Treatment Overview

Treatment for lung cancer depends on the stage of your cancer and may include surgery to remove the cancer, radiation therapy, or medications (chemotherapy). Treatment for non–small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) may be different.

Treatment for lung cancer may include one or more of the following therapies:

• Surgery (taking out the cancer). Surgery may involve removing the cancer (wedge resection), removing the affected lobe of lung (lobectomy), or removing the entire lung (pneumonectomy).
• Radiation therapy (using high-dose X-rays to kill cancer cells). Radiation therapy is often used in combination with surgery or chemotherapy or both.
• Chemotherapy (using medicines to kill cancer cells). Chemotherapy can help control the growth and spread of the cancer, but it is a cure in only a small number of people.
• Targeted therapy. Targeted therapies use medicines or antibodies to block growth factors that allow some cancers to grow. At this time, targeted therapies are used for advanced stages of lung cancer.

If you smoke and have lung cancer, quitting smoking will make your treatment more effective and may help you live longer. Smoking delays healing after surgery, so you may have a better recovery from lung cancer surgery if you have quit smoking. People with early-stage lung cancer who continue to smoke during radiation therapy have been shown to have shorter survival times that those who do not smoke.⁷ It may also make chemotherapy less effective. The nicotine in tobacco seems to help the cancer cells and their blood supply multiply while also protecting the cancer cells from destruction.⁸ For information and help quitting smoking, see the topic Quitting Smoking.

Initial treatment

The kind of treatment and the long-term outcome of lung cancer depends on the type and stage of the cancer. Your age, overall health, and quality of life must also be considered. Many people with lung cancer are diagnosed with the disease when the cancer is already in an advanced stage. Fewer lung cancers are diagnosed in the early stages when lung cancer is likely to be cured by surgery.

Non–small cell lung cancer grows and spreads more slowly. Lung surgery (thoracotomy) is usually the standard treatment for non–small cell stage I to stage IIIA cancers. Treatment for non–small cell lung cancer also includes:

• Checking for biomarkers, such as epidermal growth factor receptor (EGFR) and K-RAS. This can help your doctor choose the treatment that will work best for you.
• Treatment with a combination of the three therapies.
  • Lung surgery (thoracotomy) takes out the cancer.
  • Radiation therapy sometimes follows surgery for stages IIA, IIB, and IIIA (with lymph node involvement) and may reduce the risk of cancer returning in the chest.
  • Chemotherapy may be used to treat more advanced stages (stages III and IV). Chemotherapy may also be used after surgery for early stages such as IB, IIA, IIB, and IIIA to reduce the risk of cancer returning.

In some cases, chemotherapy with or without radiation therapy may be used before surgery.

Small cell lung cancer grows very rapidly in most people and is more likely to spread (metastasize) to other organs. Treatment for small cell lung cancer includes:

• Chemotherapy, which usually is the standard treatment for this type of lung cancer.
• Radiation therapy, which may help shrink a rapidly growing large tumor that is causing symptoms.

Radiation therapy is combined with chemotherapy to treat small cell cancer that is limited to the chest.

Home treatment measures may help relieve some common side effects of your cancer treatment. For more information, see the Home Treatment section of this topic.

What to think about during initial treatment

If you have been recently diagnosed with lung cancer, you may feel denial, anger, and grief. Reactions vary from person to person. There are steps you can take to help with your emotional reactions. If you are having a hard time moving forward with your life, talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group.

Your quality of life is critical when considering your treatment choices. Discuss your personal preferences with your oncologist when he or she recommends treatment.

You may be interested in participating in research studies called clinical trials. Clinical trials are based on the most up-to-date information and are designed to find better ways to treat people who have cancer. People who do not want standard treatments or are not cured by standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries around the world for all stages of lung cancer.

For more information about specific lung cancer treatments, see the topics:

• Lung Cancer, non–small cell – Health Professional Information [NCI PDQ].
• Lung Cancer, non–small cell – Patient Information [NCI PDQ].
• Lung Cancer, small cell – Health Professional Information [NCI PDQ].
• Lung Cancer, small cell – Patient Information [NCI PDQ].

Ongoing treatment

After initial treatment for lung cancer, it is important to receive follow-up care.

• Your oncologist will schedule regular checkups, usually every 3 to 4 months, depending on the therapies used in initial treatment. After 2 to 3 years, regular checkups will occur less often but more than just once a year, depending on your medical history.
• Checkups may include a physical exam, blood tests, chest X-rays, CT scans, or other laboratory tests recommended by your oncologist.

