Treatment Alternatives for lung cancer

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The first alternative is to do nothing. This is almost always a poor option, since almost all patients with an untreated lung cancer will be dead at the end of one or two years.

Watchful waiting is the next choice. This implies that although the patient has a lung mass, it might be benign, and therefore a period of time will be allowed to elapse. If the lesion does not grow, it can safely be assumed that the lesion is benign, and thus surgery is avoided. The problem with this approach is that further growth of the tumor may allow metastasis, and the opportunity of cure may be lost. The second problem is that some patients will be non-compliant and will not return for the follow up studies. If these patients have a lung cancer, they will die.

Surgical treatment consists of an operation, called a thoracotomy, in which a curved incision is made around the lateral portion of the chest beneath the breast and below the tip of the scapula. The muscles of the chest wall are cut and the space between the ribs is opened with a retractor to allow the surgeon to reach into the chest cavity and remove a portion of the lung. The size and location of the tumor determine how much of the lung must be removed. Segmentectomy, lobectomy and pneumonectomy are the terms for removal of a segment, a lobe or the entire lung on one side. In order to resect the lung, the surgeon dissects free the pulmonary artery and vein branches, ties or ligates them and cuts them. The bronchus is then cut, and sewn or stapled closed. The lymph nodes in the hilum and mediastinum should then be systematically dissected and removed. The ribs, muscles and skin are then sewn back together.

Radiation therapy is given by first making a phantom or model of the area of the chest to be treated. The patient then comes into the radiation therapy facility on a daily basis for a number of weeks for short exposures to powerful energy beams that destroy the tumor and tissues within the area treated.

Chemotherapy consists of a series of injections or infusions of drugs that have a toxic effect on the tumor. These treatments typically take place in a number of one month cycles during which one or more drugs are given on a number of days of outpatient therapy.

Laser ablation of tumors that are not curable, but that are causing shortness of breath due to obstruction of large bronchi, is done under general anesthesia through a bronchoscope. It is sometimes accompanied by placement of stents or by delivery of endobrachyradiation. Photo-dynamic therapy is a variant of laser ablation where the tumor cells in the bronchus are first sensitized by treating the patient with Photofrin, a drug that is selectively picked up by tumor cells, and that absorbs laser light delivered through a bronchoscope, killing the tumor cells.

More information on lasers

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