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Lung Cancer Treatment – Cancer Council Victo...

On this page: Surgery | Chemotherapy | Radiotherapy | Thoracentesis (pleural tap) | Pleurodesis | Palliative care | Reviewers

Your choice of treatment will depend on the stage of the cancer, your breathing capacity and ongoing general health, and your wishes.

  • Non-small cell lung cancer is best treated with surgery if possible, otherwise a combination of radiotherapy and chemotherapy.
  • Small cell lung cancer is usually treated with chemotherapy. Some people with cancer in one lung (limited disease) will have radiotherapy to the chest and brain (known as preventive or prophylactic radiotherapy). Because it usually spreads early, surgery is not often used for this type of cancer.

Research shows that quitting smoking will improve your chances of responding to treatment. If you smoke, your medical team will probably tell you to stop smoking before you have an operation.

Surgery

Surgical removal of a tumour offers the best chance of a cure for patients who have early-stage cancer. The surgeon, who is part of the multidisciplinary team, will determine if the cancer is confined to your lung, assess your general wellbeing and fitness for an operation, and assess your breathing capacity.

Patients must cease smoking for a minimum of four weeks before any surgery will be performed.

Types of surgery

Lobectomy: a lobe of the lung is removed

Pneumonectomy: one whole lung is removed

Wedge resection: only part of the lung, not a lobe, is removed

After an operation

After major lung surgery you’ll have an intravenous (IV) drip for at least a few days (though you’ll be able to eat and drink the day after the operation). There will be one or two temporary tubes in your chest to drain fluid and/or air from your chest cavity.

You’ll have some pain and discomfort but your medical team will work with you to reduce these effects. There’s no need to suffer in silence – tell your doctor or nurse how you’re feeling. This is important because if you’re not in pain, you’re more likely to move around and do exercises with the physiotherapist. Pain-relief may also help you clear phlegm from your chest and reduce your chances of developing a chest infection.

‘The physio came regularly to help me get up after surgery. Eventually the physio walked me around the room. By the end of the last day in hospital, I could walk around the room myself.’
-Patient

You’ll probably go home four to 10 days after the operation but you’ll still be recovering for about six weeks. The recovery time depends on the type of operation and your fitness.

Many patients who’ve had part of their lung removed experience some breathlessness. If your lung function was poor before surgery, or if you have one whole lung removed (pneumonectomy), you’ll feel breathless but exercising will help to reduce the breathlessness.

Your doctor, nurses and physiotherapist will talk to you about how to manage effectively at home. You’ll be expected to do regular exercises, like walking, to speed your recovery.

A referral to pulmonary rehabilitation is advised, especially if a complete lung is removed, to improve your breathing and confidence living with one lung.

You’ll have regular chest x-rays to check your lung or lungs are working properly.

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells.

Chemotherapy is commonly given to patients whose cancer is large or has spread outside the lungs. It may be given:

  • before surgery, to try to shrink the cancer and make the operation easier
  • before radiotherapy or during radiotherapy (chemoradiation), to increase the chance of the radiotherapy working
  • after surgery, to reduce the chances of the cancer coming back
  • as palliative treatment, to reduce symptoms, improve your quality of life or extend your life.

Generally, chemotherapy is administered intravenously through a drip or a plastic catheter (tube) inserted into a vein in your arm, hand or chest. Some types of chemotherapy are given orally (that is in tablet form).

Chemotherapy is given in cycles that typically last three weeks each. Intravenous chemotherapy may be given for a few days. The rest of the time is a break from treatment. The number of treatments you have will depend on the type of lung cancer you have and how well your body is handling the side effects. You may be able to have treatment as an outpatient.

If you have tablet chemotherapy it will probably be given on a continuous basis.

Targeted therapies

New research has discovered that the growth of some lung cancers depends on the presence of damaged genes (mutations) in the cancer. These mutations are not inherited or passed on to your children.

The cause of the mutations is unknown as some are more common in non-smokers. A number of drugs have been developed which ‘switch off’ these mutations and arrest the growth of the cancer. Because these drugs target specific mutations within the cancer, they are known as ‘targeted’ therapies. As a result, they have fewer side effects compared with traditional chemotherapy, since their effects are largely restricted to the cancer cells.

Two of the mutations for which targeted therapies are available are the EGFR and ALK mutations. If your doctor suspects that your cancer may be due to a mutation, he will ask the laboratory to analyse the cancer tissue to see if one is present. If a mutation is found, this will guide your doctor in the choice of targeted therapy for your particular cancer, which is often referred to as ‘personalised medicine’.

Other examples of targeted therapies are drugs which attack the cancer’s blood supply and so starve the cancer (anti-angiogenesis drugs), and drugs which block the signals which make the cancer grow.

You may be asked if you want to participate in a clinical trial to receive targeted therapy. Talk to your doctor for more information about new drug trials.

Side effects

Most drugs used in chemotherapy cause side effects. Different drugs have different side effects – your doctors and nurses will discuss this with you. The most common side effects include:

  • nausea, vomiting
  • mouth ulcers
  • fatigue
  • thinning or loss of hair
  • skin rashes.

