LUNG CANCER
Introduction
The three major treatment modalities for lung cancer are surgery, radiation therapy, and chemotherapy. The preferred treatment(s) for a specific patient depend on several factors, including cell type (histology) of the tumor, its location in the lungs, the extent of tumor spread to lymph nodes in the immediate area, and the presence or absence of distant metastases (that is, spread to other parts of the body).
Lung cancers are generally divided into two major histologic categories, small cell (or oat cell) and non-small cell carcinomas. The latter can be further subdivided into squamous cell carcinomas and adenocarcinomas. Several other less common histologies as well as several subtypes of adenocarcinomas also exist.
In general, early-stage non-small cell carcinomas are best treated by surgery, followed in some cases (but not all) by radiation therapy, with or without chemotherapy. In contrast, patients with more advanced non-small cell carcinomas may be best treated by a combination of radiation therapy and chemotherapy, or sometimes radiotherapy alone. Patients having other medical problems that might make surgery too risky are also often treated with radiation therapy, possibly in conjunction with chemotherapy.
On the other hand, small cell carcinomas are virtually always treated with chemotherapy, often in conjunction with radiotherapy to the chest and possibly also to the brain. This will be explained more fully in the following sections.
Before any treatment is started, the recommended treatment, the reasons it is recommended, the procedures to be carried out, the expected or possible side effects or complications, and the expected benefits are all explained to the patient and family. The patient must give permission for treatment, based on this knowledge (“informed consent”), before treatment is given.
Radiation treatments can vary widely from one institution to the next, depending on the training and expertise of the physicians and staff, as well as the treatment planning and treatment technology or capabilities available at any given center. New computer-generated treatment calculation programs enable precise administration of radiation to specific areas of concern, while limiting the dose to other, healthy tissues.
