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NON- SMALL CELL LUNG CANCER
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NON- SMALL CELL LUNG CANCER
The FDA has approved a new drug called "Photofrin". This drug can help patients in the earliest stages of lung cancer.
Our Lung cancer transcript explains what "pack-years" are. How Marijuana contributes to Lung cancer. How asbestos is linked to malignant mesothelioma.
Did you know that smoking cigars or pipes doubles the risk of Lung cancer compared to the risk in non-smokers. Other substances associated with Lung cancer include nickel, chromium compounds, chloromethyl ether, and air pollutants.
What are the signs to look for? A new cough, hoarseness, anorexia, weight loss, fatigue, are just a few of the tell tale signs to look out for. Distant metastases (spreading), are not uncommon and usually occur later on. Liver, Brain, and bone may be involved.
How radiation exposure increases the risk of "small cell" Lung cancer. We explain all about Radon, which is an important cause of Lung cancer in non-smokers.
We explain about Lymph nodes, Liver, Brain, Bone, and Bone Marrow. We talk about "oat cell" "Hexagonal cell" "lymphocytic", and "spindle cell" carcinomas.
Did you know that "Adenocarcinoma" is the most common cell type occurring in non-smokers, especially young women.
We cover Bone X-rays, Bone scans, Liver scans, CAT scans, and Gallium scans.
Lung cancer accounts for over 170,000 new cancer cases in the United States. We have taken all the relevant information regarding Lung cancer to help you understand just how this cancer develops and acts.
We tell you what causes or increases the risk for getting Lung cancer, all written in plain English. We tell you how it spreads, how it is detected and evaluated. All the Stages, and how curable is Lung cancer. In the transcript we explain the conventional treatments for Lung cancer, including Surgery, Chemotherapy, and Radiation.
Also Combination Therapy , including Pre-Operative Radiation, and Post-Operative Radiation. We explain the Latest most effective treatments for Lung cancer. Also "SVC" Syndrome also called "Superior Vena Cava". We explain about "laser beam therapy".
What are the Symptoms of Lung Cancer?
Like any cancer,very early lung cancer has no symptoms, since there are too few cancer cells to interfere with normal body functioning. As the cancer gets larger, the following commonly occur:
1) Persistant Cough, and sputum tinged with flecks of blood ("hemoptysis") must always be evaluated to rule-out cancer. The cancer can block of a bronchiole, causing obstructivepneumonia . It is important for a follow-up X-ray to be taken after a pneumonia is treated, to make sure no tumor was lurking behind it.
2) Shortness of Breath will be seen if bronchi are blocked off by the tumor, and so prevent the inspired oxygen from mixing with the blood. The effort in breathing will also increase if a fluid collection ("effusion") develops due to the cancer.
This puts more stress on the heart pumping blood through the lungs, which in turn leads to more shortness of breath andfatigue . Fatigue also can be due to a buildup of the waste-product carbon dioxide in the lungs-- it's exit blocked by the tumor. Progressive shortness of breath ("SOB") must always be evaluated.
3) Weight Loss is very common with lung cancer, as the body's resources are shunted into the growing cancer, and appetite decreases. Sometimes an unexplained weight loss is the first sign of lung cancer. The cancer itself can produce substances that interrupt appetite and metabolism ("paraneoplastic syndromes"). These substances can be monitored to gauge therapy success.
4) Pain in the chest will manifest as the cancer invades into bone and nerves. Many patients have almost no pain until late in the disease, or only a "pleuritic" (stabbing) pain on deep inspiration. The pain may radiate to the back.
5) Hoarseness can occur if the cancer invades the middle portion of the chest ("mediastinum") and damages the "recurrent laryngeal nerve", which normally control the voicebox. The voice may also change to be higher pitched.
6) Signs of Distant Spread include mental changes, stregnth and sensory loss owing to spread to the brain, and bone pain and fractures due to distant spread to bone. About 10% of the time, these "late signs" are the first indication of lung cancer. Any symptom is possible, since the cancer can spread to any body area. The most common areas of spread are to lymph glands, the other lung, liver, brain, bone, skin, and adrenal glands (on top of each kidney).
How is Lung Cancer Detected and Evaluated?
It is important to note that any of the above symptoms are more likely caused by
something other than lung cancer. However, they shouldn't be ignored. If a patient
comes to their doctor with problems suggestive of lung cancer, the doctor will do:
1) Complete Physical Examination includes checking weight, temperature and blood pressure, and the skin surface. The heart and lungs are carefully listened to ("auscultated") and any wheezes or lack of breath sounds are noted. Tapping on the back to listen for dullness ("percussion") can tell if fluid is building up in the lungs. The even expansion of the chest with each breath is observed. The quality of the voice is noted for hoarseness. The fingernails are checked for curving which indicates chronic lung disease. Examination of the lymph glands in the neck, shoulder and armpit region may show swelling there. The abdominal organs (liver, speen, kidneys, adrenals) are checked for swellings. A neurolocal exam checks the brain, special sense organs, and limb stregnth. In males the prostate is checked with a rectal exam, and in females a pelvic exam with PAP smear is done, and the breasts carefully checked
2) Routine Laboratory Tests include Complete Blood Count("CBC") to check for anemia and infection. A Chemistry Panel ("SMA") checks blood sodium, potassium, bicarbonate, chloride, calcium, phosphorus, glucose, cholesterol and liver and kidney function. Routine urinalysis("UA") detects blood, protien, glucose or infection in the urine. If surgery is contemplated, the surgeon will want an assessment of blood clotting ability ("PT/PTT") . Unfortunately, there is no single accurate blood test to pick up lung cancer ("tumor marker") as there is for prostate cancer.
