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.
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.’
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 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.
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.
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
- 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 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.
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.
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 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.