Talk to your medical team if you have side effects – in most cases drugs can be prescribed to make any side effects you experience less severe. For more information on chemotherapy treatment and its side effects, call Cancer Council on 13 11 20 or see our Understanding Chemotherapy section.

Chemotherapy temporarily weakens your immune system, so you may have trouble fighting infections like a cold or flu. If you have a high temperature (38˚C or above) while receiving chemotherapy, seek medical advice immediately.

Radiotherapy

Radiotherapy treats cancer by using x-ray beams to kill cancer cells.

Radiotherapy is offered when lung cancer can’t be managed by surgery and hasn’t spread outside the chest. Radiotherapy can also be used to treat cancer that has spread to the lymph nodes. This may stop the cancer from spreading further or from returning later. It’s often given together with chemotherapy if the intention is to cure the cancer.

It can also be used:

  • to treat an early stage small peripheral (on the outer portions of the lung rather than deep inside) lung cancer, where the patient isn’t fit for an operation or can’t abstain from smoking
  • after surgery to treat sites where lymph nodes were taken as an attempt to reduce the chances of the cancer coming back
  • to treat cancer that’s spread to other organs such as the brain or bones
  • as palliative treatment, to reduce symptoms, improve your quality of life or extend your life.

To plan radiotherapy treatment, your doctor will take an x-ray, CT or PET scan of the treatment area. To ensure that the same area is treated each time, the radiation therapist will make a few small marks on your skin.

During treatment, you will lie on a treatment table. A machine that delivers the radiation will be positioned around you. The treatment session itself will take about 10 to 15 minutes. Radiotherapy treatment is painless and the person giving you the treatment will make you as comfortable as possible.

For more information, call Cancer Council on 13 11 20 or see our Understanding Radiotherapy section.

Side effects

The side effects from radiotherapy depend on the area of your body being treated and the dose of radiation.

People who have radiotherapy to the chest for a primary lung cancer may experience tiredness and a mild reaction on the skin, like a sunburn. Some patients who have a long course of radiotherapy (several weeks) may have temporary difficulty and pain in swallowing (oesophagitis).

Any radiotherapy to the lungs will cause some scarring, which can be seen on x-rays or CT scans after treatment. Some patients experience temporary shortness of breath weeks after the radiotherapy has finished. This usually improves by itself, or may require treatment with cortisone tablets.

Thoracentesis (pleural tap)

When fluid builds up in the area between the lung and the chest wall (pleural space), you may experience symptoms like breathlessness, tiredness and pain. Your doctor can relieve the symptoms by removing the fluid, performing a procedure called thoracentesis (pleural tap).

In this procedure your doctor or radiologist will insert a hollow needle between your ribs into the pleural space to drain the fluid out. This will take about 30 to 60 minutes. A pleural tap is performed under a local anaesthetic and it’s usually done on an outpatient basis. Some of this fluid will be sent to pathology for examination.

Pleurodesis

If the fluid reaccumulates after you’ve had a pleural tap, it should be assessed for management by a procedure called pleurodesis. This is usually done with a key-hole type surgical approach (video-assisted thoracoscopic surgery or VATS).

In pleurodesis, you’ll have talcum powder instilled into the pleural space (between the lung and chest wall). The powder will inflame the membranes and make them stick together. This closes the space between the pleura, preventing the fluid from coming back. It’s ideal to have this procedure performed by a thoracic surgeon under a general anaesthetic. You’ll have a hospital stay of two or three days.

This procedure is sometimes performed by experienced doctors under local anaesthetic if a patient is deemed not fit for an operation.

Indwelling pleural drains

Some patients are not fit for surgery, and fluid is not adequately controlled with local pleurodesis, so they’re offered an indwelling pleural catheter. This is a drainage tube that is inserted into the pleural space (by a cardiothoracic surgeon or experienced interventional radiologist) for the purpose of draining fluid when the fluid accumulates and causes troublesome symptoms like breathlessness.

The tube remains in the body, capped off and secured under a dressing on the skin until needed for draining. It is connected to and drained into a company bottle when symptoms build up. In time, pleurodesis may occur and the drain may be removed but most people live the rest of their life with the drain.

The drain can be managed by the patient, a confident carer, or the community nurse service.

Palliative care

Palliative care aims to improve the quality of life of people with cancer and their families by preventing and relieving symptoms of cancer or cancer treatment. It also involves the management of other physical and emotional symptoms, and works to relieve practical problems.

Although palliative care is particularly important for people with advanced cancer, it’s not just for people who are about to die. Control of unpleasant symptoms is important at all stages of the disease, so may be required in early cases as well as in end-of-life situations. It’s best to make contact with a palliative care team early in your illness so that they can learn about and build a relationship with you. It’s best to have done this in a controlled environment rather than at a time of crisis.

Call Cancer Council on 13 11 20 to request free information about palliative care and advanced cancer.

