resection or segmentectomy – where a small piece of the lung is removed. This procedure is only suitable for a small number of patients. It is only used if your doctors think your cancer is small and limited to one area of the lung. This is usually very early-stage non-small-cell lung cancer.

People may be concerned about being able to breathe if some or all of a lung is removed, but it's possible to breathe normally with 1 lung. However, if you have breathing problems before the operation, it's likely these symptoms will continue after surgery.

Tests before surgery

Before surgery, you'll need to have some tests to check your general state of health and your lung function. These may include:

  • an electrocardiogram (ECG)– electrodes are used to monitor the electrical activity of your heart
  • a lung function test called spirometry– you'll breathe into a machine which measures how much air your lungs can breathe in and out
  • an exercise test

How it's performed

Surgery is usually done by making a cut (incision) in your chest or side and removing a section or all of the affected lung. Nearby lymph nodes may also be removed if it's thought that the cancer may have spread to them.

In some cases, an alternative to this approach, called video-assisted thoracoscopic surgery (VATS), may be suitable. VATS is a type of keyhole surgery, where small incisions are made in the chest. A small camera is inserted into one of the incisions, so the surgeon can see the inside of your chest on a monitor as they remove the section of affected lung.

After the operation

You'll probably be able to go home 5 to 10 days after your operation. However, it can take many weeks to recover fully from a lung operation.

After your operation, you'll be encouraged to start moving as soon as possible. Even if you have to stay in bed, you'll need to keep doing regular leg movements to help your circulation and prevent blood clots from forming. A physiotherapist will show you breathing exercises to help prevent complications.

When you go home, you'll need to exercise gently to build up your strength and fitness. Walking and swimming are good forms of exercise that are suitable for most people after treatment for lung cancer. Talk to your care team about which types of exercise are suitable for you.

Complications

As with all surgery, lung surgery carries a risk of complications. It is estimated that around 1 in 5 lung cancer surgeries will lead to complications. These complications can usually be treated using medicine or more surgery, which may mean you need to stay in hospital for longer.

Complications of lung surgery can include:

  • inflammation or infection of the lung (pneumonia)
  • excessive bleeding
  • a blood clot in the leg (deep vein thrombosis), which could potentially travel up to the lung (pulmonary embolism)

Radiotherapy

Radiotherapy uses pulses of radiation to destroy cancer cells. There are a number of ways it can be used to treat lung cancer.

An intensive course of radiotherapy, known as radical radiotherapy, may be used to treat non-small-cell lung cancer if you are not healthy enough for surgery. For very small tumours, a special type of radiotherapy called stereotactic radiotherapy may be used instead of surgery.

Radiotherapy can also be used to control the symptoms, such as pain and coughing up blood, and to slow the spread of cancer when a cure is not possible (this is known as palliative radiotherapy).

A type of radiotherapy known as prophylactic cranial irradiation (PCI) is also sometimes used during the treatment of small-cell lung cancer. PCI involves treating the whole brain with a low dose of radiation. It's used as a preventative measure because there's a risk that small-cell lung cancer will spread to your brain.

The 3 main ways that radiotherapy can be given are:

  • conventional external beam radiotherapy – beams of radiation are directed at the affected parts of your body.
  • stereotactic radiotherapy – a more accurate type of external beam radiotherapy where several high-energy beams deliver a higher dose of radiation to the tumour, while avoiding the surrounding healthy tissue as much as possible.
  • internal radiotherapy – a thin tube (catheter) is inserted into your lung. A small piece of radioactive material is passed along the catheter and placed against the tumour for a few minutes, then removed.

For lung cancer, external beam radiotherapy is used more often than internal radiotherapy, particularly if it's thought that a cure is possible. Stereotactic radiotherapy may be used to treat tumours that are very small, as it's more effective than standard radiotherapy alone in these circumstances.

Internal radiotherapy is usually used as a palliative treatment when the cancer is blocking or partly blocking your airway.

Courses of treatment

Radiotherapy treatment can be planned in several different ways.

People having conventional radical radiotherapy are likely to have 20 to 32 treatment sessions.

Radical radiotherapy is usually given 5 days a week, with a break at weekends. Each session of radiotherapy lasts 10 to 15 minutes and the course usually lasts 4 to 7 weeks.

Continuous hyperfractionated accelerated radiotherapy (CHART) is an alternative way of giving radical radiotherapy. CHART is given 3 times a day for 12 days in a row.

Stereotactic radiotherapy requires fewer treatment sessions because a higher dose of radiation is given during each treatment. People having stereotactic radiotherapy usually have 3 to 10 treatment sessions.

Palliative radiotherapy usually involves 1 to 5 sessions. 

