A clear knowledge about the stage of lung cancer is necessary to know about its size, and also about the extent of its spread to different lymph nodes and organs of the body. This helps the physician to decide the modality of lung cancer treatment.
For all practical purposes, plans of lung cancer treatment of the patient are based on the stage and also the type of cancer; that is whether it is small-cell lung cancer, SCLC, or nonsmall-cell lung cancer, NSCLC. In majority of the cases the main intention of surgery as a measure of lung cancer treatment, is removal of the malignant tumor, known as thoracotomy. Thoracotomy is a surgical procedure, in which the chest is opened by a thoracic surgeon under general anesthesia, and the malignant lung tissue is removed. During this surgical procedure, the thoracic surgeon may remove a part or the whole of a lung. Removal of a very small part of the lung is referred to as wedge resection, and removal of a slightly larger part of lung is known as segmentectomy. A lobectomy, removal of one lobe, is the most common surgery performed in early stage NSCLC. A pneumonectomy means removal of the entire lung.
Surgery is not typically advised for SCLC treatment, because the disease is commonly extensive at the time of diagnosis. Once the condition is diagnosed as SCLC, and the extent of the disease is described as either limited or extensive, then commonly the treatment of choice is either chemotherapy and/or radiotherapy. Sometimes surgical intervention is performed combined with chemotherapy and/or radiation therapy. Studies have revealed out that, in approximately 45% of all patients diagnosed with NSCLC, surgical resection besides being a significant therapeutic measure, effectively also controls the disease.
Radiation therapy for lung cancer treatment, may be either through external beam radiation therapy, or internal radiation therapy. In the external beam radiation therapy, which is the most commonly practiced procedure, a high-dose radiation is delivered with the help of an external machine. A few other common forms of external radiation therapy are; conventional radiation therapy, which is a two-dimensional method; 3 D conformal radiation therapy, which uses computed tomography, abbreviated as CT, a method of therapy to view the tumor in three dimensions.
Intensity Modulated Radiation Therapy, abbreviated as IMTR, is another method which provides higher doses of radiation from various angles. Radiation is sometimes delivered internally in the form of internal radiation, which is known as brachytherapy. Radiation therapy for lung cancer treatment is commonly given on a daily basis, on all the five days of a week excepting the week-end; for about six weeks. Following analysis, the oncologist determines the dose of radiation, which is measured in Gy, and pronounced as grays. In SCLC, radiation therapy is sometimes given to the brain to destroy any cells that have metastatized to the brain but are not diagnosed by scans. This is known as Prophylactics Cranial Irradiation, abbreviated as PCI.
A combination of radiotherapy and chemotherapy is highly recommended in patients with stage 3 or stage 4 lung cancer which cannot be surgically removed. Radiation therapy is found to give successful results in patients diagnosed with stage one or two NSCLC.
Of late, there has been development of different methods of molecular targeted lung cancer treatment, following various research works by scientists and oncologists. In this connection, one such drug targeting on tyrosine kinase is known as Gefitinib. This drug is found to mainly have an effect on the epidermal growth factor receptor, commonly abbreviated as EGFR. Though this drug does not effectively improve the prognosis of the patients, but however, female patients, nonsmokers, and those diagnosed with bronchioaloalveolar carcinoma are found to have profound benefits following therapy with gefitinib. Erlonitib, which is also known as Tarceva is another type of EGFR, which inhibits tyrosine kinase; and is found to improve the prognosis in patients with NSCLC.
Novel lung cancer treatment: Vaccination is the latest novel approach, which is under research for lung cancer treatment. Experiments are being performed for the study about a vaccine called human melanoma antigen-A3, abbreviated as MAGE-A3 and Antigen-Specific Cancer Immunotherapy, abbreviated as ASCI. Angiogenesis inhibitor like for example bevacizumab together combined with paclitaxel and carboplatin is found to result in an improvement in the prognosis of patients diagnosed with advanced NSCLC. But this drug is found to be associated with the side effect of causing hemorrhage in the lung, especially in patients diagnosed with squamous cell carcinoma.
Latest research studies about cytotoxic drugs and pharmacogenetics have revealed out that, there are numerous targeted drugs which are in the early stages of clinical research, like for example, cyclo-oxygenase-2. Proteasome inhibitors like bexarotene wish is the epidermal growth factor receptor inhibitor for instance cetuximab and drugs like Crizotinib have shown the evidence of promising results especially in patients diagnozed with NSCLC. Various studies like those about proto-oncogene inhibition, and replacement of tumor suppressor gene may be of great help in the future in the treatment of patients diagnosed with lung cancer.
Chemotherapy drugs are often administered in combination. For example, carboplatin and paclitaxel; vinorelbine and cisplatin or carboplatin, etc. However this combination of chemotherapeutic drugs, and the number of cycles is decided by the concerned oncologist. The Majority of the chemotherapeutic drugs used for the treatment of lung cancer are administered through the intravenous route, known as, intravenous chemotherapy. For this, a port or a catheter line is placed in the patient’s body to administer the drug. The most common examples of intravenous chemotherapy for lung cancer include carboplatin and cisplatin. Oral chemotherapy means the administration of chemotherapy drug orally either as pills or liquids; or sublingually. Two common oral chemotherapy drugs used for lung cancer include etoposide for SCLC; and vinorelbine for NSCLC.
Metronomic chemotherapy is a novel method of chemotherapy for lung cancer patients, which is quite well-tolerated by most patients. This unique method of chemotherapy is usually practiced by the health professionals at the Cancer Treatment Centers of America, abbreviated as CTCA for lung cancer treatment. Instead of a single large dose, drugs are given in smaller doses over a period of several days. Metronomic chemotherapy is frequently used in combination with radiation therapy.