Stage I and II. In general, stage I and stage II NSCLC are treated with surgery. Surgeons cure many patients with an operation. Before or after surgery, a patient may be referred to a medical oncologist. Some patients with large tumors or signs that the tumor has spread to the lymph nodes may benefit from chemotherapy before the surgery, called neoadjuvant chemotherapy or induction chemotherapy, or adjuvant chemotherapy to reduce the chance the cancer will return. Radiation therapy may be used to treat and cure a lung tumor when surgery is not recommended.
Stage III. Stage III NSCLC has spread to the point that surgery or radiation therapy alone is usually not enough to cure the disease for most people. Patients with stage III disease also have a high risk of the cancer returning, either in the same place or distantly, even after successful surgery or radiation therapy. For this reason, our doctors generally do not recommend immediate surgery, and sometimes suggest chemotherapy before surgery.
After chemotherapy, patients with stage III NSCLC may still need surgery, especially if chemotherapy is effective in shrinking the cancer. However, some patients with stage III NSCLC do get operated. Instead, they may be given a combination of chemotherapy and radiation therapy. Chemotherapy may be given either before or at the same time as the radiation therapy. This method has shown to improve the ability of radiation therapy to shrink the cancer and to lower the risk of recurrence of cancer.
Chemotherapy given at the same time as radiation therapy is more effective than chemotherapy given before radiation therapy, but causes more side effects. Patients who have received both chemotherapy and radiation therapy for stage III disease, may still go on to have surgery. However, there is debate among doctors whether surgery is needed for patients when radiation therapy has worked well, and if radiation therapy is needed in patients whose cancer disappears after chemotherapy.
For most patients with stage III NSCLC, the tumor is unresectable, meaning it cannot be removed surgically. This may be because the surgeon feels that an operation would be too risky, or that the tumor cannot be removed completely. For patients with unresectable NSCLC, with no signs of spread of cancer to distant sites or to the fluid around the lung, a combination of chemotherapy and radiation therapy can still be used to try to eliminate the cancer.
Stage IV NSCLC. Most patients with stage IV NSCLC are not treated with surgery or radiation therapy. Occasionally, doctors may recommend surgery for a brain or adrenal gland metastasis if that is the only place the cancer has spread. Radiation therapy can also be used to treat a metastasis located in only one area, such as the brain. However, patients with stage IV disease have a very high risk of the cancer spreading or growing in another location. Most patients at this stage of NSCLC receive only chemotherapy.
The goals of chemotherapy are to shrink the cancer, relieve discomfort caused by the cancer, prevent the cancer from spread further, and lengthen a patient’s life. Chemotherapy can rarely make metastatic lung cancer disappear. However, doctors know from experience that the cancer will usually return. Therefore, patients with stage IV disease are never considered “cured” of their cancer no matter how well chemotherapy works. Treatment often continues as long as it is controlling the cancer’s growth. Chemotherapy has been proven to improve both length and quality of life for patients with stage IV NSCLC. If the cancer worsens or causes too many severe side effects, the treatment may be stopped, and patients would continue to receive palliative care.
As with NSCLC, the treatment of small cell lung cancer depends on the stage. Small cell lung cancer spreads quickly, so chemotherapy is the primary treatment for all patients. Patient may hear the doctor refer to limited stage, which means there are no signs that the cancer has spread, or extensive stage, which means that the cancer that has spread, to describe the small cell lung cancer.
For patients with limited stage small cell lung cancer, chemotherapy plus radiation therapy to the chest is given twice a day. Radiation therapy is best when given during the first or second month of chemotherapy. Patients with extensive stage cancer receive chemotherapy for three to six months.
Surgery is rarely used for patients with small cell lung cancer and is only considered for patients with very early-stage disease, such as cancer in a small lung nodule. In those situations, chemotherapy, with or without radiation therapy, is given after surgery.
In patients whose cancer has shrunk after chemotherapy, radiation therapy to the head lessens the risk that the cancer will spread to the brain. This is called prophylactic cranial irradiation (PCI), and it has been shown to lengthen the lives of these patients.
Like patients with later-stage NSCLC, patients with small cell lung cancer of any stage face the risk of recurrence, even when its growth is controlled. All patients with small cell lung cancer should have regular follow-up care with their doctors, including x-rays, scans, and check-ups.
If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Patient may want to seek a second opinion before starting treatment so that he / she will be comfortable with the treatment plan chosen.
Chemotherapy is not as effective as radiation therapy or surgery to treat lung cancer that has spread to the brain. For this reason, lung cancer that has spread to the brain is treated with radiation therapy, surgery, or both. Most patients with brain metastases from lung cancer receive radiation therapy to the entire brain. This can cause side effects such as hair loss, fatigue, and redness of the scalp. With a small tumor, a type of radiation therapy called stereotactic radiosurgery can focus radiation only on the tumor in the brain and lessen the side effects.
Supportive care will also be important to help relieve symptoms and side effects. Radiation therapy or surgery may also be used to treat metastases that are causing pain or other symptoms. Bone metastases that weaken major bones can be treated with surgery, and the bones can be reinforced using metal implants.
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.
A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. After testing is done, patient and the doctor will talk about the treatment options. Often the treatment plan will include the therapies described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace.
Stay up to date with hospital-wide announcements, medical news and health updates for you and your family.