Side effects

Side effects of radiotherapy to the chest include:

  • pain in the chest
  • fatigue (tiredness)
  • persistent coughthat may bring up blood-stained phlegm (this is normal and nothing to worry about)
  • difficulties swallowing (dysphagia)
  • redness and soreness of the skin, which looks and feels like sunburn
  • hair losson your chest

Side effects should pass after the radiotherapy has been completed.

Chemotherapy

Chemotherapy uses powerful cancer-killing medicine to treat cancer. There are several ways that chemotherapy can be used to treat lung cancer. For example, it can be:

  • given before surgery to shrink a tumour, which can increase the chance of successful surgery (this is usually only done as part of a clinical trial).
  • given after surgery to prevent the cancer returning.
  • used to relieve symptoms and slow the spread of cancer when a cure isn't possible.
  • combined with radiotherapy.

 

Side effects

Side effects of chemotherapy can include:

  • fatigue
  • feeling sick
  • being sick
  • mouth ulcers
  • hair loss

These side effects should gradually pass after treatment has finished, or you may be able to take other medicines to make you feel better during your chemotherapy.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Tell your care team or GP as soon as possible if you have signs of an infection, such as a high temperature, or you suddenly feel generally unwell.

Immunotherapy

Immunotherapy is a group of medicines that stimulate your immune system to target and kill cancer cells. It can be used on its own or combined with chemotherapy.

Some of the immunotherapy medicines used to treat lung cancer are pembrolizumab and atezolizumab.

You might have immunotherapy through a plastic tube that goes into:

  • a large vein your chest (central line)
  • a vein in your arm (cannula)

It takes around 30 to 60 minutes to receive a dose, and you may need a dose every 2 to 4 weeks.

If the side effects are not too difficult to manage and the therapy is successful, immunotherapy can be taken for up to 2 years.

Common side effects of immunotherapy include:

  • feeling tired or weak
  • feeling and being sick
  • diarrhoea
  • loss of appetite
  • pain in your joints or muscles
  • shortness of breath
  • changes to your skin, such as your skin becoming dry or itchy

Speak to your doctor or nurse for more information about side effects and things you can do to help manage them.

Targeted therapies

Targeted therapies (also known as biological therapies) are medicines designed to slow the spread of advanced non-small cell lung cancer.

Targeted therapies are only suitable for people who have certain proteins in their cancerous cells. Your doctor may request tests on cells removed from your lung (a biopsy) to see if these treatments are suitable for you.

Side-effects of targeted therapies include:

  • flu-like symptoms such as chills, high temperature and muscle pain
  • fatigue
  • diarrhoea
  • loss of appetite
  • mouth ulcers
  • feeling sick

Find out more about targeted and immunotherapy medicines for lung cancer

Other treatments

As well as surgery, radiotherapy and chemotherapy, other treatments are sometimes used to treat lung cancer, such as:

Radiofrequency ablation

Radiofrequency ablation may be used to treat non-small-cell lung cancer at an early stage.

Cryotherapy

Cryotherapy can be used if the cancer starts to block your airways. This is known as endobronchial obstruction, and it can cause symptoms such as:

  • breathing problems
  • a cough
  • coughing up blood

 

Photodynamic therapy

Photodynamic therapy (PDT) can be used to treat early-stage lung cancer when a person is unable or unwilling to have surgery. It can also be used to remove a tumour that's blocking the airways.

What is the prognosis for lung cancer patients?
Following cancer treatment, your healthcare experts will assist you in understanding what to anticipate in terms of follow-up care, lifestyle adjustments, and making crucial health-related choices.

If lung cancer is localized or regional, and therapy has been given to cure the disease, follow-up testing will be done to verify the disease does not return. You'll also be evaluated for treatment-associated side effects, and therapy will be provided to alleviate any connected symptoms.

The goal of follow-up in patients with metastatic lung cancer and/or therapy is to enhance quality of life and prolong life. Tests will be performed over time to see how the cancer responds to treatment and to keep track of any adverse effects. These follow-up tests will determine the duration of therapy or the necessity to switch treatments.

 

What can I do to avoid lung cancer?


Lung cancer cannot be completely avoided. However, there are a few things you can do to reduce your risk.

 

Smoking is not permitted. If you smoke, give it up. Smokers should avoid inhaling their cigarette smoke.

Reduce your exposure to cancer-causing substances, such as:

 

  • Arsenic
  • Asbestos
  • Beryllium
  • Cadmium
  • Nickel or chromium-containing substances
  • Coal-based goods
  • Pollution from diesel engines, for example, pollutes the air.
  • Have your house tested for radon, a colorless and odorless radioactive gas.
  • Maintain a balanced diet.
  • Exercise on a regular basis.