Reviewed by: Prof David Ball, Oncologist & Chair Lung Cancer Service, Peter MacCallum Cancer Centre VIC; Jocelyn McLean RN, MN (Res), Case Manager for Thoracic Surgery, Sydney Local Health District, Eastern Zone NSW; Annie Angle, Oncology Nurse, Cancer Council Helpline Victoria; Thea Holmes, Consumer. Information developed in collaboration with The Australian Lung Foundation. We thank the health professionals who reviewed this booklet on behalf of the Foundation and Glenda Colburn, Program Development Manager, National Lung Cancer Program.

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Adapting to the Brave New World of Lung Cancer Tre...

Paradigm shift seems an inadequate, though often-used, description of what has happened in lung cancer therapy in the past decade. In this issue of ONCOLOGY, Dr. Carrizosa and colleagues lead us on a comprehensive tour of the molecular targets and therapies that have shaped this new framework for evaluating and treating patients with lung cancer. They review in detail the discovery of epidermal growth factor receptor (EGFR) gene mutations and ALK translocations, and the development of therapies that successfully target these molecular abnormalities. They discuss acquired resistance to EGFR- and ALK-directed therapies, with an eye towards future platforms for combating resistance. They outline other recent developments in lung cancer treatment, including an overview of potential KRAS-directed therapies and a discussion of developments in immunotherapy. The authors also provide a clear and useful algorithm for personalized lung cancer treatment (see Figure 4 in their article).

While the future of lung cancer treatment as outlined by the authors is promising, the present holds considerable challenges for clinicians and researchers. The BATTLE trial[1] has demonstrated the feasibility of obtaining larger patient specimens, and the authors’ diagnostic and treatment algorithm (and any sensible algorithm one can imagine) hinges on obtaining a diagnostic biopsy with adequate tissue for biomarker testing. Nevertheless, our ability to obtain sufficient tissue to make treatment decisions lags behind our understanding of the importance of selecting therapy based on molecular markers. Evaluation of patients with a suspected diagnosis of advanced lung cancer has long focused on acquiring tissue in the most rapid and safe manner possible, often resulting in small cytologic specimens. Even in the controlled setting of clinical trials with tissue acquisition as a goal, obtaining sufficient tissue for molecular studies remains a challenge, with recovery rates of viable tumor samples typically less than 50% across multiple clinical trials.[2-7] In a typical outpatient setting, care may be fragmented and biopsies performed without the input of a medical oncologist. Obtaining sufficient tissue on a first biopsy in the majority of patients is unlikely without a major change in our approach. This change will require, at a minimum, education of colleagues across multiple disciplines and earlier involvement of the medical oncologist in the care of a patient with suspected lung cancer.

The approach outlined by Dr. Carrizosa and colleagues, if successful, will ultimately result in the division of lung cancer patients into smaller and more descriptive subsets. In this future, each of these subsets is akin to a rare malignancy, and the hope of an immediately available personalized treatment option for each patient remains distant without a rapid increase in the accrual of patients to clinical trials. Participation of adult cancer patients in clinical trials is dismal at 2% to 4%,[8] with even lower participation rates for minorities and the elderly (who comprise most of our lung cancer patients). We would advocate for an algorithm where ‘refer for clinical trial participation’ appears first at each decision point. The Lung Cancer Mutation Consortium study, a touchstone for those advocating molecular testing, would not have been possible without large-scale participation of patients and the cooperation of multiple institutions from the very outset of the therapeutic decision-making process. The success story of crizotinib (Xalkori) for patients with ALK translocations also illustrates how rapid identification and accrual of patients to molecularly targeted clinical trials leads to better access to appropriate therapy for patients, not just for patients participating in the clinical trial but also for those who subsequently benefited from the relatively rapid approval of this agent by the US Food and Drug Administration (FDA).

Accrual of patients to clinical trials in the era of molecular testing will require a high level of sophistication on the part of clinicians and patients and a strong partnership between the patient, family, and physician. In an ideal world, patients would participate in tissue-acquisition trials at initial diagnosis and upon progression. Those with druggable mutations would be offered first-line targeted-therapy trials or combinations of targeted therapies. At progression, based on biopsy results revealing the mechanism of acquired resistance, patients would be directed again to the most appropriate trials. Negative perceptions surrounding early-phase clinical trials will need to change.

While the title of the article is ‘New Targets and Mechanisms in Lung Cancer,’ Dr. Carrizosa and colleagues, by necessity, focus on non-small-cell lung cancer (NSCLC). Identification of molecular drivers and the development of targeted therapies for small-cell lung cancer (SCLC) lag far behind NSCLC. While different disease biology may account for some of this discrepancy, the same challenges we face in achieving progress in NSCLC are, at least in part, to blame for the lack of progress in SCLC. Comprehensive tissue-acquisition protocols, whole-exome sequencing in large numbers of patients, and increasing clinical trial participation in patients with SCLC are vital to change. Similarly, if we are to provide new options for the large numbers of NSCLC patients with no actionable mutation, we must focus on identifying new mutations through tissue acquisition. In the meantime, these patients are ideal candidates for the large number of available immunotherapy trials.

