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Non-Small Cell Lung Cancer: When You Need More Than One Treatment

By Brenda Conaway
WebMD Feature

Treating Lung Cancer Is a Multidisciplinary Approach

“We work in a team when it comes to planning care for a lung cancer patient,” says Steven E. Schild, MD, professor and chairman of the department of radiation oncology at the Mayo Clinic in Scottsdale, Ariz. This means that you will be working with one or more of the following specialists:
 

  • Pulmonologist – a lung specialist
  • Medical Oncologist – a doctor who specializes in cancer treatments
  • Thoracic Surgeon – a doctor who specializes in chest surgery
  • Radiation Oncologist – a doctor who specializes in radiation therapy

“Because of recent advances in all fields of cancer care, treatment for lung cancer has become more technical and nuanced,” says Christopher Azzoli, MD, medical oncologist on the lung cancer service at the Memorial Sloan-Kettering Cancer Center in New York City. “We now take a multidisciplinary approach to fighting the disease. This allows us to work together to decide on the best approach for each patient.”

Recommended Related to Lung Cancer

Cellular Classification of Small Cell Lung Cancer

Before initiating treatment of a patient with small cell lung cancer (SCLC), an experienced lungcancer pathologist should review the pathologic material. Pathologic Classification The current classification of subtypes of SCLC includes the following:[1] Small cell carcinoma. Combined small cell carcinoma (i.e., SCLC combined with neoplastic squamous and/or glandular components). SCLC arising from neuroendocrine cells forms one extreme of the spectrum of neuroendocrine carcinomas...

Read the Cellular Classification of Small Cell Lung Cancer article > >

Staging Non-Small Cell Lung Cancer

What type and combination of treatments you receive is based on several factors, which can include:

  • The type of NSCLC cancer you have
  • Your overall health and other conditions you may have
  • Your lung function and any symptoms you are having, such as difficulty breathing
  • How your cancer is staged

Staging lung cancer is usually done at the same time that you are diagnosed. Your doctors will perform physical exams, biopsies, and tests such as CT scans or X-rays to determine where the cancer is located. Cancers are staged according to:

  • Size of the tumor
  • Whether cancer has spread into nearby lymph nodes
  • Whether cancer has spread, or metastasized, into other areas of the body

Cancers are staged into groups I, II, III, and IV, and are further subdivided within those groupings. Cancer tumors staged at a lower value tend to be smaller and haven’t spread as far. Staging a cancer helps doctors plan your course of treatment. “How your cancer is staged will determine whether you get chemotherapy, radiation, or surgery,” Azzoli says.

Treatment Options for Non-Small Cell Lung Cancer

Your medical team will plan a course of treatment that will provide the best option to cure your lung cancer, if possible, or to keep it in check for as long as possible. Because treatment is individualized, most lung cancer patients receive a combination of therapies.

  • Surgery provides the best chance of a cure for lung cancer. This is the general approach for stages I and II, and sometimes for stage III and IV. Surgery may be followed by a course of radiation or chemotherapy.
  • Radiation is used instead of surgery for lung cancer patients who aren’t as healthy or whose tumors can’t be removed surgically. Radiation combined with chemotherapy is generally used to treat Stage III lung cancers.
  • Chemotherapy alone won’t cure lung cancer. But used with radiation therapy and surgery, it improves the rates of cure. “Chemo is the icing on the cake when it comes to NSCLC treatment,” says Azzoli. When chemotherapy is used in addition to surgery, it is called adjuvant therapy. The goal of adjuvant therapy is to lower the chance of cancer returning. For Stage IV lung cancers, the goal of chemotherapy usually is not to cure the lung cancer, but to relieve symptoms to make the patient more comfortable.

 

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