Lung Cancer: Treatment

Medical treatment of lung cancer involves combinations of surgery, radiation, and chemotherapy. Treatment is largely palliative, although early detection and treatment of the cancerous process may significantly improve prognosis and prolong survival.

Surgery. The main treatment for squamous cell carcinoma, adenocarcinoma, and large cell cancer is surgery, unless the tumor is unresectable, or the patient is not a surgical candidate. Surgery can involve partial removal of diseased lung areas (segmentectomy, lobectomy, bronchopulmonary resection with bronchoanastomosis), or total lung removal (simple or radical pneumonectomy), with removal of metastatic lymph nodes.

Chemotherapy. Chemotherapy is the primary treatment for small cell cancer and an adjuvant for the other types. However, it has serious side effects, such as myelosuppression, neutropenia with infection, thrombocytopenia, nausea, vomiting, and alopecia, without improving significantly the life expectancy and survival rate. Doxorubicin may cause cardiomyopathy, vincristine and cisplatin are potentially neurotoxic, and cyclophosphamide may cause hemorrhagic cystitis.

Radiation therapy. Radiation may reduce tumor bulk to allow surgical resection. Radiation is usually recommended in early stages of cancer if surgery is contraindicated, or as an adjunct to surgery. A serious side effect is the “irradiated lung,” with symptoms of radiation pneumonitis (dyspnea, cough, chest pain, fever, and malaise) and later pulmonary fibrosis, with severe alteration of pulmonary parenchyma. Irradiation also depresses immune function.

Three–dimensional conformal radiation therapy. 3D CRT, a new and innovative therapeutic technique, increases the radiation dose delivered to a tumor and improves local control, allowing less irradiation of adjacent tissues than the conventional two–dimensional technique.

Fast–neutron radiotherapy. This therapy leverages high linear energy transfer to increase the effectiveness of radiation.

Symptomatic Treatments. An important part of the therapeutic plan is treatment of the symptoms that accompany lung cancer and its metastatic manifestations. Pain may be mild or severe, and requires analgesic anti–inflammatory drugs or opioid derivates. Pain in the thoracic wall can be treated with infiltrations of affected nerves with anesthetic substances or alcohol. Hemoptysis can be treated with procoagulants, such as vitamin K. Sleep disorders due to pain, lack of appetite, dyspnea, cough, and asthenia can also respond to focused treatment. Superinfections are common and should be treated with appropriate antibiotics, antifungals, and expectorants.