Achieving the goal of personalized lung cancer therapy will require abandoning or adapting long-held practices. However, as Dr. Carrizosa and his colleagues point out, change is good…and necessary.

Financial Disclosure: Dr. Pinder-Schenck receives research support from Pfizer. Dr. Antonia has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.

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Lung Cancer – Non-Small Cell – Risk Fa...

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. NSCLC occurs most often in people who smoke or in those who have smoked in the past. However, people who don’t smoke can also develop NSCLC, so it is important for all people to learn about the risk factors and signs and symptoms of NSCLC.

The following factors may raise a person’s risk of developing NSCLC:

  • Tobacco and smoking. Tobacco smoke damages cells in the lungs, causing the cells to grow abnormally. The risk that smoking will lead to cancer is higher for people who smoke heavily and/or for a long time. Regular exposure to smoke from someone else’s cigarettes, cigars, or pipes can increase a person’s risk of lung cancer, even if that person does not smoke. This is called environmental or ‘secondhand’ tobacco smoke.

    Smoking marijuana and using electronic cigarettes may also increase the risk of lung cancer, but the actual risk is unknown.

  • Asbestos. These are hair-like crystals found in many types of rock and are often used as fireproof insulation in buildings. When asbestos fibers are inhaled, they can irritate the lungs. Many studies show that the combination of smoking and asbestos exposure is particularly dangerous. People who work with asbestos in a job such as shipbuilding, asbestos mining, insulation, or automotive brake repair and who smoke have a higher risk of developing NSCLC. Using protective breathing equipment reduces this risk.

  • Radon. This is an invisible, odorless gas naturally released by some soil and rocks. Exposure to radon has been associated with an increased risk of some types of cancer, including lung cancer. Most hardware stores have kits that test home radon levels, and basements can be ventilated to reduce radon exposure.

  • Other substances. Other substances at work or in the environment can increase a person’s risk of developing lung cancer. In some parts of the world, people exposed to cooking flames from coal or wood might have increased risk of lung cancer. Other factors that may increase the risk of lung cancer include radiation, arsenic, nickel, and chromium.

  • Genetics. Some people have a genetic predisposition for lung cancer. People with parents, brothers, or sisters with lung cancer could have a higher risk of developing lung cancer themselves.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

The most important way to prevent lung cancer is to avoid tobacco smoke. People who never smoke have the lowest risk of lung cancer. People who smoke can reduce their risk of lung cancer by stopping smoking, but their risk of lung cancer will still be higher than people who never smoked.

Attempts to prevent lung cancer with vitamins or other treatments have not worked. For instance, beta-carotene, a drug related to vitamin A, has been tested for the prevention of lung cancer. It did not reduce the risk of cancer. In people who continued to smoke, beta-carotene actually increased the risk of lung cancer.

The next section in this guide is Screening and it explains how tests may find cancer before signs or symptoms appear. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

What’s new in non-small cell lung cancer res...

Research into the prevention, early detection, and treatment of lung cancer is being done in many medical centers throughout the world.

Prevention

Tobacco

Prevention offers the greatest opportunity to fight lung cancer. Although decades have passed since the link between smoking and lung cancers became clear, smoking is still responsible for at least 80% of lung cancer deaths. Research is continuing on:

  • Ways to help people quit smoking and stay quit through counseling, nicotine replacement, and other medicines
  • Ways to convince young people to never start smoking
  • Inherited differences in genes that may make some people much more likely to get lung cancer if they smoke or are exposed to someone else’s smoke

Environmental causes

Researchers also continue to look into some of the other causes of lung cancer, such as exposure to radon and diesel exhaust. Finding new ways to limit these exposures could potentially save many more lives.

Diet, nutrition, and medicines

Researchers are looking for ways to use vitamins or medicines to prevent lung cancer in people at high risk, but so far none have been shown to conclusively reduce risk.

Some studies have suggested that a diet high in fruits and vegetables may offer some protection, but more research is needed to confirm this. While any protective effect of fruits and vegetables on lung cancer risk is likely to be much less than the increased risk from smoking, following the American Cancer Society dietary recommendations (such as maintaining a healthy weight and eating a diet high in fruits and vegetables, and whole grains) may still be helpful.

Early detection

As mentioned in the section ‘ Can non-small cell lung cancer be found early? ‘, a large clinical trial called the National Lung Screening Trial (NLST) recently found that spiral CT scans in people at high risk of lung cancer (due to smoking history) lowers the risk of death from lung cancer, when compared to chest x-rays. This finding has led to the development of screening guidelines for lung cancer.

Another approach now being studied uses newer, more sensitive tests to look for cancer cells in sputum samples. Researchers have found several changes often seen in the DNA of lung cancer cells. Current studies are looking at new tests that can spot these DNA changes to see if this approach is useful in finding lung cancers at an earlier stage.

