Primary Lung Cancer
Alternate Names : Carcinoma of the Lung
What are the treatments for the disease?
Small cell lung cancer spreads throughout the body. It is sensitive to chemotherapy and radiation therapy. Surgery to remove the cancer where it started is usually not helpful. Multiple agent chemotherapy is given with limited or extensive small cell lung cancer. Response rates are good and some complete remissions are attainable. Chemotherapy is often followed or sandwiched with radiation therapy to the primary cancer site. Radiation to the brain has been used with small cell lung cancer because this is where it often spreads, even after treatment has been finished. Chemotherapy drugs that are used include etoposide, cisplatin, carboplatin, doxorubicin, vincristine, and cyclophosphamide.
Limited stage non-small cell, such as stage I and II cancer, are considered curable. Treatment includes the partial removal of the lung and the removal of lymph nodes in the chest cavity. This is followed up with radiation therapy. Chemotherapy in addition to the radiation may or may not be helpful. Pre- or postoperative chemotherapy have been given along with complete surgical removal. People with higher stages of cancer are not likely to benefit from extensive surgery. They are treated with radiation and/or chemotherapy to relieve symptoms and make them comfortable. Radiation therapy can be given from the outside of the body or through the windpipe. Chemotherapy drugs that have given response include vinblastine, vincristine, cisplatin, etoposide, and 5-fluorouracil (5-FU).
People who's cancer has spread to the brain may benefit from whole brain irradiation and corticosteroids to reduce brain swelling. Radiation and/or chemotherapy may relieve other symtoms including painful enlarged liver, bone pain caused by metastases from the lung cancer, or general failing health.
Fluid in the chest containing cancerous cells is treated with needle or chest tube drainage followed by instillation of chemotherapy into the space within the chest that holds the lungs. This will dry up any fluid and improve symptoms. Normal lung is very sensitive to radiation damage, so a complete lung cannot be exposed to radiation. Experimental therapies are desirable for treatment of all stages of this disease since it has been so common and highly lethal. Additional information will benefit the hundreds of thousands of people who have yet to develop this disease. People with this disease often suffer from too much calcium in the blood. It is treated with corticosteroids, diphosphonate medicine, or primary treatment of the cancer.
A team of medical experts is often needed to manage lung cancer. This includes thoracic surgeons, radiation therapists, cancer specialists, lung specialists, and radiologists. Experimental treatments are available at many local, regional, or national institutions. New drugs are being developed and tried in people who have incurable lung cancer. Terminal care can be provided by a hospice-based team.
What are the side effects of the treatments?
When surgery is done to remove part of a lung, it can result in the lung not being able to work. Before surgery, it is important to test the uninvolved lung to see if this can be tolerated. Opening the chest cavity is major surgery, and can have significant illness and even death associated with it.
Side effects of radiation include:
skin burn
redness, swelling, and pain in the lining of the esophagus, a condition called esophagitis
injuring the lungs
fatigue
nausea
Chemotherapy also has many side effects. The drugs that are used will cause:
hair loss
nausea
vomiting
lowered blood counts and risks of infections
potential need for transfusions
abnormal bleeding or blood clotting
damage to nerves, kidneys, and liver
People who receive radiation to the brain can have:
problems with short-term memory losses
difficulty walking
coordination problems
loss of brain cells
Some people may need daily oxygen even if they didn't before treatment. This disease can recur in spite of all of the above treatments.
What happens after treatment for the disease?
After treatment, people will be followed for lung function, any delayed or prolonged side effects of the treatments, and for recurrence of the disease.
How is the disease monitored?
Monitoring is by frequent visits to the healthcare provider. Physical exams, laboratory tests, chest CT, abdominal CT, and sometimes bronchoscopy are needed. The cancer may return within several months to a few years. People with lung cancer usually have a history of smoking. They remain at risk for development of other tumors, including another lung cancer primary.
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