1) SURGERY
If your doctor thinks the lung cancer can be treated with surgery, pulmonary
function tests will be done beforehand to see if you would still have enough
healthy lung tissue left after surgery.
·
Other tests will check the function of your heart and other
organs to be sure you’re healthy enough for surgery.
·
SURGERY to remove the cancer (often along with other treatments)
may be AN OPTION ONLY FOR EARLY STAGE
LUNG CANCER ( NSCLC)
·
If surgery can be done, it provides the best chance to cure
NSCLC.
·
Lung cancer surgery is a complex operation that can have serious
consequences, so it should be done by a Thoracic
surgeon or Onco-surgeon, who has
a lot of experience operating on lung cancers.
·
The cancer has already spread to the lymph nodes between the
lungs. This is often done just before surgery with mediastinoscopy.
Types of
lung surgery
Different operations can be used to treat (and possibly cure) NSCLC:
If one can imagine a large airway with a tumour, as similar to the sleeve of a shirt with a stain a couple of inches above the wrist, the sleeve resection would be like cutting across the sleeve above and below the stain and then sewing the cuff back onto the shortened sleeve.
*With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer.
Increasingly, doctors now treat early-stage lung cancers in the outer parts of the lung with a procedure called video-assisted thoracic surgery (VATS), which requires smaller incisions than a thoracotomy.
Radiation therapy uses high-energy rays (such as x-rays) or particles to kill cancer cells.
There are 2 main types of radiation therapy:
*Brachytherapy (internal radiation therapy)
External beam radiation therapy (EBRT) focuses radiation from outside the body on the cancer. This is the type of radiation therapy most often used to treat NSCLC or its spread to other organs.
In people with NSCLC, brachytherapy is sometimes used to shrink tumors in the airway to relieve symptoms.
Before surgery to shrink tumour size.
Concurrent therapy along with radiation for cancer that cannot be removed by surgery. As main therapy for advanced stages of cancer.
*Carboplatin
*Paclitaxel (Taxol)
*Albumin-bound paclitaxel (nab-paclitaxel, Abraxane)
*Docetaxel (Taxotere)
*Gemcitabine (Gemzar)
*Vinorelbine (Navelbine)
*Irinotecan (Camptosar)
*Etoposide (VP-16)
*Vinblastine
*Pemetrexed (Alimta)
Targeted drugs work differently from standard chemotherapy. At this time, they are most often used for advanced lung cancers, either along with chemo or by themselves. Drugs that target tumor blood vessel growth (angiogenesis) For tumors to grow, they need to form new blood vessels to keep them nourished. This process is called angiogenesis. Some targeted drugs, called angiogenesis inhibitors, block this new blood vessel growth:
This drug is often used with chemo for a time.
Then if the cancer responds, the chemo may be stopped and the bevacizumab given by itself until the cancer starts growing again.
Ramucirumab (Cyramza) can also be used to treat advanced NSCLC. VEGF has to bind to cell proteins called receptors to act. This drug is a monoclonal antibody that targets a VEGF receptor. This helps stop the formation of new blood vessels. This drug is most often given after another treatment stops working. It is often combined with chemo.
Drugs that target cells with EGFR changes
Epidermal growth factor receptor (EGFR) is a protein on the surface of cells.
Erlotinib (Tarceva)
Afatinib (Gilotrif)
Gefitinib (Iressa)
These drugs can be used alone (without chemo) as the first treatment for advanced NSCLCs that have certain mutations in the EGFR gene.
EGFR inhibitors used for squamous cell NSCLC
Necitumumab (Portrazza) is a monoclonal antibody (a man-made version of an immune system protein) that targets EGFR. It can be used along with chemotherapy as the first treatment in people with advanced squamous cell NSCLC. This drug is given as an infusion into a vein (IV).
About 5% of NSCLCs have a rearrangement in a gene called ALK.
Ceritinib (Zykadia)
Alectinib (Alecensa)
These drugs can often shrink tumors in people whose lung cancers have the ALK gene change.
Different operations can be used to treat (and possibly cure) NSCLC:
If one can imagine a large airway with a tumour, as similar to the sleeve of a shirt with a stain a couple of inches above the wrist, the sleeve resection would be like cutting across the sleeve above and below the stain and then sewing the cuff back onto the shortened sleeve.
*With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer.
Increasingly, doctors now treat early-stage lung cancers in the outer parts of the lung with a procedure called video-assisted thoracic surgery (VATS), which requires smaller incisions than a thoracotomy.
Radiation therapy uses high-energy rays (such as x-rays) or particles to kill cancer cells.
There are 2 main types of radiation therapy:
*Brachytherapy (internal radiation therapy)
External beam radiation therapy (EBRT) focuses radiation from outside the body on the cancer. This is the type of radiation therapy most often used to treat NSCLC or its spread to other organs.