Diagnosis

Fluorescence bronchoscopy

Also known as autofluorescence bronchoscopy, this technique may help doctors find some lung cancers earlier, when they may be easier to treat. For this test, the doctor inserts a bronchoscope through the mouth or nose and into the lungs. The end of the bronchoscope has a special fluorescent light on it, instead of a normal (white) light.

The fluorescent light causes abnormal areas in the airways to show up in a different color than healthy parts of the airway. Some of these areas might not be visible under white light, so the color difference may help doctors find these areas sooner. Some cancer centers now use this technique to look for early lung cancers, especially if there are no obvious tumors seen with normal bronchoscopy.

Virtual bronchoscopy

This imaging test uses CT scans to create detailed 3-dimensional pictures of the airways in the lungs. The images can be viewed as if the doctor were actually using a bronchoscope.

Virtual bronchoscopy has some possible advantages over standard bronchoscopy. First, it is non-invasive and doesn’t require anesthesia. It also helps doctors view some airways that might not be seen with standard bronchoscopy, such as those being blocked by a tumor. But it has some drawbacks as well. For example, it doesn’t show color changes in the airways that might indicate a problem. It also doesn’t let a doctor take samples of suspicious areas like bronchoscopy does. Still, it can be a useful tool in some situations, such as in people who might be too sick to get a standard bronchoscopy.

This test will likely become more available as the technology improves.

Electromagnetic navigation bronchoscopy

Lung tumors near the center of the chest can be biopsied during bronchoscopy, but bronchoscopes have trouble reaching the outer parts of the lungs, so tumors in that part of the lung often need to have a needle biopsy. This test can be a way to use a bronchoscope to biopsy a tumor in the outer part of the lung.

First, CT scans are used to create a virtual bronchoscopy. The abnormal area is identified, and a computer helps guide a bronchoscope to the area so that it can be biopsied. The bronchoscope used has some special attachments that allow it to reach further than a regular bronchoscope.

This takes extra equipment and training for the doctor, and is not widely available.

Treatment

Surgery

Doctors now use video-assisted thoracic surgery (VATS) to treat some small lung tumors. It lets doctors remove parts of the lung through smaller incisions, which can result in shorter hospital stays and less pain for patients. Doctors are now studying whether it can be used for larger lung tumors.

In a newer approach to this type of operation, the doctor sits at a specially designed control panel inside the operating room to maneuver long surgical instruments using robotic arms. This approach, known as robotic-assisted surgery, is now being tested in some larger cancer centers.

Real-time tumor imaging

Researchers are looking to use new imaging techniques, such as four-dimensional computed tomography (4DCT), to help improve treatment. In this technique, the CT machine scans the chest continuously for about 30 seconds. It shows where the tumor is in relation to other structures as a person breathes, as opposed to just giving a ‘snapshot’ of a point in time, like a standard CT does.

4DCT can be used to determine exactly where the tumor is during each part of the breathing cycle, which can help doctors deliver radiation to a tumor more precisely. This technique might also be used to help show if a tumor is attached to or invading important structures in the chest, which could help doctors determine if a patient might be eligible for surgery.

Chemotherapy

New combinations: Many clinical trials are looking at newer combinations of chemotherapy drugs to determine which are the safest and most effective. This is especially important in patients who are older and have other health problems. Doctors are also studying better ways to combine chemotherapy with radiation therapy and other treatments.

Lab tests to help predict if chemo will be helpful: Doctors know that adjuvant chemotherapy after surgery may be more helpful for some people with early (stage I or II) cancers than for others, but figuring out which patients to give it to is not easy. In early studies, newer lab tests that look at patterns of certain genes in the cancer cells have shown promise in telling which people might benefit most. Larger studies of these tests are now trying to confirm their usefulness.

Other lab tests may help predict whether a lung cancer will respond to particular chemo drugs. For example, studies have found that tumors with high levels of the ERCC1 protein are less likely to respond to chemo that includes cisplatin or carboplatin, while tumors with high levels of the RRM1 protein seem less likely to respond to chemo with gemcitabine. Doctors are now looking to see if tests for these markers can help guide the choice of treatment, so these are not a part of standard treatment.

Maintenance chemotherapy: For people with advanced lung cancers who can tolerate chemotherapy, combinations of 2 chemo drugs (sometimes along with a targeted drug) are typically given for about 4 to 6 cycles. Some recent studies have found that with cancers that have not progressed, continuing treatment beyond the 4 to 6 cycles with a single chemo drug such as pemetrexed or a targeted drug such as erlotinib may help some people live longer. This is known as maintenance therapy. A possible downside to this continued treatment is that people may not get a break from having side effects from chemotherapy. Some doctors now recommend maintenance therapy, while others await further research on this topic.

Targeted therapies

Researchers are learning more about the inner workings of lung cancer cells that control their growth and spread. This is being used to develop new targeted therapies. Some of these treatments, such as bevacizumab (Avastin), erlotinib (Tarceva), cetuximab (Erbitux), and crizotinib (Xalkori) are already being used to treat non-small cell lung cancer. Others are now being tested in clinical trials to see if they can help people with advanced lung cancer live longer or relieve their symptoms.

