Treatment

Surgery, radiotherapy and chemotherapy may be used separately or together to treat cancer of the lung.

Planning your treatment

• your general health
• the type (small cell or non-small cell) and size of the tumour
• whether it has spread beyond the lung (its stage).

You may find that other people at the hospital are having different treatment from yourself. This may be because their illness takes a different form and they have different needs. If you have any questions about your own treatment, don’t be afraid to ask your doctor or the nurse looking after you. It often helps to make a list of questions for your doctor, and to take a close friend or relative with you.

This section discusses the treatments for small cell lung cancer and non-small cell lung cancer separately, because they can be quite different. The actual treatments are discussed in more detail later in the treatment section.

Small cell lung cancer

Chemotherapy is the main treatment for small cell lung cancer. In many people chemotherapy for small cell lung cancer will enable them to live for longer with better control of symptoms. Chemotherapy may be given on its own, or before radiotherapy. If chemotherapy and radiotherapy are both used this is known as chemoradiation.

Surgery is not usually used to treat small cell cancer, except in very early cases. This is because the cancer has usually spread to other parts of the body before being diagnosed, even if it cannot be seen on a scan.

The scans and tests you had to diagnose the cancer may be repeated later to see how well the cancer is responding to treatment.

Sometimes, if chemotherapy has worked very well for people with small cell lung cancer, radiotherapy is given to the head (known as prophylactic cranial radiotherapy) to reduce the risk of the cancer spreading to the brain. CancerBACUP can send you information about prophylactic cranial radiotherapy.

In advanced lung cancer, radiotherapy may also be used very effectively to relieve symptoms, such as pain.

Non-small cell lung cancer

Early-stage (1 and 2) non-small cell lung cancer can often be removed with surgery. If people have other medical problems or are not fit enough to have surgery, radiotherapy may be given to the lung tumour, instead. Chemotherapy is sometimes given before surgery and/or radiotherapy. This is called neo-adjuvant chemotherapy. Chemotherapy is also sometimes used after surgery (adjuvant chemotherapy), to reduce the risk of the cancer coming back.

If the NSCLC has spread into tissue close to the lung or to the lymph nodes it may be treated with:

• just radiotherapy
• radiotherapy and chemotherapy
• just surgery.

If the NSCLC has spread to other parts of the body or is affecting more than one lobe of the lung, radiotherapy may be used to shrink the cancer and reduce symptoms. Sometimes chemotherapy may be given before or after the radiotherapy and may shrink the cancer for some people. The aim is to control symptoms and prolong a good quality of life. Radiotherapy may also be very effective in relieving symptoms such as pain.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but you need to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.

It is important to tell a doctor, or the nurse in charge, immediately so that he or she can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

The benefits & disadvantages of treatment

Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. Some people ask what would happen if they did not have any treatment.

Although many of the treatments can cause side effects, knowledge about how these treatments affect people and improved ways of reducing or avoiding many of these problems have made most of the treatments much easier to cope with.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. In people with early-stage non-small cell lung cancer, surgery is often done with the aim of curing the cancer. Occasionally additional treatments are also given to reduce the risks of it coming back.

If the cancer is at a more advanced stage the treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some people the treatment will have no effect upon the cancer and they will get the side effects without any of the benefit.

If you have been offered treatment that is intended to cure your cancer, deciding whether to accept the treatment may not be difficult. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead with treatment.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss this in detail with your doctor. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.

Second opinion

Usually a number of cancer specialists work together as a team and they use national treatment guidelines to decide on the most suitable treatment for a patient. Even so, you may want to have another medical opinion. Either your specialist or your GP can refer you to another specialist for a second opinion, if you feel it will be helpful. The second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will provide useful information.

If you do go for a second opinion, it may be a good idea to take a friend or relative with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.