3) Radiology Tests include plainChest X-ray which may show tumors over about 1/2 inch, signs of infection, and signs of lung obstruction or collapse. Failure to see anything on plain X-ray does not rule out cancer, but does suggest that the cancer, if present, is small. A chest X-ray may miss a small tumor hidden by a rib or the silhouette of the heart. More accurate is a CT scan of the chest, which can detect tumors over about 1 cm. in any chest location. CT scan can also pick up enlarged lymph nodes in the mediastinum (middle of the chest). Lymph nodes larger than 1 cm. are suspicious; those over 2 cm. certainly have something wrong with them (infection and/or cancer). If a CT scan is given with
"contrast dye" (injected into an arm vein) it helps highlight the blood vessels and is somewhat more accurate. CT scan can also be used for the abdomen and is excellent for showing spread to the liver, or to the adrenal glands. Brain CT will be ordered if the is suspician of spread there. Magnetic Resonance Imaging ("MRI") is a newer method that used magnetism instead of radiation, it is great for looking at soft tissues in the chest, It is 3 times as expensive as CT (~$1000) and is not routine. Bone Scan involves injecting some radioactive dye into a vein; the dye has a propensity to accumulate in damaged or cancerous bone areas, which are detected by a scan. It is gotten to help rule out spread to bone, especially if new bone pain is noted and surgery is contemplated. Bone Scan is much more accurate than plain X-rays of bone in picking up cancer spread, but also more time consuming, uncomfortable and expensive. Repeat Bone Scans may be needed to help confirm if an area seen is actually cancer, or just an old area of trauma. A "baseline" Bone Scan, as is done with breast cancer, may be reasonable so that later bone scans can be compared to it. Specialized radiology tests such as barium enemas or esophagrams are only gotten if use will be made of the information obtained from them; that is if they are useful given the clinical picture and treatment options for a particular patient.
4) Sputum Analysis (Cytology) is useful for making a diagnosis of cancer is a patient who's tumor is shedding off cells that can be coughed up. It is non-invasive and relatively inexpensive, using morning sputum specimens (deeply coughed up specimens, not saliva) collected in plastic containers for analysis. Five consecutive daily specimens may be as much as 80% accurate for detecting cancer, especially if it is located in the bronchial tubes or center the chest.
5) Biopsy (Sampling) of the tumor is the only way of definitely diagnosing any lung cancer. Either the primary tumor, cells it has sloughed off, or an area of distant spread (a metastasis) may be sampled to confirm or deny cancer. A pathologist is a physician who specializes in making disease diagnoses from tissue samples. There are several standard ways of getting a sample for the pathologist:
a) Endoscopic Brushings and Biopsy means putting a visualization tube down the patients throat into the lungs, where they are under a light anesthesia (usually valium and demerol). If the tumor is "endobronchial" is may be seen and sampled by brushing it for cells and/or cutting a piece off of it with a special biopsy scissors on the endoscope. This can be therapeutic, too, since a blockage can be relieved to restore air flow.
b) CT Scan Guided Biopsy means the patient is brought down to the CT Scanner, the tumor is visualized, and a fine-needle is placed (under local anesthesia) through the chest wall into the tumor, with pieces of tumor drawn out. It is about 85% accurate at making a diagnosis and quite safe. The biggest risk is collapsing the lung (20%) which then will require a chest tube to be put in to re-expand it, and an overnight stay.
c) BronchoAlveolar Lavage (BAL) is like getting a deep sputum specimen, literally by putting washing fluid down into the lungs, re-drawing it out, and looking for cancerous cells. It is most helpful for tumors within the bronchial tree, and can be done at the same time as endoscopy. It is performed by a pulmonologist, a physician specializing in lung disorders.
d) Mediastinoscopy means cutting a small hole above the breastbone (sternum) and inserting a scope into the central part of the chest (the mediastinum). Enlarged lymph nodes can be removed and sent to the pathologist for analysis. Some surgeons base the procedure they will do upon the results of the mediastinoscopy, and order it routinely.
e) Open Biopsy is done if an area looks suspicious, but cancer cannot be confirmed or denied by the above methods. A surgery to remove an unknown type of tumor is an open biopsy. If the entire tumor is removed, it is called an "excisional" biopsy; if it is merely sampled, it is then called an "incisional" biopsy. About 10% of patients have disease that can only be diagnosed with an open procedure, done under general anesthesia. However the biopsy same is obtained, it is sent to the pathologist who examines it to confirm or deny cancer. If cancer is detected, the particular type is specified.
