Treatment Options for Lung Cancer

Surgery may be used if the cancer is found in one lung and in nearby lymph nodes only. However, this type of lung cancer is usually found in both lungs; therefore, surgery alone is not often used.

Even if the doctor removes all the cancer that can be seen at the time of the operation, you may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that may remain. Treatment that is given after the surgery to lower the risk that the cancer will come back is called adjuvant therapy.

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. The way the chemotherapy is given depends upon the type and stage of the cancer being treated. 

• When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). 
• When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. The way radiation therapy is given depends upon the type and stage of the cancer being treated.

There are two types of radiation therapies:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.​
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Prophylactic cranial irradiation (radiation therapy to the brain to reduce the risk that cancer will spread to the brain) may also be given.

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill the cancer cells.

An endoscope is a thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may be used to place a stent in a body structure to keep the structure open. Endoscopic stent placement can be used to open an airway blocked by abnormal tissue. Follow-up tests may be needed.

Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively. The immune system uses “checkpoints” — proteins on immune cells that need to be turned on (or off) to start an immune response — to keep itself from attacking normal cells. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. But drugs that target these checkpoints can be used to treat some people with non-small cell lung cancer. Immunotherapy is typically given intravenously (through an IV) every 2 to 3 weeks.

Stage 0 treatment for Non-Small Cell Lung Cancer may include:

• Surgery (wedge resection or segmental resection).
• Photodynamic therapy using an endoscope.
• Electrocautery, cryosurgery, or laser surgery using an endoscope.

• Stage I treatment may include:
  • Surgery (wedge resection, segmental resection, sleeve resection, or lobectomy).
  • External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
  • A clinical trial of surgery followed by chemoprevention.

• Stage II treatment may include:
  • Surgery (wedge resection, segmental resection, sleeve resection, lobectomy, or pneumonectomy).
  • External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
  • Surgery followed by chemotherapy.

• Stage III non-small cell lung cancer treatment is divided into Stage IIIA, Stage IIIB, and Stage IIIC:
  • Stage IIIA: Non-small cell lung cancer that can be removed with surgery may include:
    • Surgery followed by chemotherapy.
    • Surgery followed by radiation therapy.
    • Chemotherapy and radiation therapy followed by surgery.
  • Stage IIIA non-small cell lung cancer that cannot be removed with surgery may include:
    • External radiation therapy alone for patients who cannot be treated with combined therapy.
    • Chemotherapy combined with radiation therapy.
  • Some Stage IIIA non-small cell lung tumors that have grown into the chest wall may be completely removed, and treatment of chest wall tumors may include:
    • Surgery
    • Surgery and radiation therapy
    • Radiation therapy alone
    • Chemotherapy combined with radiation therapy and/or surgery. 
  • Stage IIIB and Stage IIIC treatment may include:
    • Chemotherapy combined with radiation therapy.
    • Chemotherapy and radiation therapy followed by immunotherapy.
    • External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life.

• Stage IV treatment may include:
  • External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life
  • Combination chemotherapy
  • Combination chemotherapy and targeted therapy
  • Laser therapy and/or internal radiation therapy using an endoscope.
  • Laser therapy and/or internal radiation therapy using an endoscope.
  • Surgery
  • Stereotactic radiosurgery for tumors that have spread.