Other targeted drugs being studied include ganetespib, custirsen, and dacomitinib. Some targeted drugs already approved for use against other types of cancer, such as sorafenib (Nexavar) and sunitinib (Sutent), are also being tested for use against NSCLC.

Researchers are also working on lab tests to help predict which patients might be helped by which drugs. Studies have found that some patients do not benefit from certain targeted therapies, whereas others are more likely to have their tumors shrink. For example, a test can find changes in the EGFR gene that make it much more likely that a person’s lung cancer will respond to treatment with erlotinib (Tarceva), an EGFR inhibitor. Similar gene tests for other treatments are now being studied. Predicting who might benefit could save some people from trying treatments that are unlikely to work for them and would probably cause unneeded side effects.

Immune treatments

Researchers are hoping to develop drugs that can help the body’s immune system fight the cancer.

Drugs that block PD-1 and PD-L1: Cancer cells may use natural pathways in the body to help avoid detection and destruction by the immune system. For example, they often have a protein called PD-L1 on their surface that helps them evade the immune system. New drugs that block the PD-L1 protein, or the corresponding PD-1 protein on immune cells called T cells, can help the immune system recognize the cancer cells and attack them.

Nivolumab (Opdivo) and pembrolizumab (Keytruda) are anti-PD-1 drugs that have been shown to shrink or slow the growth of some tumors. They are now approved for use in advanced NSCLC, and are typically used after certain other treatments have been tried.

Other, similar drugs such as atezolizumab (MPDL3280A) and MEDI4736 might also shrink some lung cancer tumors. Larger studies of these new drugs are now being done.

Vaccines: Several types of vaccines for boosting the body’s immune response against lung cancer cells are being tested in clinical trials. Unlike vaccines against infections like measles or mumps, these vaccines are designed to help treat, not prevent, lung cancer. These types of treatments seem to have very limited side effects, so they might be useful in people who can’t tolerate other treatments.

Some vaccines are made up of lung cancer cells that have been grown in the lab, or even of cell components, such as parts of proteins commonly found on cancer cells. For example, the MUC1 protein is found on some lung cancer cells. A vaccine called TG4010 causes the immune system to react against that protein. A recent study compared combining the vaccine with chemotherapy to treatment with the same chemotherapy alone in patients with advanced lung cancer. The cancers in the group that got the vaccine were more likely to shrink or stop growing than the cancers in the group that just got chemo. More studies are planned to see if the vaccine will actually help patients live longer.

L-BLP25 (tecemotide) is another vaccine that targets the MUC1 protein. It is made up of the protein (MUC1) encased in a fat droplet (liposome) to try to make it more effective. A small study of patients with advanced NSCLC suggested it might improve survival time, although recent results from a larger study did not find it helped people live longer. This vaccine is now being studied for patients with stage III disease after treatment with chemotherapy and radiation, in efforts to improve the cure rate.

At this time, vaccines are only available in clinical trials.

Last Medical Review: 08/15/2014
Last Revised: 10/02/2015

Lung Cancer Prevention

Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.

To prevent new cancers from starting, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.

Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.

Different ways to prevent cancer are being studied, including:

  • Changing lifestyle or eating habits.
  • Avoiding things known to cause cancer.
  • Taking medicines to treat a precancerous condition or to keep cancer from starting.

Key Points

  • Lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.
  • Lung cancer is the leading cause of cancer death in both men and women.

Lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.

The lungs are a pair of cone-shaped breathing organs in the chest. The lungs bring oxygen into the body as you breathe in. They release carbon dioxide, a waste product of the body’s cells, as you breathe out. Each lung has sections called lobes. The left lung has two lobes. The right lung is slightly larger, and has three lobes. A thin membrane called the pleura surrounds the lungs. Two tubes called bronchi lead from the trachea (windpipe) to the right and left lungs. The bronchi are sometimes also involved in lung cancer. Tiny air sacs called alveoli and small tubes called bronchioles make up the inside of the lungs.

Enlarge

There are two types of lung cancer: small cell lung cancer and non-small cell lung cancer.

See the following PDQ summaries for more information about lung cancer:

Lung cancer is the leading cause of cancer death in both men and women.

More people die from lung cancer than from any other type of cancer. Lung cancer is the second most common cancer in the United States, after skin cancer.

The number of new cases and deaths from lung cancer is highest in black men.

Key Points

  • Avoiding risk factors and increasing protective factors may help prevent lung cancer.
  • The following are risk factors for lung cancer:
    • Cigarette, cigar, and pipe smoking
    • Secondhand smoke
    • Family history
    • HIV infection
    • Environmental risk factors
    • Beta carotene supplements in heavy smokers
  • The following are protective factors for lung cancer:
    • Not smoking
    • Quitting smoking
    • Lower exposure to workplace risk factors
    • Lower exposure to radon
  • It is not clear if the following decrease the risk of lung cancer:
  • The following do not decrease the risk of lung cancer:
    • Beta carotene supplements in nonsmokers
    • Vitamin E supplements
  • Cancer prevention clinical trials are used to study ways to prevent cancer.
  • New ways to prevent lung cancer are being studied in clinical trials.

