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Treatment for lung cancer
Treatment for lung cancer will depend on the type of lung cancer you have, the stage of the cancer, how well you can breathe (your lung function) and your general health.
If you are a current smoker, your health care team will advise you to stop smoking before you start treatment for lung cancer. This is because smoking may make the treatment less effective and side effects worse. To work out a plan for quitting, talk to your doctor or call Quitline on 13 78 48.
Treatment options by cancer type and stage
Non-small cell lung cancer (NSCLC)
|early (stage 1 or 2)||Usually treated with surgery to remove the cancer and nearby lymph nodes. If surgery is not an option or you choose not to have surgery, you may have radiation therapy. Sometimes, chemotherapy may be given after surgery to reduce the risk of the cancer returning.|
|locally advanced (stage 3)||Can be treated with surgery and chemotherapy or with radiation therapy and chemotherapy. Immunotherapy drugs may also be used. Treatment will depend on where the cancer is in the lung and the number and location of lymph nodes with cancer. In some cases, targeted therapy may be used to slow the spread of the cancer.|
|advanced (stage 4)||Depending on the symptoms, palliative drug treatment (targeted therapy, immunotherapy or chemotherapy), palliative radiation therapy or both may be used.|
Small cell lung cancer (SCLC)
|limited stage||Usually treated with chemotherapy and radiation therapy. Surgery is not used.|
|extensive stage||Mainly treated with palliative chemotherapy, with or without immunotherapy. This depends on the cancer cell type and molecular test results. Palliative radiation therapy may also be given to the primary cancer in the lung and to other parts of the body where the cancer has spread.|
Understanding the aim of treatment
For early or locally advanced non-small cell lung cancer (stages 1–3 NSCLC) or limited-stage small cell lung cancer (SCLC), treatment may be given with the aim of making all signs and symptoms of the cancer go away. This is called curative treatment.
Because lung cancer causes vague symptoms in the early stages, many people are diagnosed when the cancer is advanced (stage 4 NSCLC or extensive-stage SCLC). This means the cancer has spread outside the lung to other parts of the body. The goal of treatment is to maintain quality of life by controlling the cancer, slowing down its spread and managing any symptoms. This is called palliative treatment.
People with early NSCLC (stage 1 or 2) will generally be offered surgery to remove the tumour. How much of the lung is removed depends on several factors:
- the location of the cancer and its size
- your general wellbeing and fitness
- how your lungs are working (lung function).
Because lung cancer causes vague symptoms in the early stages, it is usually diagnosed at a later stage. Surgery is not suitable for most people with late-stage lung cancer. If there is fluid in the lung cavity (called pleural effusion) that keeps coming back, you may have surgery to control this.
Types of lung surgery
Surgery for lung cancer may remove all or part of a lung.
Removing lymph nodes
During surgery, lymph nodes near the cancer will also be removed to check whether the cancer has spread. Knowing if the cancer has spread to the lymph nodes also helps the doctors decide whether you need further treatment with chemotherapy or radiation therapy.
How the surgery is done
There are different ways to perform surgery for lung cancer. Each method has advantages in particular situations – talk to your surgeon about the best approach in your case.
VATS – Lung cancer surgery can often be done using a keyhole approach. This is known as video-assisted thoracoscopic surgery (VATS). In this approach, the surgeon makes a few small cuts (incisions) in the chest wall. A tiny video camera and operating instruments are passed through the cuts, and the surgeon performs the operation from outside the chest. A keyhole approach usually means a shorter hospital stay, faster recovery and fewer side effects.
Thoracotomy – If a long cut is made between the ribs in the side of the chest, the operation is called a thoracotomy. This may also be called open surgery. You will need to stay in hospital for 3–7 days.
What to expect after surgery
Tubes and drips – You will have several tubes in place, which will be removed as you recover. A drip inserted into a vein in your arm (intravenous drip) will give you fluid, medicines and pain relief. There may be one or two tubes in your chest to drain fluid and help your lungs expand again. There may be a tube placed into your bladder to check how much urine you pass.
Pain – You may have some pain or discomfort after surgery, but this can be controlled. Managing the pain will help you to recover and move around more quickly and allow you to do your breathing exercises. Pain will improve when tubes are removed from the chest. Pain relief may also help clear phlegm from your chest.
Recovery time – You will probably go home after 3–7 days, but it may take 6–12 weeks to get back to your usual activities. Your treatment team will explain how to manage at home. Walking can improve fitness, clear your lungs and speed up recovery.
Exercises for breathlessness – Gentle exercises as part of a pulmonary rehabilitation program will help improve breathlessness and reduce the risk of developing a chest infection. The hospital physiotherapist will show you how to do these exercises. To continue with a pulmonary rehabilitation program after you leave hospital, talk to your surgeon or visit lungfoundation.com.au.
Also known as radiotherapy, radiation therapy is the use of targeted radiation to kill or damage cancer cells so they cannot grow, multiply or spread. For lung cancer, the radiation is usually in the form of x-ray beams that come from a machine outside the body. This is called external beam radiation therapy (EBRT). It can be delivered in different ways depending on the type of lung cancer.
