Lung Cancer

Treatment

Mayo Clinic specialists from oncology, thoracic diseases, radiation oncology, thoracic surgery and other medical specialties combine their knowledge and experience to select the most appropriate lung cancer treatment or treatments for each patient. Lung cancer treatment is based on the type and stage of tumor, and the patient's general medical condition.

Treatment options include surgery, radiation, chemotherapy or a combination of these treatments. You may be offered the opportunity to participate in Mayo clinical trials when an investigational lung cancer therapy is appropriate for your medical situation.

Non-small cell lung cancer

The specific combination of treatments recommended for non-small cell lung cancer depends on cancer stage and the patient's overall health.

• Stage 0. Tumor spread is limited to the surface of the bronchus (carcinoma in situ). Treatment options are surgical resection (removal) and photodynamic therapy, treating the affected area with a laser to kill the cancer cells.
• Stages I and II. Treatment for these stages is typically tumor removal surgery. If surgery is not an option, radiation therapy with or without chemotherapy is often recommended. Mayo Clinic offers the latest lung radiation treatment options, including stereotactic body radiotherapy.
• Stages IIIA and IIIB. Generally, patients in these two disease stages receive chest radiation treatment combined with chemotherapy. Tumor removal surgery may be recommended to patients with very limited stage IIIA disease. Surgery is not recommended for stage IIIB tumors.
• Stage IV. Cancers in this stage are not treated with surgery. Chemotherapy is the main treatment option for stage IV disease. Radiation therapy may be recommended as well and targeted to areas that cause pain or other problems.
  

Small cell lung cancer

Combinations of chemotherapy and radiotherapy are most often used to treat small cell lung cancer. Surgery is not a treatment option except in rare cases during the very early stages of the disease.

• Limited stage. Treatment generally involves a combination of chemotherapy and chest radiation therapy. Most patients also are offered brain radiation treatment to prevent the spread of cancer in that region.

• Extensive stage. Chemotherapy is the most important treatment option for this disease stage. Targeted radiation therapy may be recommended for areas that cause pain or other problems. Most patients also are offered brain radiation treatment.

Treatment options

Surgery

Mayo's experienced thoracic (chest) surgeons perform lung cancer surgery with the help of a highly skilled and specialized surgical team. Non-small cell lung cancer that has not spread outside of the chest can usually be treated successfully with surgery by removing the tumor and a margin of surrounding healthy tissue.

Surgery for non-small cell lung cancer can be performed via several procedures:

• Mediastinoscopy — a minimally invasive procedure used to sample the lymph nodes along the main airway to determine how far the tumor has spread.
• Thoracoscopy — a minimally invasive procedure used to diagnose and treat lung cancer by accessing the chest through small incisions. It is also called video-assisted thoracic surgery (VATS).
• Wedge resection — removing a small section of one lung.
• Segmentectomy — removing a segment (part of a lobe) of one lung.
• Lobectomy — removing an entire lobe of one lung. The right lung has three lobes, and the left lung has two. Lobectomy is the most common type of lung cancer surgery.
• Sleeve resection — removing a part of the airway with or without the adjoining lung and reattaching the remaining ends to preserve lung tissue and avoid a larger resection.
• Pneumonectomy — removing a lung.
  

Radiation therapy

Radiation therapy for lung cancer is primarily given via external-beam radiation. Radiation oncologists develop an individualized treatment plan for each patient based on cancer stage and the patient's overall health. Treatments may be given in combination with surgery and chemotherapy.

Advances in imaging techniques, such as CT and PET scans, give radiation oncologists more precise ways to locate tumors. This helps them administer a maximum dose of radiation to the tumor from several angles with less damage to surrounding tissues.

Lung tumor scans, before and after SBRT

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Stereotactic body radiotherapy (SBRT) is a technique that precisely focuses many beams of radiation on a tumor. It is very successful at destroying small tumors while minimizing injury to surrounding healthy tissue. The primary use of this therapy is for patients who have small tumors and who are not good candidates for surgery because of other health problems. SBRT is currently being researched as an alternative to surgery.

Chemotherapy

Chemotherapy is a form of drug treatment that can be administered by mouth or by intravenous (IV) solution. Chemotherapy may increase the effectiveness of radiation treatment when both are administered together. An experimental chemotherapy drug given in a clinical trial also may be an option for patients if appropriate for their medical situation.

Photodynamic therapy

Photodynamic therapy is effective in treating lung cancer involving the bronchial tubes. In very early-stage cancers, this treatment can eliminate the cancer. In more advanced cases, photodynamic therapy is used to reduce symptoms from blockage of the bronchial tubes. This therapy is available at Mayo Clinic in Minnesota.

Clinical trials

Mayo Clinic may offer clinical trials to patients when standard treatments have been ineffective. Clinical trials are studies of new therapies that are not yet approved for treatment. Doctors use clinical trials to determine whether a therapy is safe and effective. Clinical trials may not provide a cure, but may extend life or improve quality of life. Talk with your doctor about clinical trials that may be appropriate for you.