Cancer is by far one of the most complicated ailments to treat, and lung cancer is not the exception. Different lines of treatment are available for patients with small-cell lung cancer and non-small cell lung cancer. They depend on the stage of the disease and any complication the patient may have.
This article will briefly discuss the treatment modalities of lung cancer and provide a broad understanding of how each one is selected and its side effects.
Emergency Treatment For Lung Cancer
In emergency settings, doctors treat cancer according to the symptoms or complications it is causing. The goal is not eradicating the disease but solving the problem that is causing the emergency.
In most cases, emergency in lung cancer is associated with respiratory distress and airway obstructions. The solution may require intubation, admission to an intensive care unit, and procedures such as cricothyrotomy or tracheostomy to obtain easier access to the respiratory tract. Throughout this time, supplemental oxygen is essential to maintain an adequate level of arterial blood gas.
Surgical Treatment For Lung Cancer
When not in an emergency setting, surgery is the mainstay of treatment in patients with a limited or localized disease. When no spread is found in the mediastinum or any other organ, surgical resection of the mass is performed. Different methods can be used, including lumpectomy when only the nodule is taken out, lobectomy when a complete lobe of the lung is taken out, or pneumonectomy when the totality of the affected lung is taken out. This treatment is only recommended when there is one nodule or multiple nodules in the same lung, and the most common technique is lobectomy.
Before surgery, every patient should undergo a preoperative evaluation to see if surgery is appropriate for them. Their risks are evaluated with studies such as PET, CT scans, and complete blood count. Their cardiopulmonary health is also assessed to see if they are good candidates for surgery.
Besides taking out the tumor, doctors may also need to take out lymph nodes, and this is known as lymphadenectomy. Lymph nodes in the mediastinum are routinely taken out for samples in some cases.
Common side effects of surgery are usually related to wound care and infection. Complications depend on the anesthetics and the cardiorespiratory status of the patient.
Radiotherapy For Lung Cancer
In localized cancer, radiation therapy is recommended combined with surgery or when surgery is not a choice due to cardiopulmonary problems and other health conditions. There are different schedules, and each one can be adapted for each patient. For example, it is known that patients with very poor health benefit from a type of schedule known as hyperfractionated radiation therapy. It is also known that complex radiotherapy improves the prognosis in elderly patients who are not candidates for chemotherapy.
There is also adjuvant radiotherapy, which is meant to eliminate traces of the tumor after surgery. This type of treatment is currently controversial, and not all doctors use this approach. Early-stage non-small-cell lung cancer can be treated with stereotactic body radiotherapy, which uses high doses of radiation in 1 or 2 fractions. This allows reducing the side effects and the negative aspects of radiotherapy.
Side effects of radiotherapy are usually localized to the treatment area and include peeling skin, itchiness, reddening, or drying of the skin. It may also cause swallowing problems, shortness of breath, a sore throat, weakness, and fatigue.
ChemotherapyFor Lung Cancer
This therapy for cancer uses cytotoxic agents that attack cells when they divide very rapidly. Most cells won’t divide as rapidly as cancer, so it should only affect cancer in theory. But other rapidly-dividing cells in the body can be affected too, especially those of the gastrointestinal tract and the bone marrow.
Chemotherapy is usually recommended at some point of the therapy, especially when there’s a relapse of the disease or in cases of metastasis. Adjuvant chemotherapy has an essential role among elderly patients and is often considered in late-stage conditions or when spread to other organs is not confirmed but strongly suspected.
This type of therapy is beneficial for small-cell lung cancer because many non-small-cell lung cancer types are known to be resistant to this approach.
Side effects of chemotherapy include systemic problems such as weight changes, loss of appetite, weakness, and fatigue. It also causes several symptoms associated with tissues that divide rapidly, such as the gastrointestinal lining and the bone marrow. Thus, patients typically exhibit constipation, diarrhea, nausea, vomiting, mouth sores, anemia, and other alteration in their blood.
Targeted Therapy For Lung Cancer
As we understand lung cancer more thoroughly, it is possible to develop targeted therapy for specific cancer types according to their metabolism. This type of treatment is not available for everyone and depends on the type of cancer you have and particular markers and genetic traits.
Side effects are not as common or severe as in chemotherapy, but they also include dry skin, hepatitis, elevated liver enzymes, and diarrhea.
Management For Brain Metastasis and Spinal Cord Compression
Metastasis to the neurologic system and bone metastasis that trigger spinal cord compression is more common in small-cell lung cancer due to the aggressiveness of the disease.
In these cases, symptomatic treatment is given to the patient with corticosteroid and brain radiation therapy to destroy metastasis in the brain. If the patient does not yet display symptoms, chemotherapy is preferred, and then radiotherapy can be planned.
In spinal cord compression cases, corticosteroids are also administered immediately to prevent further damage to the affected nerves. Then, management requires surgical decompression of the area, which is often combined with radiation therapy depending on the trigger.
In lung cancer patients, long-term monitoring is essential to reduce the incidence of adverse events and complications. Throughout this period, patients are prompted to quit smoking, eat healthily, and exercise to reduce the risk factors that may further aggravate their condition.
References:
Farago, A. F., & Keane, F. K. (2018). Current standards for clinical management of small cell lung cancer. Translational lung cancer research, 7(1), 69.
Herbst, R. S., Morgensztern, D., & Boshoff, C. (2018). The biology and management of non-small cell lung cancer. Nature, 553(7689), 446-454.
