Cancer treatment team
Many hospitals have multidisciplinary teams (MDTs) that treat lung cancer.
An MDT is made up of a number of different specialists.
- a thoracic surgeon (a specialist in lung surgery)
- a clinical oncologist (a specialist in the non-surgical treatment of cancer)
- a pathologist (a specialist in diseased tissue)
- a radiologist (a specialist in radiotherapy)
- a social worker
- a psychologist
- a specialist cancer nurse, who will usually be your first point of contact with the rest of the team
- Respiratory physician
If you have lung cancer, you may see several or all of these healthcare professionals as part of your treatment.
Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.
Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, the advantages and disadvantages of particular treatments.
Your treatment plan
Your recommended treatment plan will depend on the type and stage of your lung cancer.
In cases of stage 1 and 2 non-small lung cancer, it may be possible to achieve a complete cure by removing the cancer through surgery.
In cases of stage 3A non-small lung cancer, surgery is not usually possible because the cancer has spread too far. Instead, an intensive course of radiotherapy is used to try to achieve a cure, or at least to slow the spread of the cancer and prolong survival times.
In cases of stage 3B and 4 non-small lung cancers, the cancer has usually spread too far to be cured. Chemotherapy and radiotherapy can help to control the symptoms.
In cases of small cell lung cancer, surgery is usually possible only if the cancer is diagnosed in its earliest stages. However, in most cases of small cell lung cancer, a cure is not possible. Radiotherapy and chemotherapy can be used to control the symptoms and slow the spread of the cancer.
There are also a number of newer treatments that can be used under certain circumstances. These include:
- radiofrequency ablation - heat is used to kill cancer cells
- cryotherapy - cold is used to kill cancer cells
- photodynamic therapy - lasers are used to kill cancer cells
- growth inhibitors - medication that interferes with the processes that cancer cells need to multiply and grow; a medication called erlotinib is used in the treatment of lung cancer.
There are three types of lung cancer surgery:
- Wedge resection - a small piece of the lung is removed. This is used to treat very early stage non-small cell lung cancer.
- Lobectomy - one or, in the case of the right lung, two lobes are removed. This is used when the cancer is confined to the lobe(s).
- Pneumonectomy - the entire lung is removed. This is used when the cancer has spread throughout the lung.
People are naturally concerned that they will not be able to breathe if some or all of a lung is removed. But it is possible to breathe normally with one lung. However, if you have breathing problems before the operation, such as breathlessness, it is likely that these symptoms will persist after surgery.
Before surgery can take place, you will need to have a number of tests to check your general state of health and your lung function. This will ensure that your body can withstand the effects of the surgery.
These tests may include:
- an electrocardiograph (ECG) - electrodes are used to monitor the electrical activity of your heart
- spirometry - you will breathe into a machine called a siprometer, which measures how much air your lungs can breathe in and out.
If the test results confirm that your health is good enough to undergo surgery, then surgery can go ahead.
Surgery is usually performed by making an incision (cut) in your chest or side, and removing a section, or all, of the affected lung. Nearby lymph nodes may also be removed if it is thought that the cancer may have spread to them.
In some cases, an alternative to this approach called video-assisted thoracoscopic surgery (VATS) may be suitable. VATS is a type of keyhole surgery where small incisions are made in the chest. A small fibre-optic camera is inserted into one of the incisions, then transmits images of the inside of your chest to a monitor.
In order to remove affected lung tissue, the surgeon can insert surgical instruments through the other incisions, guided by the images on the monitor.
VATS is usually only recommended for early stage non-small lung cancers because the technique is not suitable when anything larger than a lobe of the lung needs to be removed.
As with all surgery, lung surgery carries a risk of complications, which are estimated to occur in one out of every five cases.
Complications of lung surgery include:
- inflammation or infection of the lung (pneumonia)
- excessive bleeding
- a leak of air from the lung wall
- a blood clot in the leg (deep vein thrombosis), which could potentially travel up to the lung (pulmonary embolism)
These complications can usually be treated using medication and/or additional surgery, which means that you may have to stay longer in hospital.
In the absence of any complications, you will probably be ready to go home 5-10 days after your operation. However, it can take many weeks to recover fully from a lung operation. After your operation, you will be encouraged to start moving about as soon as possible.
Movement is very important. Even if you have to stay in bed, you will need to keep doing regular leg movements to help your circulation and prevent blood clots from forming. A physiotherapist will show you breathing exercises to help prevent complications.
When you go home, you will need to exercise gently to build up your strength and fitness. Walking and swimming are good forms of exercise that are suitable for most people after treatment for lung cancer. Discuss with your care team which types of exercise are suitable for you.
Chemotherapy uses powerful cancer-killing medication to treat cancer. There are a number of different ways that chemotherapy can be used to treat lung cancer. For example, it can be:
- given before surgery in order to shrink the tumour(s), which increases the chance of a successful surgery
- given after surgery to prevent the cancer returning
- used to relieve symptoms and slow the spread of cancer when a cure is not possible
- combined with radiotherapy (chemoradiation); this can be given before and after surgery, and/or it can be used to relieve symptoms
Chemotherapy treatments are usually given in cycles. A cycle involves taking the chemotherapy medication for several days before having a break for a few weeks to let your body recover from the effects of the treatment.
The number of cycles of chemotherapy that you require will depend on the type and the grade of your lung cancer. Most people require 4-6 courses of treatment over the space of 3-6 months.
Chemotherapy for lung cancer involves taking a combination of different medications. The medications are usually delivered through a drip into your vein, or into a tube that is connected to one of the blood vessels in your chest.
