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Non-Small-Cell Lung Cancer (cont.)

Surgery

Surgical removal of the tumor provides the best chance of long-term, disease-free survival and the possibility of a cure. In stages I and II NSCLC, removal of the tumor by surgery is almost always possible unless the person is ineligible for surgery because of other medical conditions or complications of the tumor. (These patients usually receive radiation therapy.) Generally, only some stage IIIA cancers are operable. Persons with stage IIIB or IV tumors are generally not candidates for surgery.

Less than half of people with NSCLC have operable tumors. Approximately half of people who undergo surgery have a relapse after surgery.

Before a patient can undergo surgery for lung cancer, he undergoes pulmonary function tests to make sure his lungs are strong enough.

The standard operations for lung cancer include lobectomy (removal of one lobe of the lung) or pneumonectomy (removal of the whole lung). Attempts to remove a smaller part of the lung (wedge resections) carry a higher risk of recurrence and poor outcome.

Like all operations, these procedures have benefits and risks. All operations carry a risk of complications, both from the operation itself and from the anesthesia. The surgeon discusses these benefits and risks with the patient. Together, they decide whether the patient is a candidate for surgery.

Other Therapy

Clinical trials should always be considered as an alternative in the treatment of advanced non–small-cell lung cancer.

Follow-up

Following surgery for any operable lung cancer, the patient has a risk of developing a second primary lung cancer. Following any treatment, the original tumor may come back.

  • Many lung cancers come back within the first 2 years after treatment.
  • The patient should undergo regular testing so that any recurrence can be identified as early as possible.
  • The patient should be checked every 3-4 months for the first 2 years and every 6-12 months afterward.

Palliative and terminal care

Palliative care refers to medical or nursing care whose goal is 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 of suffering becomes the primary goal for many. Palliative care consultation can prolong survival in patients with advanced inoperable - or metastatic (widespread) - lung cancer, as demonstrated in a major study published in the New England Journal of Medicine in 2010 (Temel, et al).

  • Whenever possible, the patient should receive a palliative care consultation early in the course of their treatment.
  • Planning should begin with a conversation between the patient (or someone representing the patient if she is too ill to participate) and her health care provider.
  • During these meetings, the patient can discuss likely outcomes, medical issues, and any fears or uncertainties he or she may have.

Palliative care may be undertaken through the providers office, and care may be given at home. Palliative care consists of both counseling and coordination of care to be sure that the patients understand the goals of treatment and participates in their treatment decisions at each step. It also helps to manage symptoms optimally, and coordinates care of pre-existent conditions in the face of the cancer diagnosis.

Palliative care is not the same as hospice care.

End-of-life care with the aid of Hospice providers usually comes at the point when palliative measures including active treatments with chemotherapy and radiation are generally recognized as no longer effective even in palliating the disease or halting its progression. At that point, an early referral to Hospice is appropriate. Hospice providers can coordinate and manage symptoms at home in a special Hospice facility, or when necessary, a nursing home or hospital.

  • Breathlessness is treated with oxygen and medications such as opioids (narcotic drugs such as opium, morphine, codeine, methadone, and heroin).
  • Pain treatment includes anti-inflammatory medications and opioids. The patient is encouraged to participate in determining doses of the pain medication because the amount needed to block pain varies 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.
Medically Reviewed by a Doctor on 9/11/2014
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