Treatment

Your doctors will tell you about the benefits, risks and side-effects of the treatments being offered.

Each person is different and your surgery and/or treatment will be tailored to your needs and discussed fully with you before proceeding. Throughout your care, procedures, surgery and treatment will not be carried out without your consent. This is an important process to make sure you understand your treatment.

Treatment for lung cancer can be given in many ways, or a combination of:

• surgery
• chemotherapy
• radiotherapy
• supportive/palliative care
• targeted treatments
• immunotherapy

Surgery

Surgery may be the most appropriate treatment for people with a localised lung cancer. Surgery to remove the cancer is a major operation and it will take a number of weeks to recover from it.

Lung surgery in Northern Ireland is provided at the Royal Victoria Hospital by Thoracic (chest) Surgeons.

Anyone going to the Royal Victoria Hospital for surgery may be asked to come up to meet one of the medical team for a pre-assessment appointment before their operation, to ensure they are fit and safe for surgery. In some cases patients are asked to have an anaesthetic assessment.  If patients require this then they may need to be admitted overnight.

The main surgical procedures performed as lung cancer treatments are outlined below:

• Lobectomy – this form of surgery is one which removes larger lung cancer tumours. This surgery removes a lobe of the lungs. There are 3 lobes in the right lung and 2 lobes in the left lung. A lobectomy can be performed as open surgery or as a video assisted thorascopic surgery.
• Pneumonectomy – this type of surgery removes larger cancer tumours of the lungs. It involves the surgical removal of the lung. The surgeon makes an incision in the chest while the patient is under general anaesthesia and the lung is then removed through the incision.
• Wedge resection – this type of surgery is performed on patients with small cancer tumours in the lungs. The tumour and surrounding tissue are removed. A wedge resection removes a triangle shaped slice of the affected tissue.

For more information on lung cancer surgery visit the Roy Castle Lung Cancer Foundation website and/or Macmillan Cancer Support website.

The treatment for non-small cell lung cancer is different from the treatment for small cell lung cancer. Because small cell lung cancer can spread more quickly, surgery is not usually the best treatment option.

Chemotherapy

Chemotherapy drugs target cancer cells but also affect the cells in the body that divide rapidly. Some of these are healthy cells such as hair follicles, skin cells and cells that line the mouth and bowel.  This is the reason for some side effects, however, healthy cells are able to repair themselves while cancer cells do not recover.

Radiotherapy

This treatment uses high energy x-rays (radiation) to kill cancer cells. Like chemotherapy they also affect rapidly dividing cells, so whilst healthy cells can be affected they are able to repair themselves whereby cancer cells do not.

Targeted therapies

Targeted therapy only works for some people with particular types of non-small cell lung cancer. They work by targeting the mutations in the genes of cancer cells to slow or stop them growing and dividing (unlike chemotherapy which kills the cancer cell).  If tests show you have such a mutation then these drugs may work for you.  The Doctor will discuss treatment options with you.

Immunotherapy

The immune system helps protect your body from bacteria and viruses. Normal cells are able to stay safe from the effects of the immune system, however, some cancer cells can look like normal healthy cells and avoid being destroyed by the body’s immune system; this allows them to grow and multiply.  Immunotherapy stops cancer cells being able to hide so the immune system can attack them.

Supportive/palliative care

Supportive care is a term for a range of services to help you, your family and your carers to cope with your lung cancer and any treatment. The range of services includes:

• Social support
• Symptom control
• Psychological support
• Information giving
• Self-help and guidance

Palliative care is an aspect of supportive care and is a term used for the range of services available if your lung cancer is advanced and progressing and cannot be cured. This type of care includes:

• Symptom management
• Support for spiritual and psychological needs
• Assistance to help you live as actively as possible

It can be provided alongside treatment such as chemotherapy and radiotherapy when the aim is to reduce symptoms, slow cancer progression and improve quality of life.

After treatment

After treatment is completed, patients will have regular check-ups. These are very important for the surgeon or oncologist to monitor patient progress.

Patients may have x-rays, but the most important part of the follow-up will be the specialist’s examination of their lungs.

If patients have any problems or notice any new symptoms in between review appointments, they should let their GP, consultant or named nurse know as soon as possible and they can arrange a more urgent review.