Lung Cancer Treatment Options By Stage [I to IV]

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Lung Cancer Treatment Options

NSCLC (NON SMALL CELL LUNG CANCER)

The treatment of NSCLC mainly depends on the stage, type, location of the tumor, pulmonary function, performance status of the patient, presence of certain genetic abnormalities, along with other factors.

Following is the preferred treatment approach for different stages of NSCLC, but the final decision is taken after clinical assessment of the patient by an oncologist.

Lung Cancer Treatment Options

STAGETNMTREATMENT
0Tis N0 M0Stage 0 NSCLC is limited to the superficial layer of the airway and can be treated by surgery alone as the standard treatment. Sometimes, endobronchial therapies like photodynamic therapy (PDT), laser therapy, or brachytherapy may be employed to treat Stage 0 NSCLC.
ITmi-2a N0 M0Surgery resection with mediastinal lymph node dissection is the standard treatment. Chemotherapy may be added in selected cases. In inoperable cases (poor lung reserve, poor performance status, etc), radiation therapy may be employed as the primary treatment.
IIT2b/T3 N0 M0

OR

T1a-2b N1 M0
Surgical resection with mediastinal lymph node dissection is done, while preoperative chemoradiation may be considered in selected cases. Chemotherapy should be considered after surgery. In inoperable cases, chemotherapy and/or radiotherapy may be given.
IIIT1-4 N0-3 M0 
(Node-positive disease)
Stage III NSCLC treatment generally includes a combination of surgery, radiation therapy, and chemotherapy. The overall treatment approach depends on the size and location of the tumor, the location of the lymph node involved, and overall health status of the patient.
IVAny T Any N M1
(Metastatic disease)
Chemotherapy, targeted therapy or immunotherapy is the mainstay of treatment. Other treatment options like surgery, radiation therapy or bone-directed therapy may be considered for palliation or relief of symptoms.

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Following is the brief description of various treatment types employed for NSCLC:

  1. Surgery: Surgery is the treatment of choice for early stage and some advanced stage lung cancers that have not spread to distant body parts and can be completely removed.

    For early-stage disease, a tumor can be removed with segmentectomy, wedge resection, or sleeve resection, where only a part of the affected lobe is removed.

    In case of advanced stage disease, lobectomy (surgical removal of the entire globe) or pneumonectomy (surgical resection of the entire lung) may be required depending on the size and location of the tumor.

    Surgery can also be employed as a palliative treatment for an advanced-stage disease to relieve airway obstruction by a growing tumor.

  2. Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells.

    It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy).

    Sometimes, it is used as palliative therapy to relieve pain, bleeding, and obstructive problems associated with the advanced-stage disease.

  3. Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells.

    It is considered to be the mainstay of treatment for advanced stage disease that has spread to distant body parts. Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement.

    It may be used in the neoadjuvant (prior to surgery), adjuvant (after surgery) and palliative (metastatic disease) settings. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells.

  4. Targeted Therapy Targeted drugs are designed to target a specific gene or protein characteristic of the lung cancer cells. With the advancement in diagnostic techniques, a number of genetic abnormalities for NSCLC have been identified that can be targeted with the help of targeted drugs.

    Molecular testing to confirm the genetic abnormality is the pre-requisite for starting a targeted therapy. Examples of targeted drugs for lung cancer include Erlotinib [targets epidermal growth factor receptor (EGFR) protein], Bevacizumab [targets vascular endothelial growth factor (VEGF) receptor], Crizotinib (targets ALK gene changes), and Dabrafenib (targets BRAF gene changes in the cancer cells), etc.

    They are generally used alone or in combination with chemotherapy for the treatment of advanced stage disease.

  5. Immunotherapy: Cancer cells utilize certain mechanisms to escape from the immune system of the patient from attacking these cells.

    Immunotherapeutic agents activate the immune system to recognize and kill cancer cells. Nivolumab targets the PD-1 protein on T-cells and activate them to kill cancerous cells.

    Atezolizumab targets PD-L1, a protein that binds to PD-1 that is present on some tumor cells and on immune cells. This activates the immune system to kill the PD-L1 expressing cancer cells.

  6. Palliative Treatment: These treatments help in improving the overall quality of life by providing relief from the symptoms and reducing the suffering caused by the disease.

    These are generally given as supportive care and may include surgery, radiotherapy, photodynamic therapy, laser therapy, radiofrequency ablation, placing stents to ease airway obstruction, or using drugs to reduce pain and other symptoms.

SCLC (SMALL CELL LUNG CANCER)

Similar to NSCLC, the treatment for SCLC depends on the stage assigned to the disease with the help of the investigational tests.

Very few patients are diagnosed with Stage I SCLC who can be considered the candidates for surgical resection. Thus, chemotherapy with or without radiotherapy remains the mainstay of the treatment.

The following are preferred treatment approaches for different stages of SCLC:

STAGETREATMENT
Limited stageChemotherapy with or without radiotherapy is the preferred treatment for the limited-stage SCLC.
Surgery may be employed for an early-stage disease, but chemotherapy with or without radiotherapy is generally recommended after surgery due to a high recurrence rate of SCLC.

Prophylactic cranial irradiation may also be employed to prevent the spread of disease to the brain as per physician’s discretion.
Extensive stageChemotherapy with or without radiotherapy is the preferred treatment for the extensive-stage SCLC. Radiation therapy is usually employed for the disease spread to distant organs not directly benefitted from chemotherapy.
Prophylactic cranial irradiation may also be employed to prevent the spread of disease to the brain as per physician’s discretion.

Following is the brief description of various treatment types employed for SCLC:

  1. Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. Chemotherapy is the mainstay of treatment for SCLC.
  2. Radiation Therapy: Radiotherapy is commonly combined with chemotherapy for the treatment of SCLC. Radiotherapy is also employed for the treatment of cancer spread to distant body parts including the brain.

    Whole brain radiation treatment is generally given to patients with spread of disease to the brain or to patients who are at higher risk of disease spread to the brain. Radiotherapy can also be used for palliation of symptoms of the disease such as pain, bleeding, and obstructive problems.

It is very important to assess the benefits of each lung cancer treatment option versus the possible risks and side effects before making a treatment decision. Sometimes the patient’s choice and health condition are also important to make a treatment choice.

Following are ultimate goals of treating stomach cancer:

  • Prolongation of life
  • Reduction of symptoms
  • Improvement in overall quality of life
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