Lung cancer

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Treatments for non–small cell lung cancer

If you have non–small cell lung cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for non–small cell lung cancer, your healthcare team will consider:

  • the stage of the cancer
  • whether the cancer can be removed with surgery
  • any genetic changes to the lung cancer cells
  • immune checkpoint markers in lung cancer cells
  • your overall health, including your lung function
  • your personal preferences (what you want)

You may be offered one or more of the following treatments for non–small cell lung cancer.

Surgery

Surgery may be offered for non–small cell lung cancer if the tumour can be completely removed and if you are healthy enough to have surgery. The type of surgery will depend on where the cancer is found in the lung. Lymph nodes are removed with all types of surgery.

A wedge or segmental resection removes the tumour along with a margin of healthy tissue around the tumour.

A lobectomy removes the lobe of the lung where the tumour is. A bilobectomy is a type of lobectomy that removes 2 of the 3 lobes of the right lung.

A pneumonectomy removes the whole lung.

An extended pulmonary resection removes the muscles, nerves, blood vessels and other tissues near the lung to remove cancer that has spread to the chest wall or other tissues around the lung.

A chest wall resection removes the muscles, bones and other tissues of the chest wall.

A sleeve resection removes a tumour from one of the airway tubes of the lung (the bronchi) along with a margin of healthy tissue around the tumour.

Chemotherapy

Chemotherapy may be used before or after surgery for non–small cell lung cancer. It may also be given as the main treatment if you are not well enough for surgery or don’t want to have surgery. Chemotherapy may also be given after the main treatment to slow or stop cancer from coming back (this is called maintenance or adjuvant therapy).

Non–small cell lung cancer is usually treated with a combination of 2 drugs, which is more effective than any one drug alone. The most common chemotherapy drug combinations used for non–small cell lung cancer include cisplatin as one of the drugs.

Radiation therapy

External radiation therapy may be used for non–small cell lung cancer that can’t be removed with surgery, or if you aren’t well enough to have surgery or don’t want to have it. It may also be used after surgery for stage 3A non–small cell lung cancer.

There are several different types of external radiation therapy used for non–small cell lung cancer, including 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and stereotactic body radiotherapy (SBRT).

If you can’t have external radiation therapy because of lung problems, you may be offered brachytherapy to treat a tumour that is blocking an airway of the lung. Brachytherapy is a type of internal radiation therapy that uses radiation from radioactive material placed in the body to kill cancer cells.

Chemoradiation

Chemotherapy is sometimes combined with radiation therapy to treat non–small cell lung cancer. This is called chemoradiation. The 2 treatments are given during the same time period. Chemoradiation is only offered if you are healthy enough to have both treatments at the same time.

Targeted therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. It is offered instead of chemotherapy for non–small cell lung cancer that has spread to the lymph nodes or other parts of the body or for non–small cell lung cancer that has come back after chemotherapy treatments.

The type of targeted therapy given will depend on the type of genetic change found during diagnosis using cell and tissue studies. Some of the targeted therapy drugs used for non–small cell lung cancer include gefitinib (Iressa), crizotinib (Xalkori), alectinib (Alecensaro) and larotrectinib (Vitrakvi).

Immunotherapy

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. It is used for advanced or metastatic non–small cell lung cancer after it has stopped responding to chemotherapy or targeted therapy. The type of immunotherapy drug offered will depend on what types of changes are found in the cancer cells during cell and tissue studies. Some of the immunotherapy drugs used for non–small cell lung cancer include pembrolizumab (Keytruda) and nivolumab (Opdivo).

Endobronchial therapies

An endobronchial therapy removes a blockage caused by the cancer inside the lung and helps with symptoms, such as problems with breathing, pain or coughing up blood. There are different types of endobronchial therapy.

Endobronchial therapies may also be used to treat non–small cell lung cancer if you cannot have surgery or radiation therapy.

Quitting smoking

If you smoke, it’s important that you quit before having surgery, chemotherapy or radiotherapy. Research shows that people who quit smoking before lung cancer treatment have a better chance of living longer, a lower risk of side effects from treatment and a lower risk of developing another cancer.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Follow-up care

Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 3 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.

Clinical trials

Talk to your doctor about clinical trials open to people with non–small cell lung cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Questions to ask about treatment

To make the decisions that are right for you, ask your healthcare team questions about treatment.

chest wall

The area of the body between the neck and the abdomen. It includes the rib cage, muscles and tissues that move during breathing.

The chest wall protects the lungs, heart and liver. 

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