Goals

• Cure cancer
• Keep cancer from spreading
• Slow growth of cancer
• Kill the cancer that has spread
• Relieve symptoms

Treatment decisions are based upon

• Cell type
• Stage of the cancer
• Size of the tumor
• Location of the tumor
• Spread of the cancer (inside of the lung and in other areas of the body)
• Lymph node involvement of the cancer

Staging for NSCLS

Staging describes the amount or seriousness of the lung cancer.  The staging of lung cancer is important tothe proper selection of treatment of lung cancer.

There are four stages of lung cancer. Stage I is when the tumor is relatively small and the cancer has not spread outside of the tumor itself. The most serious is stage IV, when the cancer has spread to other parts of the body or lung.  Staging is based on:

• Size and location of the primary tumor
• Lymph node involvement (spread of cancer into lymph nodes)
• Metastasis (spread) to other organs outside of the lung

Occult (hidden) stage

There is no tumor found by bronchoscopy, chest x-ray, CT scan, or MRI. At this point the tumor may be too small to detect. However, there are cancer cells found in the mucus. Very few lung cancers are found at this stage.

Stage 0 (carcinoma in situ)

In stage 0 (carcinoma in situ) cancer is found in just a few layers of the lung. It has not spread outside of the lung. Very few lung cancers are found at this stage.

Stage I

Stage I is when the cancer is only in the lung and normal lung tissue surrounds the tumor. The cancer is not in the lymph nodes nor has it spread. Stage I is divided into stages IA and IB, based on the size of the tumor.

Stage II

In stage II, the cancer has spread to nearby lymph nodes or to the chest wall. Stage II has two stages (A and B) based on extent of the lymph node involvement.

Stage III

In stage III, the cancer has spread outside of the lung such as: lymph nodes in the mediastinum (the middle area between the lungs that contains the heart, major blood vessels, and other structures), diaphragm, neck or spread to the lymph nodes on the opposite side of the chest or in the lower neck.

Stage III is divided into stage IIIA (which is sometimes treated with surgery) and stage IIIB (which is rarely treated with surgery).

Stage IV

In stage IV, cancer has spread to other parts of the body or to another lobe of the lungs.

Shortly after the diagnosis is made decisions are made regarding the right treatment for your lung cancer.  The right diagnosis is crucial to the treatment decisions. The traditional treatments that may be considered for your treatment are listed below, however new treatments and advancements could be available.

Surgery

The cancerous lung tissue can be removed by several ways. The selection of surgery type is based on the type of cancer, the location of the tumor, and the stage of cancer (see staging). Surgery may be the only treatment that is needed to treat the cancer. In other cases surgery may be followed by chemotherapy and/or radiation. In some cases radiation or chemotherapy may be done before the surgery to reduce the size of the tumor.

Surgery types

• Wedge resection or Segmentectomy: a surgical procedure to remove the tumor and a small amount of normal tissue around it.
• Lobectomy: A surgical procedure to remove a whole lobe (section) of the lung.
• Pneumonectomy: Surgery to completely remove the lung.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or disrupting the growth of the cancer. Choosing the right chemotherapy is based upon the lung cancer cell type and the stage of the lung cancer. Chemotherapy can be delivered in different ways.

• Systemically is when the chemotherapy is taken by mouth or injected into a vein or muscle, the chemotherapy enters the bloodstream and reaches cancer cells throughout the body.
• Regional chemotherapy is when the chemotherapy is directly placed in the tumor, organ, or body cavities.

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. 

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Radiosurgery is a method of delivering radiation directly to the tumor with little damage to healthy tissue. It does not involve surgery and may be used to treat certain tumors in patients who cannot have surgery. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Photodynamic Therapy (PDT) is a type of laser therapy where a special chemical (light-activated) that is injected into the bloodstream and absorbed by cells all over the body. This special chemical quickly leaves the normal cells but stays in cancer cells for a longer period of time.

When a laser light (a narrow beam of intense light) is aimed at the cancer cells the special chemical will cause them to light up. The laser beam then is used to destroy the cancer cells.