Treatment for lung cancer depends upon a variety of factors. The most important factors are the histopathologic (diseased tissue) type of lung cancer and the stage of the cancer.
Once the stage of the lung cancer has been determined, the oncology team and the patient work together to develop a treatment plan. It is important for lung cancer patients to discuss the value of different forms of therapy with their oncologist. Other factors that affect lung cancer treatment include the patient's general health, medical conditions that can affect treatment (such as chemotherapy), and tumor characteristics.
Characteristics of the lung tumor are used to help separate patients into two groups: patients who are at low risk for cancer recurrence and patients who are at high risk for cancer recurrence. Specific prognostic—disease-forecasting—factors are used to place patients in either of these groups. In particular, the histopathologic groupings of small cell lung carcinoma (SCLC) versus non-small cell lung carcinoma (NSCLC) may be used to better predict a patient's prognosis and expected response to therapy.
Surgical resection (cutting away) of the tumor generally is indicated for cancer that has not spread beyond the lung. Surgery for lung cancer may be conducted using a variety of techniques. Thoracotomy, which is performed throught the chest wall, and median sternotomy, which is performed by cutting through the breastbone, are standard methods used for lung cancer surgery.
Alternative approaches include anterior limited thoractomy (ALT), which is performed on the frontal chest using a small incision; anterioraxillary thoracotomy (AAT), which is performed on the frontal chest near the underarm; and posterolateral thoracotomy (PLT), which is performed on the back/side region of the trunk.
ALT, in particular, is less invasive than standard thoractomy—that is, this procedure involves less disturbance of the body than large incisions or other intrusive measures. ALT may result in less blood loss during and after surgery, less postoperative drainage, and less postoperative pain than standard thoracotomy.
Recently, surgeons have developed other less invasive procedures for the removal of cancerous lung tissue. For example, video-assisted thoracoscopy (VAT), also known as video-assisted thoracic surgery (VATS), involves using a video camera to help visualize and operate on the lung within the chest cavity. The surgical incisions made during VAT are much smaller than those required for thoracotomy or sternotomy.
However, some physicians caution that VAT does not allow complete lung examination to identify and remove metastases that are not detected by preoperative chest x-ray. VAT is perhaps most appropriate for Stage 1 and Stage 2 cancers that require lobectomy (surgical removal of a lung lobule) with lymphadenectomy (removal of one or more lymph nodes) and for peripheral (outer edge) lung tumors that can be removed by wedge resection. In such cases, follow-up is required to establish a long-term prognosis.
Computed tomography (CT) scans also have been added to VAT technology to improve lung cancer surgery. Experts have found that percutaneous (through the skin) CT-guided localization wires can help to identify tumorous lung nodules. In this way, wires are used to assist VAT in cases that require sublobectomy resection (partial removal of a lung lobe).
Unfortunately, surgical procedures can cause a condition called lymphocytopenia—low number of lymphocytes (white blood cells) in the blood—which is linked to shorter survival times among patients with advanced lung cancer. Lymphocytopenia may be related to a deficiency in interleukin-2 (IL-2), a hormone that controls the activity of T lymphocytes (thymus-dependent lymphocytes). Preoperative treatment with recombinant human interleukin-2 (rhIL-2) may help to prevent the decrease in lymphocytes that occurs after surgery for operable lung cancer.
If the tumor is aggressive and/or widespread, chemotherapy, radiotherapy (radiation therapy), and other therapies may be used in addition to or instead of surgery to treat lung cancer.
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