In people with NSCLC, brachytherapy is sometimes used to shrink tumors in the airway to relieve symptoms.
Before surgery to shrink tumour size.
Concurrent therapy along with radiation for cancer that cannot be removed by surgery. As main therapy for advanced stages of cancer.
*Carboplatin
*Paclitaxel (Taxol)
*Albumin-bound paclitaxel (nab-paclitaxel, Abraxane)
*Docetaxel (Taxotere)
*Gemcitabine (Gemzar)
*Vinorelbine (Navelbine)
*Irinotecan (Camptosar)
*Etoposide (VP-16)
*Vinblastine
*Pemetrexed (Alimta)
Targeted drugs work differently from standard chemotherapy. At this time, they are most often used for advanced lung cancers, either along with chemo or by themselves. Drugs that target tumor blood vessel growth (angiogenesis) For tumors to grow, they need to form new blood vessels to keep them nourished. This process is called angiogenesis. Some targeted drugs, called angiogenesis inhibitors, block this new blood vessel growth:
This drug is often used with chemo for a time.
Then if the cancer responds, the chemo may be stopped and the bevacizumab given by itself until the cancer starts growing again.
Ramucirumab (Cyramza) can also be used to treat advanced NSCLC. VEGF has to bind to cell proteins called receptors to act. This drug is a monoclonal antibody that targets a VEGF receptor. This helps stop the formation of new blood vessels. This drug is most often given after another treatment stops working. It is often combined with chemo.
Drugs that target cells with EGFR changes
Epidermal growth factor receptor (EGFR) is a protein on the surface of cells.
Erlotinib (Tarceva)
Afatinib (Gilotrif)
Gefitinib (Iressa)
These drugs can be used alone (without chemo) as the first treatment for advanced NSCLCs that have certain mutations in the EGFR gene.
EGFR inhibitors used for squamous cell NSCLC
Necitumumab (Portrazza) is a monoclonal antibody (a man-made version of an immune system protein) that targets EGFR. It can be used along with chemotherapy as the first treatment in people with advanced squamous cell NSCLC. This drug is given as an infusion into a vein (IV).
About 5% of NSCLCs have a rearrangement in a gene called ALK.
Ceritinib (Zykadia)
Alectinib (Alecensa)
These drugs can often shrink tumors in people whose lung cancers have the ALK gene change.
·
Pneumonectomy: This
surgery removes an entire lung. This might be needed if the tumor is close to
the center of the chest.
·
Lobectomy: The
lungs are made up of 5 lobes (3 on the right and 2 on the left). In this
surgery, the entire lobe containing the tumor(s) is removed. This is often the
preferred type of operation for NSCLC if it can be done.
·
Segmentectomy
or wedge resection: In these surgeries, only part of a lobe is removed. This
approach might be used, for example, if a person doesn’t have enough lung
function to withstand removing the whole lobe.
·
Sleeve
resection: This operation may be used to treat some cancers in large
airways in the lungs.
*A surgeon may be able to do this operation
instead of a pneumonectomy to preserve more lung function.
These operations require general
anesthesia (where you are in a deep sleep) and are usually done through a
surgical incision between the ribs in the side of the chest (called a
thoracotomy).
The type of operation your doctor
recommends depends on the size and location of the tumor and on how well your
lungs are functioning.
Doctors often prefer to do a more
extensive operation (for example, a lobectomy instead of a segmentectomy) if a
person’s lungs are healthy enough, as it may provide a better chance to cure
the cancer.
When you wake up from surgery, you will
have a tube (or tubes) coming out of your chest and attached to a special
canister to allow excess fluid and air to drain out. The tube(s) will be
removed once the fluid drainage and air leak subside. Generally, you will need
to spend 5 to 7 days in the hospital after the surgery.
Video-assisted
thoracic surgery (VATS)
·
During this operation, a thin, rigid tube with a tiny video
camera on the end is placed through a small cut in the side of the chest to
help the surgeon see inside the chest on a TV monitor.
·
One or two other small cuts are created in the skin, and long
instruments are passed through these cuts to do the same operation that would
be done using an open approach (thoracotomy).
·
One of the incisions is enlarged if a lobectomy or pneumonectomy
is done to allow the specimen to be removed.
·
Because only small incisions are needed, there is usually less
pain after the surgery and a shorter hospital stay – typically 4 to 5 days.
·
Most experts recommend that only early-stage tumors near the
outside of the lung be treated this way.
·
The cure rate after this surgery seems to be the same as with
surgery done with a larger incision.
·
But it’s important that the surgeon doing this procedure is
experienced, because it requires a great deal of technical
RECOVERY
AFTER LUNG SURGERY
Surgery for lung cancer is a major
operation. Recovering from lung cancer surgery typically takes weeks to months.
·
If the surgery is done through a thoracotomy (a long incision in
the chest), activity might be limited for at least a month or two.
