Lung Cancer Treatment Options New
Lung Cancer Treatment Options New More than one in four cancers diagnosed affects the lungs, and lung cancer is still the leading cause of cancer-related death among American men and women. At the same time, it may well happen that a large number of lung cancers are preventable. Inhalation of carcinogenic substances such as tobacco smoke can lead to changes in lung tissue – so-called precancerous changes – shortly after exposure. Nevertheless, cancer itself usually develops over a period of many years and, if detected early enough, can often be successfully treated with a variety of treatments.
What are my treatment options?
Assessment before treatment
- Before treatment, a biopsy is usually performed to determine if and what type of cancer is present in a patient.
- Tests are recommended to determine the stage of the tumor. These tests usually include blood tests and imaging. Imaging usually includes computed tomography (CT) of the breast and may include a PET/CT examination and an MRI of the brain. Treatment options and expected treatment outcomes depend on the stage of the tumor.
- Treatment options at a glance
- How does the treatment method depend on the type of lung cancer?
- How does the stage of the disease control the treatment of lung cancer?
- How effective is the treatment of inoperable lung cancer?
- Treatment options at a glance
About one-third of lung cancer patients are diagnosed with a localized disease that is indicated either by surgical resection or, if the patient is not eligible for complete surgical resection, by final radiotherapy can be treated. Another third of patients suffer from a disease that has already spread to the lymph nodes. In these cases, radiotherapy is used together with chemotherapy and occasional surgery. The last third of patients may have tumors that have already spread through the bloodstream to other parts of the body and are typically treated with chemotherapy and sometimes radiotherapy to relieve symptoms.
- Surgery with the removal of the entire globe in which the tumor is located in the primary treatment for patients with early-stage cancer who are in good general condition. The aim of the operation is to completely remove all tumor cells and thus achieve a cure. Unfortunately, lung cancers tend to develop in smokers over 50, who very often suffer from other lung diseases or serious conditions that increase the risk of surgery. The position and size of a lung tumor determine how extensive the operation must be. Inappropriately selected patients, an open thoracotomy or less invasive video-assisted thorax surgery or robot-assisted thorax surgery with smaller incisions may be recommended.
- Lobectomy, the removal of an entire pulmonary lobe, is a recognized method for the removal of lung cancer when the lungs function well. The risk of mortality is less than three to four percent and tends to be highest in older patients. There are three lobes on the right (top, middle, and bottom) and two on the left (top and bottom).
- Sublobary resection can be called either a “wedge resection” or a “segmentectomy”. If lung function prevents a lobectomy or a tumor is very small, a sublobar resection can be performed in which a small, limited to a limited area cancer can be removed with a small part of the surrounding lung tissue. Sublobarian resection may carry a higher risk of recurrence than lobectomy. Sublobar resections are associated with a lower loss of lung function compared to lobectomy, as a smaller part of the lungs is removed. They carry an operating mortality risk of 1.4 percent. Not all small tumors can be removed by sublobar resections. Usually, these are deep in the middle of the lobe.
- Pneumonectomy: If the entire lung needs to be removed by “pneumonectomy”, the expected mortality rate is higher (five to eight percent), with the oldest patients having the highest risk. This happens when tumors are very large or are very close to the large blood vessels (pulmonary artery or vein) of the breast or main bronchi.
- Mediastinoscopy: A mediastinoscopy is performed by a small incision in the lower neck above the sternum (breast leg) and is used to remove the lymph nodes in the central breast (mediastinum). An alternative to mediastinoscopy is an EBUS.
- Radiotherapy or radiotherapy provides high-energy X-rays that can destroy rapidly dispersing cancer cells or alleviate symptoms or relieve symptoms. It has many uses in lung cancer:
- As an initial treatment
- Shrink the tumor before surgery
- After surgery to eliminate all cancer cells that remain in the treated area
- To treat lung cancer that has spread to the brain or other parts of the body, or to alleviate symptoms
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- Radiotherapy can not only attack the tumor but also help alleviate some of the symptoms caused by the tumor, such as bleeding. In the case of initial treatment instead of surgery, radiotherapy can be done alone or in combination with chemotherapy. Today, many patients with small localized lung cancer, but who are not candidates for surgery, are treated with a radiation technique known as stereotactic body radiation therapy (SBRT). Poor candidates for surgery include the elderly, patients with chronic heart failure, and patients receiving a blood-thinning drug at risk of surgical bleeding. SBRT involves treatment with a variety of small, focused rays that track the lung tumor along with its respiratory movement, typically in three to five treatments. This treatment gives lung cancer very high doses of radiotherapy in patients who are not eligible for surgery. SBRT is mainly used to treat localized diseases in the early stages. For more information about SBRT, see the SRS and SBRT pages.
