Which treatment for lung cancer?

• A quick guide to what's on this page
• How treatment is planned
• Treatment and type of lung cancer
• Treatment by stage for small cell lung cancer
• Treatment by stage for non small cell lung cancer 
• Being cared for by a multidisciplinary team
• Discussing things with your doctor

Your cancer specialist looks at a number of factors that help them to plan your treatment. These include

• The type of lung cancer you have
• Where the cancer is within the lung
• Your general health
• Whether the cancer has spread (the 'stage')
• Results of blood tests and scans

You may find that other people you meet are having different treatment from you. This may be because they have a different type of lung cancer. Or it may be that some of the other factors listed above are different. Don't be afraid to ask your doctor or specialist nurse any questions you have about your treatment.

Surgery, radiotherapy and chemotherapy are all used to treat lung cancer. They can each be used alone or together. Your doctor will plan the best treatment for you.

The treatment for non small cell lung cancer is different from the treatment for small cell lung cancer.

Small cell lung cancer is mostly treated with chemotherapy. Surgery is only suitable if there is no sign that the cancer has spread to the nearby lymph glands and this is rare with small cell lung cancer. It has usually spread at the time of diagnosis. So chemotherapy is usually the main treatment. You may also have radiotherapy to treat this type of lung cancer. There is information below about the treatment of small cell cancer by stage.

Non small cell lung cancer can be treated with surgery, chemotherapy, radiotherapy or a combination of these, depending on the stage when the cancer is diagnosed. There is information below about the treatment of non small cell cancer by stage.

If you have early stage small cell lung cancer you are most likely to have chemotherapy and radiotherapy to the lung. It is quite common for this type of cancer to spread to the brain. So doctors often recommend that people with early small cell lung cancer have radiotherapy to the brain to try to kill any cancer cells that may have already spread there. This is called prophylactic cranial irradiation or PCI.

If you have very early stage small cell lung cancer that has not spread to any lymph nodes, you may have surgery to remove the part of the lung containing the tumour (a lobectomy) followed by chemotherapy and radiotherapy. But usually the cancer has already spread at the time of diagnosis and surgery is not then possible.

If you have small cell cancer that has spread to lymph nodes or other areas of the body you may have chemotherapy, radiotherapy or biological therapy treatment to relieve symptoms. If chemotherapy works well to shrink the lung tumour down and you are fairly fit you may also have radiotherapy to the brain to kill any cancer cells that may have already spread there. This is called prophylactic cranial irradiation or PCI.

Stage 1

Stage 1 non small cell lung cancer is very uncommon. You normally have surgery to remove part of the lung (a lobectomy) or all of the lung (a pneumonectomy). If you can't have an operation for other health reasons, your doctor may suggest radiotherapy instead to try to cure the cancer. Another option for small tumours if you cannot have surgery is RFA, or radio frequency ablation.

Stage 2

For stage 2 non small cell lung cancer, depending on the position of the tumour, you may be offered surgery to remove part of the lung (a lobectomy) or all of the lung (a pneumonectomy). If the cancer is completely removed, your specialist may suggest chemotherapy to try to lower the risk of the cancer coming back. This is called adjuvant chemotherapy. It is important that your doctor talks to you beforehand about the benefits and side effects of chemotherapy. If you can't have surgery, you may be offered radiotherapy to try to get rid of the cancer completely.

Stage 3

For stage 3 non small cell lung cancer you may be able to have surgery, depending on where the cancer is in the lung. You may need to have the whole lung removed (a pneumonectomy). If there are cancer cells in the middle area of the chest (the mediastinum), your doctor may suggest radiotherapy instead. The cancer may be too close to your heart to operate safely.

If your doctor spots signs of cancer in the lymph nodes on the same side of your chest as the lung cancer, they may advise you to have chemotherapy before the surgery. This is called neoadjuvant chemotherapy. If cancer cells are not found in the lymph nodes until after the surgery your doctor is likely to advise you to have chemotherapy and possibly radiotherapy after the operation.

If your doctor spots signs of cancer in the lymph nodes on the opposite side of your chest, surgery is not possible but you may have a course of chemotherapy. After the chemotherapy it might be possible to have further treatment with radiotherapy. You may also have further treatment with a biological therapy called erlotinib (Tarceva).

Stage 4

Treatment for stage 4 non small cell lung cancer aims to control the cancer for as long as possible and to shrink the tumour down to reduce symptoms. Many trials have used chemotherapy in this situation and we now know that it can improve survival time as well as relieving symptoms. A biological therapy called erlotinib (Tarceva) is sometimes used when chemotherapy is no longer working. It aims to control symptoms and try to help people live longer.

You may also have radiotherapy to control symptoms such as pain or a cough. As well as radiotherapy, other treatments can relieve a blockage and reduce symptoms if you have a tumour in one of the main airways (the left or right bronchus). These treatments include internal radiotherapy (brachytherapy), laser treatment, freezing the tumour (cryotherapy), using a rigid tube (a stent) to keep the airway open, and light therapy (photodynamic therapy - PDT). There is detailed information about treatments to relieve an airway blockage in the advanced lung cancer treatment section.

NHS guidelines state that everyone diagnosed with lung cancer should be under the care of a multi-disciplinary team. This is a team of health professionals who work together to discuss your case and how best to manage your treatment and care. The team includes specialist surgeons, cancer specialist doctors, specialist lung cancer nurses, doctors specialising in diagnosis from tissue specimens (histopathologists), physiotherapists, occupational therapists, psychologists, social workers, dieticians and sometimes other health professionals or specialists.

It's important that you feel OK about the treatment your specialist recommends. Most people feel more comfortable about this if they understand why a particular treatment decision has been made. This can be even more important if you've been told that a particular treatment isn't suitable for you. These days, most doctors expect patients to want to ask questions and they appreciate that you need things explained in a way you can understand.

An appointment where you are given your diagnosis and told about your treatment options is very important and you are likely to be shocked and find it hard to take in information or make decisions. If you feel that you need more time to think things through or discuss the options, you can ask your specialist to see you again to discuss things more fully before you make a decision about treatment. There are also lung cancer specialist nurses you can talk to who can answer questions about your cancer and its treatment.

Some people feel they would like to get an opinion from a second doctor before they decide on their treatment. Most doctors are happy to refer you to another specialist for a second opinion if you would find this helpful. You should discuss this with your GP or cancer specialist who can make the referral for you.  When you go to see the doctor it often helps to write down a list of questions you want to ask. You could also take a close friend or relative with you - they can help you to remember what was said.

Our lung cancer organisations page gives details of people who can provide information about your choice of treatment. Some organisations can put you in touch with a cancer support group. You can find details of counselling organisations in our counselling section. Our lung cancer reading list has information about books and leaflets on lung cancer treatments.