Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Treatment decisions in lung cancer depend on whether SCLC or NSCLC is
present. Treatment also depends on tumor stage, particularly in NSCLC. A
person's general physical condition (the ability to withstand treatment
procedures) is also taken into account.
Chemotherapy and radiation may lead to a cure in a
small number of patients. These therapies result in shrinking of the tumor and
are known to prolong life for extended periods in most patients.
Chemotherapy and radiation are very effective at
Inoperable NSCLCs are treated with chemotherapy or a
combination of chemotherapy and radiation.
If SCLC is in an early stage (confined to the
thorax), the standard of care is chemotherapy and radiation therapy given at
the same time.
In later stages (spread outside of the thorax), SCLC
is treated with chemotherapy and palliative radiation therapy to areas where
metastases may be present.
The brain is sometimes treated with radiation even if no tumor is present there. Called prophylactic cranial irradiation (PCI), this therapy may prevent a tumor from forming. PCI is
not suitable for all patients, however, and side effects may occur.
Limited SCLC (has not spread outside the chest
cavity) has an 80% to 90% rate of response to combination chemotherapy and
radiation therapy. Remission (no cancer detected by physical examination or
X-ray studies) occurs in 50% to 60% of cases.
Of all cases of advanced-stage lung cancer (spread
outside the chest cavity), approximately 50% to 60% of SCLC and 15% to 40% of NSCLC
will go in to remission with chemotherapy.
If relapse occurs, a different type of chemotherapy
regimen may offer symptom relief and modest survival benefit.
Even with an initially favorable response to
treatment, SCLC tends to relapse within one to two years in most patients,
particularly in those with extensive disease.
Recent research has shown benefits of adjuvant chemotherapy
in early stage NSCLC in preventing or delaying recurrence of the tumor, even
after surgery that is felt to be successful at removing all of the cancer.
Chemotherapy uses toxic chemicals that travel through the bloodstream. It affects healthy cells as well as cancerous cells, and this accounts for the many well-known side effects of chemotherapy, including nausea and vomiting, hair loss, skin problems, mouth sores, and fatigue.
Radiation therapy does not affect cells throughout
the body the way chemotherapy does. However, it does affect healthy tissues
overlying or directly adjacent to the tumor. To a large extent, the side
effects of radiation depend on which part of the body is targeted with
Based on clinical trial data, chemotherapy has been found to be beneficial for all stages of non-small cell lung cancer, including the earlier stages, stage I or II. People with lung cancer should be referred to an oncologist for discussion of options.