Prevention of lung cancer includes quitting smoking and avoiding exposure to potentially cancer-causing substances in the work environment.
Doctors use various treatments for both small cell and non–small cell lung cancer. Surgery, chemotherapy, and radiation therapy can be used individually or in combination. The precise combination of treatments depends on the type, location, and severity of the cancer, whether the cancer has spread, and the person's overall health. For example, in some people with advanced non–small cell lung cancer, treatment includes chemotherapy and radiation therapy before, after, or instead of surgical removal. Some people with non–small cell lung cancer survive significantly longer when treated with chemotherapy, radiation therapy, or some of the newer targeted therapies. Targeted therapies include drugs, such as biologic agents that specifically target lung tumors. Recent studies have identified proteins within cancer cells and the blood vessels that nourish the cancer cells. These proteins may be involved in regulating and promoting cancer growth and metastasis. Drugs have been designed to specifically affect the abnormal protein expression and potentially kill the cancer cells or inhibit their growth. For example, doctors may give epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors to people who have not responded to traditional chemotherapy regimens. Some people may receive vascular endothelial growth factor (VEGF) and VEGF receptor inhibitors in combination with standard chemotherapy regimens.
Laser therapy, in which a laser is used to remove or reduce the size of lung tumors, and photodynamic therapy, in which light is used to shrink tumors, are sometimes used. Radiofrequency ablation, in which an electrical current is used to destroy tumor cells, can sometimes be used in people who have small tumors or are unable to undergo surgery.
Surgery: Surgery is the treatment of choice for non–small cell lung cancer that has not spread beyond the lung (early-stage disease). In general, surgery is not used for early-stage small cell lung cancer, because this aggressive cancer requires chemotherapy and radiation therapy. Surgery may not be possible if the cancer has spread beyond the lungs, if the cancer is too close to the windpipe, or if the person has other serious conditions (such as severe heart or lung disease).
Before surgery, doctors do pulmonary function tests (see Symptoms and Diagnosis of Lung Disorders: Pulmonary Function Testing (PFT)) to determine whether the amount of lung remaining after surgery will be able to provide enough oxygen and breathing function. If the test results indicate that removing the cancerous part of the lung will result in inadequate lung function, surgery is not possible. The amount of lung to be removed is decided by the surgeon, with the amount varying from a small part of a lung segment to an entire lung.
Although non–small cell lung cancers can be removed surgically, removal does not always result in a cure. Supplemental (adjuvant) chemotherapy after surgery can help increase the survival rate.
Occasionally, cancer that begins elsewhere (for example, in the colon) and spreads to the lungs is removed from the lungs after being removed at the source. This procedure is recommended rarely, and tests must show that the cancer has not spread to any site outside of the lungs.
Radiation Therapy: Radiation therapy is used in both non-small cell and small cell lung cancers. It may be given to people who do not want to undergo surgery, who cannot undergo surgery because they have another condition (such as severe coronary artery disease), or whose cancer has spread to nearby structures, such as the lymph nodes. Although radiation therapy is used to treat the cancer, in some people, it may only partially shrink the cancer or slow its growth. Combining chemotherapy with radiation therapy improves survival in this group. People with limited or extensive-stage small cell lung cancer who have been responding well to chemotherapy may benefit from radiation therapy to the head to prevent spread of cancer to the brain. If the cancer has already spread to the brain, radiation therapy of the brain is commonly used to reduce symptoms such as headache, confusion, and seizures. Radiation therapy is also useful for controlling the complications of lung cancer, such as coughing up of blood, bone pain, superior vena cava syndrome, and spinal cord compression.
Chemotherapy: Chemotherapy is used in both non-small cell and small cell lung cancers. In small cell lung cancer, chemotherapy, sometimes coupled with radiation therapy, is the main treatment. This approach is preferred because small cell lung cancer is aggressive and has often spread to distant parts of the body by the time of diagnosis. Chemotherapy can prolong survival in people who have extensive-stage disease. Without treatment, the median survival is only 6 to 12 weeks.
In non–small cell lung cancer, chemotherapy also prolongs survival and treats symptoms. In people with non–small cell lung cancer that has spread to other parts of the body, the median survival increases to 9 months with treatment. Targeted therapies may also improve cancer patient survival.
Other Treatments: Other treatments are often needed for people who have lung cancer. Because many people who have lung cancer have a substantial decrease in lung function whether or not they undergo treatment, oxygen therapy (see Rehabilitation for Lung and Airway Disorders: Oxygen Therapy) and bronchodilators (drugs that widen the airways) may aid breathing. Many people with advanced lung cancer develop such extreme pain and difficulty in breathing that they require large doses of opioids in the weeks or months before their death. Fortunately, opioids can substantially relieve pain if adequate doses are used.