Avoiding risk factors and increasing protective factors may help prevent lung cancer.

Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking, eating a healthy diet, and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.

The following are risk factors for lung cancer:

Cigarette, cigar, and pipe smoking

Tobacco smoking is the most important risk factor for lung cancer. Cigarette, cigar, and pipe smoking all increase the risk of lung cancer. Tobacco smoking causes about 9 out of 10 cases of lung cancer in men and about 8 out of 10 cases of lung cancer in women.

Studies have shown that smoking low tar or low nicotine cigarettes does not lower the risk of lung cancer.

Studies also show that the risk of lung cancer from smoking cigarettes increases with the number of cigarettes smoked per day and the number of years smoked. People who smoke have about 20 times the risk of lung cancer compared to those who do not smoke.

Secondhand smoke

Being exposed to secondhand tobacco smoke is also a risk factor for lung cancer. Secondhand smoke is the smoke that comes from a burning cigarette or other tobacco product, or that is exhaled by smokers. People who inhale secondhand smoke are exposed to the same cancer -causing agents as smokers, although in smaller amounts. Inhaling secondhand smoke is called involuntary or passive smoking.

Family history

Having a family history of lung cancer is a risk factor for lung cancer. People with a relative who has had lung cancer may be twice as likely to have lung cancer as people who do not have a relative who has had lung cancer. Because cigarette smoking tends to run in families and family members are exposed to secondhand smoke, it is hard to know whether the increased risk of lung cancer is from the family history of lung cancer or from being exposed to cigarette smoke.

HIV infection

Being infected with the human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS), is linked with a higher risk of lung cancer. People infected with HIV may have more than twice the risk of lung cancer than those who are not infected. Since smoking rates are higher in those infected with HIV than in those not infected, it is not clear whether the increased risk of lung cancer is from HIV infection or from being exposed to cigarette smoke.

Environmental risk factors

  • Radiation exposure: Being exposed to radiation is a risk factor for lung cancer. Atomic bomb radiation, radiation therapy, imaging tests, and radon are sources of radiation exposure:
    • Atomic bomb radiation: Being exposed to radiation after an atomic bomb explosion increases the risk of lung cancer.
    • Radiation therapy: Radiation therapy to the chest may be used to treat certain cancers, including breast cancer and Hodgkin lymphoma. Radiation therapy uses x-rays, gamma rays, or other types of radiation that may increase the risk of lung cancer. The higher the dose of radiation received, the higher the risk. The risk of lung cancer following radiation therapy is higher in patients who smoke than in nonsmokers.
    • Imaging tests: Imaging tests, such as CT scans, expose patients to radiation. Low-dose spiral CT scans expose patients to less radiation than higher dose CT scans. In lung cancer screening, the use of low-dose spiral CT scans can lessen the harmful effects of radiation.
    • Radon: Radon is a radioactive gas that comes from the breakdown of uranium in rocks and soil. It seeps up through the ground, and leaks into the air or water supply. Radon can enter homes through cracks in floors, walls, or the foundation, and levels of radon can build up over time.

    Studies show that high levels of radon gas inside the home or workplace increase the number of new cases of lung cancer and the number of deaths caused by lung cancer. The risk of lung cancer is higher in smokers exposed to radon than in nonsmokers who are exposed to it. In people who have never smoked, about 30% of deaths caused by lung cancer have been linked to being exposed to radon.

  • Workplace exposure: Studies show that being exposed to the following substances increases the risk of lung cancer:

    These substances can cause lung cancer in people who are exposed to them in the workplace and have never smoked. As the level of exposure to these substances increases, the risk of lung cancer also increases. The risk of lung cancer is even higher in people who are exposed and also smoke.

  • Air pollution: Studies show that living in areas with higher levels of air pollution increases the risk of lung cancer.

Beta carotene supplements in heavy smokers

Taking beta carotene supplements (pills) increases the risk of lung cancer, especially in smokers who smoke one or more packs a day. The risk is higher in smokers who have at least one alcoholic drink every day.

The following are protective factors for lung cancer:

Not smoking

The best way to prevent lung cancer is to not smoke.

Quitting smoking

Smokers can decrease their risk of lung cancer by quitting. In smokers who have been treated for lung cancer, quitting smoking lowers the risk of new lung cancers. Counseling, the use of nicotine replacement products, and antidepressant therapy have helped smokers quit for good.

In a person who has quit smoking, the chance of preventing lung cancer depends on how many years and how much the person smoked and the length of time since quitting. After a person has quit smoking for 10 years, the risk of lung cancer decreases 30% to 50%.

See the following for more information on quitting smoking:

Lower exposure to workplace risk factors

Laws that protect workers from being exposed to cancer-causing substances, such as asbestos, arsenic, nickel, and chromium, may help lower their risk of developing lung cancer. Laws that prevent smoking in the workplace help lower the risk of lung cancer caused by secondhand smoke.