- In most cases, radiotherapy is carried out by external radiation technology, in which an X-ray beam is directed directly at the tumor. Treatment is carried out in a series of sessions or fractions, usually over six to seven weeks in conventional treatments and over one to five treatments in patients who can be treated with SBRT. For more information, see the External Radiotherapy (EBT) page. Three-dimensional compliant radiotherapy or intensity-modulated radiotherapy (IMRT) are relatively new techniques based on a 3D image of the tumor taken with CT scanning. This image serves as a target for a high-dose beam that can adapt in shape and size to the tumor. This method minimizes the radiation exposure of normal lung tissue nearby. For more information, see the Intensity Modulated Radiotherapy (IMRT) page.
- In brachytherapy, the radiation is released directly to the site of the disease. This is usually achieved either by a surgical procedure in which radioactive semen is sewn to the edge of the surgical resection after resection of the primary tumor. When an obstructive tumor is inserted into a respiratory tract, the radiation is released by a plastic tube, which is temporarily inserted into the airway, in place of the obstruction. This can help alleviate severe symptoms but does not cure cancer.
- Chemotherapy is a medicine that is toxic to cancer cells. The drugs are usually administered by direct injection into a vein or by a catheter in a large vein. Chemotherapy is often used after surgery to sterilize microscopic diseases. It can also slow tumor growth and alleviate symptoms in patients who cannot undergo surgery. Newer biological agents, which may have fewer side effects than conventional chemotherapy and maybe just as effective in some cases, are used. This treatment is used at all stages of lung cancer and can prolong the lives of older people if they are in good general condition. Some chemotherapy drugs increase the damage to tumors by irradiating cancer cells. Others keep the tumor cells at a stage where they are most susceptible to radiation or impair the ability of cancer cells to repair themselves after radiation therapy. There is growing evidence that a combination of these drugs in combination with radiotherapy is more effective than radiotherapy alone, but there is a significant risk of serious side effects.
Chemotherapy can cause significant side effects, such as nausea with vomiting and damage to the white blood cells needed to fight infections. However, most of these side effects can be combated and treated in various ways.
How does the treatment method depend on the type of lung cancer?
There are two main types of lung cancer with different microscopic appearances:
- Small cell lung cancer (SCLC) – also known as oat cell cancer – usually occurs inactive or former cigarette smokers. Although SCLC is less common than the other type of lung cancer, it is a more aggressive tumor that is more likely to spread to other parts of the body. Chemotherapy is the mainstay of SCLC treatment. Radiotherapy is often used in combination with chemotherapy to treat lung tumors that have not spread beyond the breast or other organs. Surgery is not commonly used in SCLC due to the tendency to spread rapidly. While operations are rarely used to treat patients with SCLC, tissue samples are occasionally taken for microscopic examinations to determine the type of lung cancer present. In small cell lung cancer, the radiotherapist may propose radiotherapy directed to the brain after treatment aimed at the disease in the breast, although no cancer was found there. This is called prophylactic skull irradiation and is intended to prevent lung cancer metastases from forming in this vital site.
- Non-small cell lung cancer (NSCLC) tends to grow more slowly and it takes longer to spread beyond the lungs. Local treatments such as surgical procedures and/or radiotherapy are the main duration of treatment for NSCLC. When chemotherapy is used, it is often used to increase the effectiveness of surgery or chemotherapy, and generally differs from SCLC in NSCLC. Different types of chemotherapy can be used for different types of non-small cell lung cancer.
How does the stage of the disease control the treatment of lung cancer?
