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.
Surgery is the preferred treatment for patients with early stage NSCLC. Unfortunately, 60% to 80% of patients have advanced or metastatic disease and are not suitable candidates for surgery.
People who have NSCLC that has not spread can
tolerate surgery provided they have adequate lung function.
A portion of a lobe, a full lobe, or an entire lung
may be removed. The extent of removal depends on the size of the tumor, its
location, and how far it has spread.
A technique called cryosurgery is
sometimes used for NSCLC. In cryosurgery, the tumor is killed by freezing it.
This treatment is mainly for relief of symptoms and not for cure.
Cure rates for small cancers at the edges of the lung are around 80%.
Despite complete surgical removal, a large proportion of patients with early stage cancer have
a recurrence of the cancer and die from it.
Surgery is not widely used in SCLC. Because SCLC spreads widely and rapidly through the body, removing it all by surgery usually is impossible.
An operation for lung cancer is major surgery. Many people experience pain, weakness, fatigue, and shortness of breath after surgery. Most have problems moving around, coughing, and breathing deeply. The recovery period can be several weeks or even months.
Lung Cancer Follow-up
Following surgery for any operable lung cancer, there is an increased risk of
developing a second primary lung cancer as well as risk that the original tumor will come back.
Many lung cancers come back within the first two
years after treatment.
Regular testing should be performed so that any
recurrence can be identified as early as possible.
A person who has undergone surgery should receive follow-up care and
examinations according to recommendations from the treatment team.
Palliative and terminal care
Palliative care or hospice care refers to
medical or nursing care to reduce symptoms and suffering without attempting to cure the underlying disease. Because only a small number of people with lung cancer are cured, relief from suffering becomes the primary goal for many.
The patient, his or her family, and the doctor will probably recognize when the patient has reached the point that palliative care is necessary.
Whenever possible, the transition to palliative care
should be planned in advance.
Planning should begin with a three-way conversation
between the patient, someone representing the patient (if he or she is too ill
to participate), and the health-care provider.
During these meetings, likely outcomes, medical issues, and any fears or uncertainties can be discussed.
Palliative care may be given at home, in a hospital if home care is not possible, or in a hospice
facility. Palliative care consists mainly of treatments to relieve shortness of breath and pain.
Breathlessness will be treated with oxygen and
medications such as opioids, which are narcotic drugs such as opium, morphine, codeine, methadone, and heroin.
includes anti-inflammatory medications and opioids. The patient is encouraged
to participate in determining doses of the pain medication, because how much
is needed to block pain will vary from day to day.
Other symptoms, such as anxiety, lack of sleep, and depression, are treated with appropriate medications and, in some cases, complementary therapies.
nicotine sprays, nicotine inhalers, and
some prescription medications have been
successfully used to help people trying to quit smoking.
Eliminating or minimizing exposure to passive smoking is also an
effective preventive measure.
Using a home radon test kit can identify and allow
correction of increased radon levels in the home, which can also cause lung
Smokers who use a combination of supplemental nicotine, medical therapy, group therapy, and behavioral training show a significant drop in smoking rates.
Screening for lung cancer consists of the following:
Currently, the American Cancer Society does not recommend routine chest
X-ray screening for lung cancer.
What this means is that many health-insurance plans do not cover screening
chest X-rays or CT scans.
Periodic chest X-rays may be appropriate for current
or former smokers. Discuss the pros and cons of this approach with a
Low-dose CT scans have shown potential in detecting early-stage lung
cancer and therefore more surgical cures. This procedure requires a special type of CT
scanner (spiral CT) and has been shown to be an effective tool for the
identification of small lung cancers in smokers and former smokers. However, it
has not yet been proven conclusively whether the use of this technique actually saves lives
or lowers the risk of death from lung cancer. Trials are under way to further
determine the utility of spiral CT scans in screening for lung cancer.
The U.S. Preventive Services Task Force (USPSTF) has determined that current evidence is insufficient to recommend for, or against, screening for lung cancer. This means that further research is needed to clarify whether screening tests for lung cancer are beneficial.