Lung Cancer

How is lung cancer treated?

Treatment for lung cancer depends on the type of lung cancer, stage of cancer and general health and fitness of the patient. An individual with cancer should be assessed by a specialist to determine which modality of treatment is best suited for them.

Treatment by type and stage of lung cancer

SCLC

Limited stage disease is usually treated with a combination of chemotherapy and radiotherapy to the lungs and mediastinal lymph nodes. After completion of chemoradiation, radiotherapy to the brain may be recommended to reduce the risk of cancer relapse in the brain. Extensive stage disease is usually treated with a combination of chemotherapy and immunotherapy. Some patients may also be treated with radiotherapy depending on their sites of spread and response to treatment.

NSCLC

• Stage 1 and 2 NSCLC: Surgery is considered the standard treatment for stage 1 and stage 2 NSCLC. The most common surgery for lung cancer is lobectomy, which involves the removal of the affected lobe of the lung. Other types of operations such as a sub lobar resection (removal of less than a lobe of the lung) or pneumonectomy (removal of the entire lung) are occasionally performed depending on the patient’s underlying health status as well as the size and location of the patient’s lung cancer. Whenever possible, these operations are performed by video-assisted thoracoscopic surgery (VATS) using small incisions on the chest to facilitate recovery after surgery. Depending on the stage of lung cancer and findings at the time of surgery, patients may be recommended chemotherapy, targeted therapy, immunotherapy and/or radiotherapy to reduce recurrence risk.
• Stage 3: Management of stage 3 lung cancer usually requires multidisciplinary care as it comprises a combination of surgery, radiation, chemotherapy and immunotherapy. Some patients with stage 3 lung cancer may be unsuitable for surgery, such as those where the cancer has spread to multiple lymph nodes in the middle of both lungs (‘mediastinum’) or where the cancer is very close to vital organs such as the heart or big blood vessels. For these patients a combination of chemotherapy with radiotherapy to the lungs and lymph nodes may be recommended, followed by immunotherapy treatment.
• Stage 4: Treatment of stage 4 NSCLC depends on the subtype (squamous or non-squamous) as well as the molecular profile of the tumour, and comprises various options such as chemotherapy, targeted therapy and/or immunotherapy.

Types of treatment

• Chemotherapy: Refers to the use of drugs to destroy growing cancer cells, by preventing them from growing and dividing, and can be given either intravenously (through a vein) or by tablets.
• Radiotherapy: Uses high-energy x-rays to kill cancer cells in a specific area, while minimising damage to normal cells nearby. Depending on the stage of the cancer, it may be used as the main treatment. In early stage lung cancer, stereotactic body radiotherapy (SBRT) is used as an alternative to surgery. In locally advanced lung cancer, radiation is sometimes given along with chemotherapy. It may also be used after lung cancer surgery if there are any areas of cancer that could not be removed. Volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) can reduce radiation doses to normal organs. Radiosurgery and SBRT may also be used to treat cancers that have spread to other organs in some cases.
• Targeted therapy: Refers to drugs which are designed to ‘target’ specific changes in the cancer cells that help them to grow, divide and spread. Targeted therapy is usually recommended based on the molecular profile of lung cancer.
• Immunotherapy: Refers to a group of drugs called immune checkpoint inhibitors (ICI) which work by helping the body’s immune system recognize and destroy cancer cells.