Side effects of chemotherapy include:
- easily bruised skin
- unusual spontaneous bleeding, such as bleeding gums or nosebleeds
- mouth ulcers
- hair loss
These side effects should gradually pass once your treatment has finished. It usually takes 3-6 months for your hair to grow back.
Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team and/or your GP as soon as possible if you have the possible signs of an infection, such as:
- a high temperature (fever) of 38ºC (100.4ºF) or higher
- suddenly feeling generally unwell
Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancerous cells.
Radiotherapy can be used after surgery to treat lung cancer, or it can be used to control the symptoms and slow the spread of cancer when a cure is not possible (palliative radiotherapy).
A more intensive course of radiotherapy, known as radical radiotherapy, can also be used to try to achieve a cure in cases of non-small cell lung cancer when a person is not healthy enough to have surgery.
A type of radiotherapy known as prophylactic cranial irradiation (PCI) is also used to treat small cell lung cancer. PCI involves directing high-energy pulses at your brain.
It is used as a preventative measure because there is a risk that small cell lung cancer will spread to your brain.
The two ways that radiotherapy can be given are described below.
- External beam radiotherapy - a machine is used to beam high-energy pulses of radiation at affected parts of your body.
- Internal radiotherapy - a catheter (thin tube) is inserted down a bronchoscope and into your lung. A small piece of radioactive material is placed inside the catheter and positioned against the site of the tumour before being removed after a few minutes.
There are also several different ways that a course of radiotherapy treatment can be planned.
Radical radiotherapy is usually given five days a week, with a break at weekends. Each session of radiotherapy lasts between 10 and 15 minutes. The course of radiotherapy usually lasts 3-7 weeks.
Continuous hyperfractionated accelerated radiotherapy (CHART) is an alternative method of delivering radical radiotherapy. CHART is given three times a day for 14 days in a row.
As CHART is usually only available in specialist cancer centres, you may have to travel to another part of the country for treatment.
Palliative radiotherapy usually only requires one or two sessions to control your symptoms.
A course of internal radiotherapy usually takes 1-3 sessions to complete. Internal radiotherapy tends to cause few or no side effects because the radiation is beamed directly at the tumour.
External radiotherapy can cause side effects because the radiation can also damage healthy tissues and cells.
Side effects of radiotherapy include:
- chest pain
- persistent cough that may bring up blood-stained phlegm (this is normal and nothing to worry about)
- difficulties swallowing (dysphagia)
- redness and soreness of the skin, which looks and feels like sunburn
- hair loss, which can occur on your chest and, if you are receiving PCI, on your head
Side effects should pass once the course of radiotherapy has been completed.
Erlotinib (Tarceva) is a medication that can be used to treat people with non-small cell lung cancer who have not responded to chemotherapy.
Erlotinib works by blocking the actions of proteins called epidermal growth factors (EGFs), which cancer cells use to reproduce and multiply. Erlotinib is taken as a tablet, once a day, one or two hours before food.
Common side effects of erlotinib include:
- skin rash
- itchy skin
- sore red eyes (conjunctivitis) or dry eyes
- mouth ulcers
The side effects of erlotinib are usually mild. If they become troublesome, contact your care team because additional treatments are available.
If you develop a skin rash, avoid exposing any affected skin to the sun.
Do not smoke when taking erlotinib because it will make the medication less effective.
There is no evidence whether erlotinib is safe to take during pregnancy. Therefore, if you are a sexually active, fertile woman, use a reliable method of contraception to avoid getting pregnant.
Erlotinib can react unpredictably with other medicines, including non-prescription medication and complimentary therapies, such as St John's Wort. Therefore inform your care team about any medication or therapies that you are using before you start taking erlotinib.
Radiofrequency ablation is a new type of treatment that can treat cases of stage 1 non-small cell lung cancer.
The doctor carrying out the treatment will use a CT scanner to guide a needle to the site of the tumour. The needle will be pressed into the tumour and radiowaves will be sent through the needle. These waves generate heat, which kills the cancer cells.
The most common complication of radiofrequency ablation is that a pocket of air gets trapped between the inner and outer layer of your lungs (pneumothorax). This can be treated by placing a tube into the lungs to drain away the trapped air.
Cryotherapy is a treatment that can be used in cases where the cancer starts to block your airways. This is known as endobronchial obstruction, and it can cause symptoms such as:
- breathing problems
- coughing up blood
Cryotherapy is performed in a similar way to internal radiotherapy, except that instead of using a radioactive source, a device known as a cryoprobe is placed against the tumour.
The cryoprobe can generate very cold temperatures, which help to shrink the tumour.
Photodynamic therapy is a treatment that can be used to treat early stage lung cancer when a person is unable or unwilling to have surgery. Alternatively, as with cryotherapy, photodynamic therapy can be used to remove a tumour that is blocking the airways.
Photodynamic therapy is carried out in two stages. Firstly, you will be given an injection of a medication called porfimer sodium, which will make all the cells in your body very sensitive to light.
The next stage is carried out 24-72 hours later. A bronchoscope will be guided to the site of the tumour(s), and a laser will be beamed through it. The cancerous cells, which are now sensitive to light, will be destroyed by the laser beam.
Side effects of photodynamic therapy include:
- inflammation of the airways
- a build-up of fluid in the lungs
Both of these side effects can cause symptoms of breathlessness and lung and throat pain. However, these symptoms should gradually pass as your lungs recover from the effects of the treatment.
Your skin will also be very sensitive to light for up to 60 days after treatment. You will need to avoid exposure to bright light, including sunlight. Most people are unable to leave their house during the daytime unless all of their body is covered and they are wearing sunglasses.
You should gradually build up your exposure to bright light during the end of this 60-day period. Your care team can give you more information and advice about the best way to do this.