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Lung cancer

Lung cancer treatment

This page explains the main treatments for lung cancer and talks about the outlook for people with lung cancer.

Different treatments work for different types of lung cancer. To decide on treatment for a particular patient, doctors look at:

  • the type of cancer the patient has
  • the patient's age and overall health
  • the stage the lung cancer is at — whether it has spread to other parts of the body

After looking at those things, doctors may recommend one or more of these treatments:

Surgery

There are many kinds of surgery to remove lung cancer tumours:

  • Pneumonectomy: doctors remove one entire lung (people can breathe using the remaining lung).
  • Lobectomy: doctors remove a section of the lung (a lobe).
  • Segmentectomy or wedge resection: doctors remove a part of a lobe.
  • Laser surgery: a high-energy beam of light destroys the cancer cells in a tumour.
Chemotherapy

Chemotherapy is medicine that fights cancer. Some kinds of chemotherapy come in pills. Other kinds are delivered into your bloodstream by intravenous drip (IV), where a machine slowly drips medicine into tubes that go into your veins. Some chemotherapy is given by injection (a shot).

Radiation therapy

Radiation therapy uses high-energy radiation to kill cancer cells. The radiation can be delivered by a machine that directs the high-energy rays towards the cancer, or by a small radioactive pellet that gets implanted in or near the tumour.

Targeted therapies

Targeted therapies are a newer treatment for certain kinds of non–small cell lung cancer (NSCLC). They come as a pill you take once a day.

In Canada, two targeted therapies have been approved for non–small cell lung cancer treatment, gefitinib (Iressa©) and erlotinib (Tarceva©).

Gefitinib (Iressa) and erlotinib (Tarceva) belong to a group of medicines called "growth factor receptor tyrosine kinase inhibitors". They prevent the activation of a protein called epidermal growth factor receptor (EGFR) that spans the outer wall of cells. Normally, activation of EGFR protein sends signals to the inside of cells to make them divide. Gefitinib and erlotinib interfere with this protein. This helps stop the cancer cells from growing and spreading.

Gifitinib and erlotinib will work best in people whose cancer cells have specific genetic mutation, called “activating mutations of the epidermal growth factor receptor tyrosine kinase” (“EGFR-TK” for short). However, these targeted medicines are used in cancer patients who have the mutation and those whose mutational status is unknown (who have not been tested for the mutation).

Erlotinib hydrochloride (Tarceva) is for adults with non-small cell lung cancer at an advanced stage:

  • who have tried chemotherapy, but the chemotherapy did not help stop the cancer

    AND
  • whose cancer has the activating mutations of the Epidermal Growth Factor Receptor tyrosine kinase (EGFR-TK).

Gefitinib (Iressa) was first approved for adult patients with advanced non-small cell lung cancer who were not helped by other treatments. It has also recently been approved in Canada for the initial (first-line) treatment of adult patients who are nonsmokers or previous light smokers who have the adenocarcinoma type of non-small cell lung cancer and whose cancer:

  • has spread around the lungs or to other parts of the body (metastasized)

    AND
  • has the activating mutations of the Epidermal Growth Factor Receptor tyrosine kinase (EGFR-TK).

Currently, provincial health plans and private plans do not cover the cost of gefitinib (Iressa) as first-line treatment, and hospitals do not usually test patients to see if they have the Epidermal Growth Factor Receptor tyrosine kinase (EGFR-TK) mutation.

Photodynamic therapy

With photodynamic therapy, you're injected with a special medicine that gets absorbed by cancer cells. Then doctors shine a high-energy laser light on you, which activates the medicine and helps it destroys the cancer cells. Photodynamic therapy can be used to treat some cases of early-stage lung cancer. It can also be used to help relieve symptoms of a blocked airway (airways are the breathing tubes in your lungs).

What's the goal of lung cancer treatment?

The goal of lung cancer treatment is different for different patients.

For patients who have a chance of a cure, doctors offer curative treatments. Curative treatments are any treatments whose goal is to cure the cancer, to make it disappear.

Even if doctors can't cure a person's lung cancer, they can give treatments to help him feel more comfortable— these are called palliative treatments. Palliative treatments are any treatments that try to improve a person's symptoms. They do not try to cure the lung cancer, but the do try to keep it at bay.

No matter what stage a person's lung cancer is at, doctors can do things to help them feel more comfortable.

Is it normal to feel overwhelmed and overloaded with information about lung cancer?

Yes. When you or someone you love gets diagnosed with lung cancer, it can be shocking and scary. It's normal to feel overwhelmed.

Some people want to know everything about their lung cancer right away. Some people want a little information at a time. Other people don't ask a lot of questions and don't want to hear more information than they feel they can handle. People need time and support to work through their feelings and adjust to a new lung cancer diagnosis.

The next question on this page is about what to expect (prognosis). If you want to learn about the outlook for people with lung cancer, read the information below. If you'd prefer to skip over it because you're not ready, that's okay too.

What's the outlook (prognosis) for people with lung cancer? What are their chances of a cure?

Doctors are discovering new ways to diagnose and treat lung cancer, giving people a better chance of recovery than before. But lung cancer is still one of the deadliest cancers. Canadian women with lung cancer have an average five-year survival rate of 18%. In other words, 18% of women diagnosed with lung cancer are likely to be alive five years after their diagnosis. Canadian men with lung cancer have an average five-year survival rate of 13%.1

These survival rates are based on averages and do not apply to everyone. To find out about a particular patient's outlook, ask their doctors. The doctors know all about the patient's case and can give personalized information. Of course, no one can predict the future exactly, but the doctors will try their best, based on their experience and expertise.

What if the doctors aren't telling us what to expect, and we want to know?

If you have questions about what to expect, ask the doctor. You can ask if the cancer can be cured, what the options are, and what can be done to help the patient feel comfortable. Many people want to know about what to expect so they can prepare for it.

People with terminal cancer can get treatments to help relieve their symptoms and control their pain. They may get care from doctors and nurses who are experts at keeping dying patients as comfortable as possible. They may stay in a hospice or a palliative care ward, or may be able to get hospice or palliative care services at home.

Patients who are dying often want to get their papers in order, have important conversations, and spend time with people they love. Even when they can't hope for a cure, patients and families can hope for other good things: to have as little pain as possible, to enjoy the time that's left, and to leave a legacy that will remind people of them — a song, a letter to grandchildren, a book of family stories, or a newly planted tree, for example.

You can learn more about hospice, palliative and end-of-life care from the Canadian Virtual Hospice, a non-profit website that offers personalized information and support for patients, family members, and health care providers facing end of life issues.

Where can I get more information and support for lung cancer?

The Canadian Cancer Society, a non-profit organization, offers:

  • in-depth information on lung cancer, on its website
  • a toll-free phone line for questions on cancer, as well as peer support and in-person support groups.

Lung Cancer Canada, a non-profit organization, offers a peer support program that matches people with lung cancer (and their families and caregivers) with people who have been in similar circumstances. They also offer an information service staffed by trained volunteers.

MedlinePlus, a website from the US National Library of Medicine, offers a web page with links to reliable information on lung cancer.

References

1. These chances of survival are calculated based on the likelihood of survival of similar people in the general population. They are averages, and may not apply to your particular case. If you have questions about cancer survival rates, please ask your doctor. Rates are from: Canadian Cancer Society’s Steering Committee: Canadian Cancer Statistics 2009. Toronto: Canadian Cancer Society, 2009.