Standard EBRT – This is usually given every weekday over several weeks. Treatment aimed at making the signs and symptoms of cancer go away (curative course) may involve 20–33 treatments over 4–6 weeks. Palliative radiation therapy usually involves 1–15 treatments.
Stereotactic body radiation therapy (SBRT) – This is also called stereotactic ablative body radiation (SABR). It is a way of giving a very precise high dose of radiation therapy to small NSCLCs. It is sometimes used instead of surgery. SBRT is often given as 3–4 treatment sessions over a couple of weeks. It is suitable only for tumours that are not close to major airways or major blood vessels.
Radiation therapy may be given on its own, with surgery or with chemotherapy (called chemoradiation). It may be recommended:
- if you are unable or choose not to have surgery
- to treat locally advanced (stage 3) NSCLC or limited-stage SCLC
- after surgery if tests show cancer in the mediastinal lymph nodes, to reduce the risk of the cancer coming back in the mediastinum
- as palliative treatment to improve quality of life by relieving pain or other symptoms.
Planning radiation therapy
Before treatment starts, you will have a planning session at the radiation therapy centre to design a treatment plan for you. During this appointment, you will have a CT scan to pinpoint the area to be treated, and marks will be put on your skin so the radiation therapist treats the same area each time.
The radiation oncology team will explain the treatment schedule and discuss possible side effects.
Having radiation therapy
Radiation therapy is delivered using a machine called a linear accelerator. Each treatment day, a radiation therapist will help you to lie on the treatment table and make sure you are in the correct position before leaving the room. Before the radiation therapy is given, you will have an x-ray or CT scan to make sure the correct area is being treated.
When the treatment starts, you will not feel or see anything, but you may hear a buzzing sound from the machine. The treatment itself takes only a few minutes, but a session may last 10–20 minutes because of the time it takes to set up the machine.
Side effects of radiation therapy
The side effects of radiation therapy vary depending on the dose of radiation and the number of treatments. Most are temporary and disappear a few weeks or months after treatment. Radiation therapy itself is painless, but the radiation may affect some tissues of the body and cause some of the side effects below.
Discomfort when swallowing and heartburn – These side effects may occur during the treatment period and continue for up to four weeks after treatment ends. Until they improve, you may need to eat soft foods and avoid hot drinks, such as tea and coffee.
Fatigue – Feeling tired is common after radiation therapy. Plan your daily activities so you can rest regularly. You may find physical exercise helps to reduce fatigue. It may also help to talk to your family, friends or employer about how they can help you.
Skin changes – The skin on your chest and back may become red or dry, like sunburn. It is important to avoid getting direct sunlight on these areas. Apply a moisturising cream to the skin daily to help look after your skin – talk to your medical team about which products they recommend.
Shortness of breath and cough – Radiation therapy may cause inflammation of the lungs, known as radiation pneumonitis. This may cause shortness of breath, a cough or both. These side effects may happen during treatment, but they are more likely to appear 1–6 months after treatment ends. Radiation pneumonitis is usually temporary and can be treated with steroid (corticosteroid) tablets.
Side effects can change from one treatment session to the next and may build up over time. Tell the radiation oncology team about any side effects you have, as most can be managed.
Chemotherapy is the use of drugs to kill cancer cells or slow their growth. It can be used at different times:
- before surgery to try to shrink the cancer and make it easier to remove the cancer (neoadjuvant chemotherapy)
- before or in combination with radiation therapy to make radiation therapy more effective (chemoradiation)
- after surgery to reduce the risk of the cancer returning (adjuvant chemotherapy)
- when cancer is advanced – to reduce symptoms and improve quality of life.
Chemotherapy is usually given through a vein (intravenously). Each chemotherapy treatment is followed by a rest period to give your body time to recover. Together, the session and rest period are called a cycle. The number of cycles will depend on the type of lung cancer and side effects you have. You will probably have chemotherapy as an outpatient. Ask your doctor about the treatment plan recommended for you. Some types of chemotherapy come in tablet form and can be taken by mouth (orally). These are sometimes used on an ongoing basis.
Side effects of chemotherapy
Chemotherapy works on cells that are dividing rapidly. Cancer cells divide rapidly, as do some healthy cells such as the cells in your blood, mouth, digestive system and hair follicles. Side effects occur when chemotherapy damages these normal cells. As the body constantly makes new cells, most side effects are temporary. Some side effects are listed below.
Anaemia – A low red blood cell count is called anaemia. This can make you feel tired, breathless or dizzy. Your treatment team will monitor your red blood cell levels and suggest treatment if necessary.
Risk of infections – Chemotherapy drugs can lower the number of white blood cells that fight infections caused by bacteria. If you get an infection caused by a virus, such as a cold, flu or COVID-19, the risk of getting a bacterial infection is increased even more. It is important to have good hand and mouth hygiene, and social distancing and isolation are recommended. If you feel unwell or have a temperature above 38°C, call your doctor immediately or go to the hospital emergency department.
