Lung Cancer: Treatment Choices

You may have questions and concerns about your treatment choices. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. They can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or they may offer more than one and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your choices. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may need a second opinion. In addition, you may want to involve your family and friends in this process.

For some lung cancers, the goal of treatment is to cure the cancer. If cure is not possible, treatment may be used to shrink the cancer or keep it under control for as long as possible. Treatment can also improve quality of life by helping to control the symptoms of the disease. The goals of lung cancer treatment can include one or more of these things:

• Remove or destroy the cancer in the lung

• Remove or destroy tumors in other parts of the body

• Kill or stop the growth or spread of lung cancer cells

• Prevent or delay the cancer's return

• Ease symptoms from the cancer, such as pain or trouble breathing

Several types of treatment can be used for lung cancer. Different combinations of treatment may be used, depending on the type and stage (extent) of the cancer, and other factors. Each treatment has its own goals. Here is an overview of each type of treatment:

• Surgery. If you have non-small cell lung cancer (NSCLC) that has not spread, surgery is often the first choice for treatment. Surgery is used for only a small number of people with very early-stage small cell lung cancer (SCLC). Sometimes surgery may be considered after radiation or chemotherapy in people who have responded well with a decrease in tumor size. Surgery for lung cancer is often followed by other treatments.

• Radiation therapy. Radiation therapy uses high energy X-rays or radioactive particles to destroy cancer cells. It is often a choice when you have an early-stage tumor but are not healthy enough for surgery. It can also be used for more advanced cancers. It may be used by itself or with chemotherapy. Radiation therapy can also be used to help relieve symptoms from cancer that has spread. 

• Chemotherapy. Chemotherapy is the use of medicines to stop the growth of cancer cells by either killing the cells or stopping them from dividing. It is usually part of the treatment for SCLC and NSCLC.

• Targeted therapy. This type of treatment uses medicines that zero in on the specific changes in cancer cells or in nearby tissues that cause the cancer to grow and spread. Several targeted medicines can be used to treat some advanced NSCLCs, either alone or along with chemotherapy. You will need tests to see if you have certain gene changes that mean targeted therapy might help treat your cancer.

• Immunotherapy. Immunotherapy uses medicines to boost your own immune system to attack the cancer cells. Medicines called immune checkpoint inhibitors can be used. 

• Photodynamic therapy (PDT). For PDT, a light-sensitive medicine is injected into the body. Then a special light on the end of a bronchoscope is aimed at the cancer cells, killing them. This treatment can be used to reduce symptoms of lung cancer, such as trouble breathing. It may also be used to treat very small tumors in people who can't have the usual treatments.

• Laser therapy. A laser beam is a narrow beam of intense light. It's used to kill cancer cells. Very small lung cancers in the linings of airways can sometimes be treated with a laser on the end of a bronchoscope. Lasers can also be used to help people with advanced tumors breathe better by opening up blocked airways.

• Radiofrequency ablation (RFA). RFA can be used to treat some small tumors near the outside of the lungs, especially in people who can't or don't want to have surgery. A metal probe is passed through the chest wall and into the tumor. High-energy radio waves are sent into the probe to destroy the tumor. 

• Supportive care. Your healthcare provider may advise therapies that help ease your symptoms, but don’t treat the cancer. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if they believe that available treatments are more likely to do you more harm than good.

Researchers are always looking for new ways to treat lung cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

At first, thinking about treatment choices may seem overwhelming. Talk with your healthcare provider, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each choice. Discuss your concerns with your provider before making a decision.