Treatment of lung cancer
Treatment depends on whether the lung cancer is small cell type or non-small cell type lung cancer, and what stage the tumour has reached.
Small cell lung cancer
Small cell lung cancer has a survival without treatment of only 2-4 months. Surgery is not an option with this type of cancer because it does not improve outcome. Small cell lung cancer does respond well to chemotherapy and radiotherapy. The treatment of this disease is usually palliative although there are occasionally long term survivors. Extent or stage of disease is divided into two groups these are:
- Limited stage disease – 1/3 of people with small cell lung cancer
- Extensive stage disease – 2/3 of people with small cell lung cancer
The survival rate for this type of cancer:
- Two year survival is 10%
- Five year survival is 5%.
Limited stage disease in small cell lung cancer
This type of disease has not spread outside the affected lung or the lymph nodes most closely associated with it in the neck (the supraclavicular lymph nodes). With treatment including palliative chemotherapy and radiotherapy median survival can be increased to 16-24 months. The 2 year survivors are likely to emerge from this group, some of them may become long term survivors. The chances of long term survival are small but this outcome is more likely if the person has a small localised tumour, is female and fit and healthy when diagnosed (as opposed to being ill with a cough etc).
Of these longer term survivors, about 60% will develop brain metastases over the following 3 years. The risk of this can be halved using prophylactic cranial irradiation (PCI) (radiotherapy to the head). Once brain metastases have developed median survival is three months.
Extensive stage disease in small cell lung cancer
This type of disease has spread outside the affected lung and lymph nodes. The usual treatment of this disease is -:
- Palliative chemotherapy – 3-6 months
- Palliative radiotherapy – weeks
With maximal treatment, the median survival is 6-12 months.
Non-small cell lung cancer
The outcome with this type of lung cancer is not good. The treatment offered and the survival achieved varies depending on stage of disease. Extent or stage of disease is divided into three groups based on stage of disease and treatment that is likely to be offered.
- Early disease - those who can have their cancer removed surgically (usually stage 1 or 2). About 10-15 % of people with lung cancer fall into this group. Of patients with non-small cell cancer who have surgery 60-80% Stage 1 and 25-50% Stage 2 will survive 5 years. Occasionally someone with this stage of disease may not be fit enough to be offered surgery but may be offered radiotherapy and chemotherapy instead. Survival out come of this treatment is similar to surgery.
- Locally advanced disease e.g. Stage 2B, 3A - which is too extensive to be removed surgically but has not spread outside the lung and local lymph nodes also occurs in 10-15%.
- Metastatic disease – cancer has already spread to other organs – this is much more common in lung cancer than other cancers and is one of the reasons for poor survival. 70-80% will be in this group when they are first diagnosed.
Non-small cell - Early disease
This cancer will not have spread to other organs and is small enough to be removed safely. Tumours like this have the best chance of a long term cure although 5 year survival is only 50%. After surgery, adjuvant chemotherapy is often used to reduce the risk of recurrence.
The after effects of removal of part of or a whole lung are likely to be reduced exercise tolerance, this may vary from inability to walk on the flat or go up stairs at normal speed due to breathlessness to quite mild effects only seen when exercising at near full capacity. Recovery time from lung surgery (pneumonectomy – removal of the lung or lobectomy – removal of part of the lung (a lobe) is six weeks). If disease recurs survival is as for metastatic lung cancer.
Non-small cell locally advanced disease
This type of disease is not treatable with surgery but can be treated aggressively with both chemotherapy and radiotherapy to the tumour itself. Of those with limited disease who have combined chemotherapy and radiotherapy median survival is 18 to 24 months whereas those with extensive disease who have palliative chemotherapy median survival is 12 months. If disease recurs survival is as for metastatic lung cancer.
Non-small cell metastatic lung cancer
The treatment will be aimed at relieving symptoms and this may include:-
Chemotherapy and radiotherapy treatment to reduce symptoms from chest disease and selected metastases e.g. brain metastases or painful bone metastases.
- Median survival without palliative chemotherapy is 16-24 weeks
- Median survival with palliative chemotherapy 30 weeks
Amended June 2008