Lower exposure to radon

Lowering radon levels may lower the risk of lung cancer, especially among cigarette smokers. High levels of radon in homes may be reduced by taking steps to prevent radon leakage, such as sealing basements.

It is not clear if the following decrease the risk of lung cancer:

Diet

Some studies show that people who eat high amounts of fruits or vegetables have a lower risk of lung cancer than those who eat low amounts. However, since smokers tend to have less healthy diets than nonsmokers, it is hard to know whether the decreased risk is from having a healthy diet or from not smoking.

Physical activity

Some studies show that people who are physically active have a lower risk of lung cancer than people who are not. However, since smokers tend to have different levels of physical activity than nonsmokers, it is hard to know if physical activity affects the risk of lung cancer.

The following do not decrease the risk of lung cancer:

Beta carotene supplements in nonsmokers

Studies of nonsmokers show that taking beta carotene supplements does not lower their risk of lung cancer.

Vitamin E supplements

Studies show that taking vitamin E supplements does not affect the risk of lung cancer.

Cancer prevention clinical trials are used to study ways to prevent cancer.

Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.

The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.

New ways to prevent lung cancer are being studied in clinical trials.

Clinical trials are taking place in many parts of the country. Information about clinical trials can be found in the Clinical Trials section of the NCI website. Check the list of NCI-supported cancer clinical trials for prevention trials for non-small cell lung cancer and small cell lung cancer that are now accepting patients. These include trials for quitting smoking.

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about lung cancer prevention. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (‘Date Last Modified’) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ‘standard.’ Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials are listed in PDQ and can be found online at NCI’s website. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as ‘NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].’

The best way to cite this PDQ summary is:

National Cancer Institute: PDQ® Lung Cancer Prevention. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.moverfairfaxva.com/?p=276. Accessed <MM/DD/YYYY>.

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 2,000 scientific images.

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Cancer

Cancer survival rate: What it means for your prognosis

Find out what a survival rate can tell you and what it can’t. This can help you put survival statistics in perspective.

By Mayo Clinic Staff

When first diagnosed with cancer, many people ask about their prognosis. You might want to know whether your cancer is relatively easy or more difficult to cure. Your doctor can’t predict the future, but can make an estimate based on other people’s experiences with the same cancer.

It’s up to you whether you want to know the survival rates related to your cancer. The numbers can be confusing and frightening.

What is a cancer survival rate?

Cancer survival rates or survival statistics tell you the percentage of people who survive a certain type of cancer for a specific amount of time. Cancer statistics often use an overall five-year survival rate.

For instance, the overall five-year survival rate for bladder cancer is 78 percent. That means that of all people who have bladder cancer, 78 of every 100 are living five years after diagnosis. Conversely, 22 out of every 100 are dead within five years of a bladder cancer diagnosis.

Cancer survival rates are based on research from information gathered on hundreds or thousands of people with a specific cancer. An overall survival rate includes people of all ages and health conditions who have been diagnosed with your cancer, including those diagnosed very early and those diagnosed very late.

Your doctor may be able to give you more specific statistics based on your stage of cancer. For instance, 52 percent, or about half, of people diagnosed with early-stage lung cancer live for at least five years after diagnosis. The five-year survival rate for people diagnosed with late-stage lung cancer that has spread (metastasized) to other areas of the body is 4 percent.

Overall survival rates don’t specify whether cancer survivors are still undergoing treatment at five years or if they’ve become cancer-free (achieved remission). Other types of survival rates that give more specific information include:

  • Disease-free survival rate. This is the number of people with cancer who achieve remission. That means they no longer have signs of cancer in their bodies.
  • Progression-free survival rate. This is the number of people who still have cancer, but their disease isn’t progressing. This includes people who may have had some success with treatment, but the cancer hasn’t disappeared completely.

Cancer survival rates often use a five-year survival rate. That doesn’t mean cancer can’t recur beyond five years. Certain cancers can recur many years after first being found and treated. For some cancers, if it has not recurred by five years after initial diagnosis, the chance of a later recurrence is very small. Discuss your risk of a cancer recurrence with your doctor.

How are cancer survival rates used?

You and your doctor might use survival statistics to:

  • Understand your prognosis. The experience of other people in your same situation can give you and your doctor an idea of your prognosis – the chance your cancer will be cured. Other factors include age and general health. Your doctor uses these factors to help you understand the seriousness of your condition.
  • Develop a treatment plan. Statistics can also show how people with your same cancer type and stage respond to treatment. You can use this information, along with your goals for treatment, to weigh the pros and cons of each treatment option.

    For instance, if two treatments give you similar chances for remission, but one has more side effects, you might choose the option with fewer side effects.

    In another example, a treatment may offer a chance for a cure, but only for 1or 2 people out of every 100. For some, these chances are promising enough to put up with side effects. For others, the chance for a cure isn’t worth the treatment’s side effects.

    Your doctor can help you understand the benefits and risks of each treatment.

See more In-depth