·
People who have VATS instead of thoracotomy tend to have less
pain after surgery and to recover more quickly.
·
If the lungs are in good condition (other than the presence of
the cancer) usually return to normal activities occurs after some time if a
lobe or even an entire lung has been removed.
·
If one also has another lung disease such as emphysema or
chronic bronchitis (which are common among long-time smokers), you might become
short of breath with certain levels of activity after surgery.
2) RADIO
FREQUENCY ABLATION (RFA) for NSCLC
This treatment might be an option for
some people some small lung tumors that are near the outer edge of the lungs,
especially if they can’t tolerate surgery.
·
RFA uses high-energy radio waves to heat the tumor. A thin,
needle-like probe is put through the skin and moved in until the tip is in the
tumor. Placement of the probe is guided by CT scans. Once the tip is in place,
an electric current is passed through the probe, which heats the tumor and
destroys the cancer cells.
·
RFA is usually done as an outpatient procedure, using local
anesthesia (numbing medicine) where the probe is inserted. You may be given
medicine to help you relax as well.
Radiation
Therapy
·
*As main treatment approach along with chemotherapy if Surgery
not possible (due to location or size of tumour or patient not fit)
·
After surgery ( alone or with chemo) to kill any remaining
cancer cells
·
Before surgery ( along with chemo) to shrink tumour size.
·
To treat a single area of cancer spread, such as a tumour in the
brain or an adrenal gland.
·
To relieve (palliate) symptoms of advanced NSCLC such as pain,
bleeding, trouble swallowing, cough, or problems caused by spread to other
organs such as the brain.
Types of
radiation therapy
*External beam radiation therapy
External
beam radiation therapy
Brachytherapy
(internal radiation therapy)
CHEMOTHERAPY for NSCLC:
Adjuvant
chemotherapy After surgery ( sometimes along with radiation) to kill any
cancer cells left behind.
Drugs
used to treat NSCLC
The chemo drugs most often used for
NSCLC include:
*Cisplatin
·
Most often, treatment for NSCLC uses a combination of 2 chemo
drugs.
·
Studies have shown that adding a third chemo drug doesn’t add
much benefit and is likely to cause more side effects.
·
Single-drug chemo is sometimes used for people who might not
tolerate combination chemotherapy well, such as those in poor overall health or
who are elderly.
·
If a combination is used, it often includes cisplatin or
carboplatin plus one other drug.
·
Sometimes gemcitabine with vinorelbine or paclitaxel, may be
used.
·
For people with advanced lung cancers who meet certain criteria,
targeted therapy a drug such as bevacizumab (Avastin), ramucirumab (Cyramza),
or necitumumab (Portrazza) may be added to treatment as well.
·
Doctors give chemo in cycles, with a period of treatment
(usually 1 to 3 days) followed by a rest period to allow the body time to
recover.
·
Some chemo drugs, though, are given every day.
·
Chemo cycles generally last about 3 to 4 weeks.
·
For advanced cancers, the initial chemo combination is often
given for 4 to 6 cycles.
·
If the initial chemo treatment for advanced lung cancer is no
longer working, the doctor may recommend second-line treatment with a single
chemo drug such as docetaxel or pemetrexed, or with a targeted therapy or
immunotherapy drug.
Targeted therapy drugs for NSCLC:
Bevacizumab (Avastin) is used to treat
advanced NSCLC. It is a monoclonal antibody (a man-made version of a specific
immune system protein) that targets vascular endothelial growth factor (VEGF),
a protein that helps new blood vessels to form.
It normally helps the cells grow and
divide.
Drugs called EGFR inhibitors can block
the signal from EGFR that tells the cells to grow. Some of these drugs can be
used to treat NSCLC.
EGFR inhibitors used in NSCLC with EGFR
gene mutations
These are more common in women and
people who haven’t smoked.
Erlotinib can also be used for advanced
NSCLC without these mutations if chemo isn’t working. All of these medicines
are taken as pills.
EGFR inhibitors that also target cells
with the T790M mutation
Drugs that target cells with ALK gene
changes
This change is most often seen in
non-smokers (or light smokers) who have the adenocarcinoma subtype of NSCLC.
Crizotinib (Xalkori)
Although they can
help after chemo has stopped working, they are often used instead of chemo in
people whose cancers have the ALKgene rearrangement.
Thanks for reading and please keep visiting our blog to discover and appreciate more Yoddhas.
Feel free to contact the Yoddhas team at team@yoddhas.com
Join our free patients group https://www.facebook.com/groups/yoddhathewarrior/
Feel free to contact the Yoddhas team at team@yoddhas.com
Join our free patients group https://www.facebook.com/groups/yoddhathewarrior/
Lastly, Praise the Yoddhas; Support the Yoddhas ; Love the Yoddhas!
Author-
Dr. Ganjoo
Head-Yoddhas Medical Expert Panel
