What happens after you or a loved one receives a diagnosis of lung cancer? Receiving a lung cancer diagnosis can be overwhelming and traumatic for patients and their families. Therefore, the first step is to take some time to process the news. Then, it’s time to make some decisions. While it’s understandable to feel a sense of urgency after a lung cancer diagnosis, there is usually time to consider all treatment options and maybe even get a second opinion before choosing a treatment plan, said Pragnan Kancharla, M.D., an oncologist at MedStar Health.
“It is important to learn as much as possible about each case before starting treatment,” he said. “With that in mind, some lung cancers are very aggressive. When we diagnose a patient with small cell lung cancer, we must start treatment immediately because it is very aggressive. Otherwise, patients can and should take some time.”
Soon after the diagnosis, your healthcare provider (HCP) will request tests to see if the cancer has spread to your lungs or lymph nodes and other parts of the body. These tests may include: CT scans, MRIs, PET scans, and bone scans. This process is called staging. Knowing the type and stage of your lung cancer is important for treatment.
Meet with your cancer care team
After staging, a dedicated care team will study your case and begin treatment planning. Your team will include various specialists. The team that will take care of you during your cancer treatment may vary depending on the exact diagnosis, but may include:
– An oncologist: Uses medicines to treat cancer, including chemotherapy, immunotherapy, and targeted therapy.
– A thoracic surgeon: Treats diseases of the chest and lungs.
– A radiation oncologist: Uses radiation therapy to treat cancer.
– A pulmonologist: Treats diseases of the lungs.
– Other healthcare providers: include nurses, pharmacists, respiratory therapists, and social workers who will help you manage your cancer treatment and any other medical conditions you may have.
Remember that, in addition to your cancer care team, you will still need to see your primary care provider during cancer treatment to monitor any other medical conditions and your overall health.
Treatment options for lung cancers
Your specific treatment plan will be based on the type of lung cancer you have and how far it has spread. People with small cell lung cancer (SCLC) usually receive a combination of chemotherapy and radiation therapy. People with non-small cell lung carcinomas (NSCLC), the most common type, will receive some combination of surgeries, radiation therapy, chemotherapy, immunotherapy, or targeted therapy.
Surgery for lung cancer
If your lung cancer is in its early stages, your care team may recommend surgery. Surgeries that completely remove the tumor may even cure the disease. But surgery is complex, and your heart must be healthy enough for you to undergo the procedure. Surgeons perform various types of operations to treat lung cancer. The recommendation is based on the size and location of the tumor and how well your lungs function. The amount of tissue your surgeon will remove can vary from just the tumor and surrounding tissue to the entire lung.
Radiation therapy for lung cancer
With radiation therapy, high-energy particles or rays are used to kill cancer cells. Healthcare providers often use external beam radiation therapy, in which machines outside the body deliver radiation to the tumor through the skin. With lung cancer, healthcare providers also sometimes use internal radiation therapy, called brachytherapy. This is when radioactive material is placed near the tumor. Radiation therapy can be used for many stages and different types of lung cancer.
Chemotherapy for lung cancer
With chemotherapy, your oncologist will prescribe drugs that directly kill cancer cells. You will likely receive chemotherapy through your veins (IV) or a catheter inserted in your chest. Like radiation therapy, chemotherapy is used for many stages and types of lung cancer. Some common scenarios include:
– Chemotherapy could be the first treatment you receive (neoadjuvant chemotherapy) to try to shrink the tumor before surgery.
– You could receive chemotherapy after surgery (adjuvant chemotherapy) in case any cancer cells survived.
– If surgery is not an option, chemotherapy could be the main treatment used for advanced local diseases.
– Chemotherapy could be used for advanced lung cancers that have spread outside the lungs to treat tumors in those areas.
Immunotherapy for lung cancer
Contrary to chemotherapy, immunotherapy drugs “train” your immune system to recognize and attack cancer cells. Checkpoint proteins normally prevent the immune system from harming your body’s normal cells. A group of medications known as immune checkpoint inhibitors act as switches that activate your immune system. Doctors use two types of immune checkpoint inhibitors to treat lung cancer:
– PD-1/PD-L1 inhibitors: These drugs target the PD-1 protein on your body’s T cells that prevent your immune system from attacking itself. When the drugs block PD-1, they increase your immune response against cancer cells. Before starting any of these medications, your doctor will request a blood test to see how much PD-L1 protein your tumor cells have.
– CTLA-4 inhibitors: Like PD-1/PD-L1 inhibitors, these drugs increase your immune response. But they do so by blocking another protein. CTLA-4 is another protein on T cells that controls whether your immune system attacks itself. CTLA-4 inhibitors are more frequently used with a PD-1 inhibitor. For advanced lung cancers, CTLA-4 inhibitors may be used together with chemotherapy.
Targeted therapy for lung cancer
Recently, scientists have discovered specific genetic mutations or gene errors that cause lung cancer. If your tumor has one of these mutations, your doctor may recommend targeted therapy for that mutation. “Targeted therapy analyzes the mutation and tries to block or counteract it directly, preventing cancer cells from multiplying,” said Kancharla.
If your tumor does not have that specific mutation, targeted therapies will not work for you. That is why it is very important for your healthcare provider to request molecular tests of your blood or tumor cells before you start any treatment. Currently, targeted therapies are most often used for advanced lung cancers. They are sometimes used in conjunction with chemotherapy. In other cases, they may be provided as a standalone treatment. Some of the most common mutations occur in these genes: EGFR, ALK, and KRAS.
Clinical trials for lung cancer
Lung cancer has seen significant increases in patient survival rates. This progress has occurred in part because thousands of patients have participated in clinical trials investigating new drugs and treatment types for cancer. Clinical trials are an option for people with lung cancers that do not respond to standard treatments.
“Clinical trials have made a difference in the level of success we have when treating lung cancers,” said Kancharla. “We willingly explain the potential risks and benefits of any clinical trial and appreciate that so many patients are willing to participate in research.”
If you are interested in finding out if there is a clinical trial for your specific case, ask your healthcare provider or use the American Lung Association’s clinical trial locator.