Small cell lung cancer:
- For limited-stage diseases (limited to the chest), chemotherapy and radiotherapy are used as a cure. Radiation typically begins at the same time as the first or second dose of chemotherapy. Six weeks of irradiation once daily or three weeks of irradiation twice a day are common irradiation schemes.
- For a limited stage, the radio oncologist can propose radiotherapy that targets the brain, even though no cancer has been found there.
- In the case of an extensive SCLC at the stage, chemotherapy is alone the mainstay of therapy.
- For an extended stage, the radio oncologist may consider radiotherapy aimed at the brain, even though no cancer was found there. There is less strong evidence of prophylactic brain radiation than in limited-stage diseases.
- Compression radiation to the bulky areas of the original tumor in the breast can also be considered.
- In the event of a recurrence of a disease or disease that persists after initial treatment, radiotherapy or chemotherapy can help to relieve pain or other symptoms. Through radiotherapy or laser treatment, the airways can remain open and the patient can breathe more freely.
Non-small cell lung cancer:
- Early-stage: The earliest NPLs are very small tumors. Special tests may be required to locate the main tumor. Early-stage tumors undergo stereotactic or radiotherapy surgery.
- Advanced stage: Combined treatment is indicated when cancer has spread to structures near the lungs, such as the chest wall, diaphragm or lymph nodes in the breast. Depending on the exact location of cancer, radiotherapy can be done alone or in combination with surgery and/or chemotherapy.
- The tumor that has spread to other parts of the body: Systemic therapy (chemotherapy, targeted therapy or immunotherapy) is the main treatment for patients whose tumors have spread through the breast or into the opposite lung. Surgery generally does not benefit people whose cancer has spread across the breast. Chemotherapy prolongs life and radiotherapy can be used to alleviate symptoms caused by the tumor. Sometimes brain surgery is recommended for patients whose NSCLC has patients whose NSCLC has spread to the brain.
- Every lung cancer patient should consider participating in a clinical trial to find more effective treatments for lung cancer.
Read more: Lung Cancer Treatment Options and Prognosis
How effective is the treatment of inoperable lung cancer?
Lung Cancer Treatment Options New It is extremely important to remember that “inoperable” does not mean “incurable” when it comes to lung cancer. In fact, an increasing number of patients are being treated with a non-surgical approach across all stages of this disease. The effectiveness of the treatment depends on the stage of the disease. At an early stage of an inoperable disease, which is treated only with radiotherapy, the control of the local disease is typical. In more advanced diseases, a combination of chemotherapy and radiation is administered with curative intent. The cure rates are lower, but with the spread of the disease to the lymph nodes in the breast still possible. The doctor or radiotherapist may propose a combination of chemotherapy and radiotherapy for an active patient.
If a cure is not possible, palliative treatment is recommended. This is the use of drugs, chemotherapy, radiotherapy or other measures to alleviate symptoms of lung cancer without actually eliminating the tumor. The radiotherapy doses used are lower to avoid side effects. If you and your oncologist or family doctor believe at any given time that active treatment is no longer advisable, hospice care can provide comfort and support. Pain relief is a very important part of the treatment of lung cancer. Although many effective treatments are available and there are devices that can be used to dispense medications without overdose when needed, many cancer patients still do not receive adequate pain relief. If the needs of the patient are clearly expressed, the treating doctors can better ensure adequate care.
What happens during radiotherapy?
Radiotherapy is the delivery of focused high-energy X-rays (photons), gamma rays or atomic particles. It affects cells that quickly divide – like cancer cells – much more than those that do not share. Most cancers, including lung tumors, consist of cells that divide faster than those in normal lung tissue, raising hopes that the tumor can be eliminated without damaging the surrounding normal tissue. Radiotherapy attacks the genetic material – or DNA – in tumor cells, making it impossible for them to grow and produce more cancer cells. Normal body cells can also be damaged – albeit less pronounced – but they can repair themselves and function properly again. The main strategy is to keep the daily radiation dose so high that a high percentage of rapidly dividing cancer cells are killed, while at the same time the damage to the slower-sharing normal tissue cells in the same area is killed. minimized.
What are the possible side effects of radiotherapy?