Radiation therapy may be used to prevent small cell lung cancer from growing in the brain. This is called prophylactic cranial irradiation (PCI). PCI may be most beneficial if you have limited small cell lung cancer and have had successful treatment with chemotherapy and radiation therapy to the chest. But PCI is not advised for older people whose thinking process may be impaired.

Treatment if the condition gets worse

The long-term outcome (prognosis) for lung cancer that does not respond to treatment as hoped or that comes back after being treated is poor, and treatment focuses on managing your pain and improving your quality of life (palliative care).

Treatment to help control your symptoms (such as pain, coughing up blood, shortness of breath, and weakness) may include:

• Radiation therapy. This may be done to shrink cancers that make swallowing or breathing difficult or that are causing pain.
• Chemotherapy.
• Chemotherapy combined with radiation therapy.
• Surgery, if your cancer has spread to your brain.
• Laser surgery.
• Radiation applied directly to the cancer during surgery.

Other treatments being studied for lung cancer include radiofrequency ablation and cryosurgery. Each of these is a way of trying to destroy the cancer cells without major surgery. These treatments may be useful for people who are not able to have surgery either because they are in poor health or because their cancer is too advanced.

Additional treatment measures

• Oxygen therapy may relieve your shortness of breath. It is usually used at the end stage of the disease, but it may also be used for pneumonia or other treatable conditions.
• Thoracentesis is used to remove fluid from around your lungs (pleural effusion). A large amount of fluid may cause pain and shortness of breath.
• Pleurodesis is used to prevent fluid buildup around your lungs. Pleurodesis is a procedure that is intended to cause inflammation of the lining around your lungs. The irritated tissue reacts by producing scar tissue, which causes the two layers of the lung lining to stick together. This removes the space where fluid can build up around your lungs. Pleurodesis is commonly used to treat fluid buildup around your lungs that returns after repeated thoracentesis.
• Small tubes (pleural catheters) to drain fluid from around the lungs are used to relieve fluid buildup (pleural effusion).
• Treatments that burn (cauterize) selected areas of blocked airways or that place stents—small, coiled, wire-mesh tubes that can be inserted into a blocked airway and expanded to hold it open—are also becoming more common.
• Pain medicines can be taken regularly. These may include prescribed narcotic medicines, such as codeine, or medicines you can buy without a prescription, such as aspirin and similar drugs.

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

• Acupuncture to relieve pain.
• Meditation or yoga to relieve stress.
• Light massage (not deep tissue or intense pressure) or biofeedback to ease tension.
• Breathing exercises for relaxation.

For people with lung cancer, studies have shown that mind-body treatments like those mentioned above may help you feel better and cope better with treatment. These treatments also may reduce chronic low back pain, joint pain, headaches, and pain from treatments. Acupuncture may also help with nausea and vomiting from chemotherapy.⁹

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

What To Think About

Most treatments for lung cancer cause some side effects. Which side effects you experience will depend on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects related to each treatment.

Side Effects of Chemotherapy

Side Effects of Radiation Therapy to the Chest

Side Effects of Surgery for Lung Cancer

Palliative care

Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body but also in your mind and spirit. Some people combine palliative care with curative care.

As soon as you find out you have lung cancer, you may want to start palliative care along with your other treatment. Having this type of care may help you feel better. And it may help you avoid having too much medical treatment. One study of people with non–small-cell lung cancer who started palliative care when they were diagnosed with lung cancer found that they not only felt better but also lived a little longer than the people who didn't have palliative care.¹⁰

Some treatments for advanced-stage lung cancer are considered palliative care. These treatments cannot cure your cancer, but they can control your symptoms, reduce your pain, and make you feel more comfortable. They include:

• Radiation therapy.
• Medicines, including chemotherapy.
• Therapies such as radiofrequency ablation or cryosurgery that can destroy cancer cells without major surgery.
• Complementary medicine.

In addition to helping your body feel better, palliative care can help you feel better emotionally and spiritually. Talking with a palliative care provider may help you cope with your feelings about living with a long-term illness. It may also help your loved ones better understand your illness and how to support you. Or it could help you make future plans about your health and your medical care.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

If you have advanced-stage cancer, you may choose not to have treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the following topics:

Hospice Care

Care at the End of Life