Mouth ulcers – Some chemotherapy drugs cause mouth sores, ulcers and thickened saliva, which make it difficult to swallow. Your treatment team will explain how to take care of your mouth.
Hair loss – You may lose hair from your head and chest, depending on the chemotherapy drugs you receive. The hair will grow back after treatment is completed, but the colour and texture may change.
Nausea, vomiting or constipation – You will usually be prescribed anti-nausea medicine with your chemotherapy drugs, but some people still feel sick (nauseous) or vomit, or become constipated. Let your treatment team know if you have these side effects, as they may be able to offer another anti-nausea medicine.
This is a type of drug treatment that attacks specific features of cancer cells, known as molecular targets, to stop the cancer growing and spreading. The molecular targets are found in or on the surface of cancer cells (for example, they may be genes or proteins). Targeted therapy can often be given by mouth as tablets or capsules. These drugs can be highly effective, but they will only work if the cancer contains the particular gene or protein and, even then, they do not work for everyone. Ask your oncologist about molecular testing and whether targeted therapy is an option for you.
Targeted therapy is currently available for people with NSCLC whose tumours have specific genetic changes (mutations) when the cancer is advanced or has come back after initial surgery or radiation therapy. This area of science is changing rapidly, and it’s likely that new mutations and targeted therapy drugs will continue to be discovered. Talk to your oncologist about clinical trials.
Cancer cells often become resistant to targeted therapy drugs over time. If the first-line treatment stops working, your oncologist may suggest trying another targeted therapy drug or another systemic treatment. This is known as second-line treatment.
Side effects of targeted therapy
Although targeted therapy may cause less harm to healthy cells, it can still have side effects. These vary depending on the targeted therapy drugs used – common side effects include skin changes such as acne-like rash, tiredness, diarrhoea, nausea or vomiting. It’s important to report any new or worsening side effects to your medical team. If left untreated, some side effects can become serious and may even be life-threatening. For a detailed list of side effects, visit eviq.org.au.
This is a type of drug treatment that uses the body’s own immune system to fight cancer. Immunotherapy drugs known as checkpoint inhibitors block proteins, such as PD-L1, that stop immune cells from recognising and destroying the cancer cells. Once the proteins are blocked, the immune cells can recognise and attack the cancer.
Several checkpoint inhibitors have been approved for most types of advanced NSCLC. One has also been approved for extensive-stage SCLC when it is used together with chemotherapy. Several other checkpoint inhibitors are currently being tested in clinical trials for lung cancer, including using a combination of these drugs.
Checkpoint inhibitors do not work for all lung cancers, but some people have had good results in the short and long term. Your medical oncologist will discuss which treatment approach is best for you.
Side effects of immunotherapy
The side effects of immunotherapy drugs are different to those caused by chemotherapy or targeted therapy. Immunotherapy can cause inflammation of any body organ, which may lead to different side effects depending on which part of the body is inflamed. Common side effects include fatigue, rash, painful joints and diarrhoea. Most people have mild side effects that can be treated easily and usually improve. Let your medical team know if you have new or worsening symptoms. If left untreated, some side effects can become serious and may even be life-threatening. For a detailed list of side effects, visit eviq.org.au.
If the cancer is advanced when it is first diagnosed or comes back after treatment, your doctor will discuss palliative treatment for any symptoms caused by the cancer. They may refer you to a palliative care specialist. Palliative treatment aims to manage symptoms without trying to cure the disease. It can be used at any stage of advanced lung cancer to improve quality of life and does not mean giving up hope. Rather, it is about living as fully and comfortably as possible.
Systemic treatment (chemotherapy, immunotherapy and targeted therapy), radiation therapy and surgery may be used palliatively to slow the spread of cancer and control symptoms such as pain or breathlessness. If you are experiencing a build-up of fluid in the lungs, various procedures can drain the fluid and help prevent it building up again.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, spiritual and social needs. The team also supports families and carers.
This information is reviewed by
This information was last reviewed in October 2020 by the following expert content reviewers: A/Prof Nick Pavlakis, President, Australasian Lung Cancer Trials Group, President, Clinical Oncology Society of Australia, and Senior Staff Specialist, Department of Medical Oncology, Royal North Shore Hospital, NSW; Dr Naveed Alam, Thoracic Surgeon, St Vincent’s Private Hospital Melbourne, VIC; Prof Kwun Fong, Thoracic and Sleep Physician and Director, UQ Thoracic Research Centre, The Prince Charles Hospital, and Professor of Medicine, The University of Queensland, QLD; Renae Grundy, Clinical Nurse Consultant – Lung, Royal Hobart Hospital, TAS; A/Prof Brian Le, Director, Palliative Care, Victorian Comprehensive Cancer Centre – Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, and The University Of Melbourne, VIC; A/Prof Margot Lehman, Senior Radiation Oncologist and Director, Radiation Oncology, Princess Alexandra Hospital, QLD; Susana Lloyd, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Nicole Parkinson, Lung Cancer Support Nurse, Lung Foundation Australia.