- Most patients get tired easily after receiving their first radiation treatments. This fatigue gradually increases with progressive treatment and can become severe, seriously limiting the ability to exercise normal daily activities. As a rule, fatigue decreases one to two months after completion of radiotherapy. When you get tired, it is important to rest sufficiently. At the same time, your doctor may recommend that you stay as active as possible.
- In some patients, hair loss occurs in the area of the chest wall, which is enclosed in the irradiation field. Depending on how much radiation is emitted, this can be temporary or permanent.
- Skin irritation often occurs after a few weeks of radiotherapy. The affected area can be red, dry, tender and itchy. This reaction can become quite severe during a long course of treatment. It helps to keep the skin clean with mild soap and warm water, to dry it well and to avoid very hot water when bathing. Sunscreens should be used when the skin is exposed to sunlight in the treated area. Perfumes, cosmetics, and deodorants should not be used in the area of treatment. After the daily treatments, you can apply a cream or lotion without fragrance.
- A temporary loss of appetite is possible.
- Esophagitis or inflammation of the esophagus (the tube that transports food from mouth to stomach) is common when radiotherapy is directed at the lymph nodes in the central breast or when the tumor is near the esophagus and is severe Can. The esophagus is very sensitive to radiation and the symptoms are worse in patients who also receive chemotherapy. Esophagitis can make swallowing difficult, and some patients need painkillers or fluids released through the vein to survive the entire course of radiation treatment. Some people experience esophagitis as feeling a lump or discomfort before it becomes overly painful. Some foods (such as spicy or sour foods or bread) feel worse than others. It is important to remember that while certain foods can cause pain when swallowing, eating these foods does not cause any harm. You should avoid foods that cause pain until about a month after the last day of radiation. Inflammation generally disappears towards the end of treatment and begins to disappear in most patients within two to three weeks of treatment.
- Inflammation of the lungs, known as radiation pneumonitis, can develop three to six months after the end of radiotherapy. It causes coughing and shortness of breath as well as fever, but in most cases do not require specific treatment and improves within two to four weeks. It can occasionally happen earlier and require steroids and/or oxygen.
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What kind of aftercare should I expect?
Lung Cancer Treatment Options New At the end of radiotherapy, your doctor will normally want to see you after four to six weeks and every three to six months for the first two years. After that, you may be seen every six months for three years, and then once a year. Your doctor or radio oncologist often recommends that you perform computed tomography (CT) or positron emission tomography (PET) about four to eight weeks after completion of treatment when the response is expected to be greatest. These images help to assess the reaction and allow comparison with images taken during follow-up. In this way, treatment-related complications can be detected at an early stage and the difference between recurrent cancer and lung scars caused by high-dose irradiation can be identified. Regular thoracic imaging (usually no more than two to four times a year) can allow recurrent cancers to be detected in time for successful treatment.
In addition to X-rays, other tests such as blood count and bronchoscopy can also be a routine part of the post-examination. Other tests, such as bronchoscopy, can be performed for certain symptoms or findings in breast imaging. If new symptoms appear on another part of the body, tests can be performed to identify potential problems.
After treatment, the tumor may be permanently disappeared (cured) or regrow in an area of the original tumor (recurrence) or left behind after treatment (residual tumor). Patients who have had cancer may develop a second, unrelated primary lung cancer. This happens at a rate of about 3 percent of patients per year.
Lung Cancer Treatment Options New
Are there any new developments in the treatment of my disease?
- Less invasive surgical methods are currently being investigated. They require a much smaller incision and allow the patient to get up within a few hours of the end of the operation.
- Immunotherapy is used to strengthen the patient’s immune system and help fight cancer. Some studies, but not all, have shown better survival rates when these drugs are administered after surgery.
- Gene therapy can kill cancer cells or slow their growth when healthy genes are released directly into a lung tumor.
- Angiogenesis inhibitors are agents that prevent new blood vessels from forming in growing cancers and actually shut down the blood supply to the tumor. This remains an experimental approach, but it is partly promising as it appears to cause very few side effects.
- Genetic tests are evaluated to select patients for appropriate treatment.
- Stereotactic body therapy (SBRT) can control early-stage tumors at a rate comparable to that achieved by surgery.