6) Other Standard Tests include lung function studies to determine how much lung may safely be removed at surgery, and EKG to check heart function. This is part of a pre-operative evaluation to see if the patient can tolerate surgery. Generally, if there has been a heart attack in the prior 6 months, the risk of major surgery is considered too great.
How is the Extent of Lung Cancer Gauged?
Like all cancers, the extent of non-small cell lung cancer is given by the"stage". The staging system most used for lung is the "American Joint Cancer Committee" (AJCC) system. It takes into account the size of the primary tumor, spread to lymph nodes, and distant spread (metastasis):
Stage I means the cancer is relatively small (usually less that 2 inches across) and has not spread to any lymph nodes. It can block off a section of lung.
Stage II means the cancer has spread to local lymph nodes ( "hilar" nodes) but not to those lymph nodes in the center of the chest ("mediastinal" ).
Stage IIIA means the cancer may invade the diaphragm, chest wall, or block off an entire lung. It may have also spread to mediastinal lymph nodes.
Stage IIIB means the cancer can invade the heart, vertebrae, trachea, great blood vessels or mediastinum. There may be fluid collection in the lung that contains malignant cells. Any lymph nodes in the chest can be involved.
Stage IV means the cancer has spread distantly, i.e. to the liver, bone or brain.
What is the Classical Survival from Lung Cancer?
The survival with any cancer is variable, depending upon the stage it was detected, the exact type of cancer, the treatment obtained, the patient's will to survive, and general health besides for the diagnosis of cancer. We cannot say how long any individual patient will live, we are M.D.'s, not "M.Dieties". The textbook figures for classical treatment of non-small cell lung cancer, by stage are:
Stage 5-year survival (probably "cured")
I 65%
II 45%
IIIA 22%
IIIB 8%
IV 6%
Bear in mind that many patients survive longer than the above figures, and that the above figures include all deaths from whatever cause (i.e. heart attack) to patients with lung cancer. In a major Veteran's Hospital study, the biggest 3 factors determining legnth of survival were extent of disease, weight loss, and "performance status" (how functional the person was). Nonetheless, experienced physicians don't make predictions for how long patients will live, since patients make liars out of us. If we say the will live for years, they may succumb within months. If we say that have weeks or months, many embarass or prediction by living for years! We are all born with a terminal disease called earthly life, and the question is not just how long we endure, but the quality of that endurance. Even for incurable disease, a competent and compassionate doctor should be able to make the patient's symptoms much less distressing. There should never be a need to resort to suicide owing to discomfort. As the great American pioneer doctor Sir Wm. Osler said, "cure rarely, palliate sometimes, comfort always".
What is the Conventional Treatment for Lung Cancer?
The conventional treatments for non-small cell lung cancer have been surgery and radiation therapy. Many patients have also receivedchemotherapy, although the classical chemotherapy failed to exend survival for patients with metastatic disease. Each of these three "modalities" is now discussed in turn:
Surgery has been, and remains, the best treatment for very early lung cancer. About 40% of patients have disease limited to the thorax (chest) at diagosis, and 80% of these can have total removal of their cancer at surgery ("complete resection"). For a small cancer, it has been shown best to remove a complete "segment" of the lung, rather than just the area of tumor. This is because removing one segment does not compromise breathing ability, and gives a better chance of removing all cancer cells. Thus, "segmentectomy" is the least drastic surgery for lung cancer, with the shortest time to recovery. If the cancer has spread beyond a segment, than an entire "lobe" of lung, consisting of multiple segments, will be removed in a "lobectomy" . This is more drastic and can compromise breathing, since 1/3 to 1/2 of the involved lung is being removed. The most drastic procedure is removal of an entire lung, called a "pneumonectomy" . This will lead to less exercise tolerance and easier fatigue in anybody, although most people can live with one lung. Before any major lung removal is considered, the patient will be sent for heart and lung function tests to help ensure they can tolerate the surgery. This is especially important in patients who have been long-time smokers, and those with emphysema or asthma. If the patient cannot tolerate the proper surgery, radiation therapy will be recommended instead.
The risks for surgery depend on how much lung is removed, and the general health of the patient prior to surgery. Overall, there is about a 5% chance of death from major thoracic surgery, when performed by an expert cardio-thoracic surgeon. Risks include pneumonia, heart attack, stroke, and blood clots. It may be difficult to wean the patient off the the ventilator if the other lung tissue is damaged. Healing is normally complete enough to allow lifting heavy objects in 3 weeks. It is crucial to get proper pulmonary "toilet" after surgery, meaning not giving so much pain medicine that the patient doesn't want to breath on the own or cough up phlegm, and using spirometers (breathing exercise devices) to help re-expand the remaining lung tissue.
The results of surgery alone vary by stage. For stage I disease, complete resection results in up to 80% cure. For stage II and IIIA, the cure rates with surgery are 50% and 25% respectively. The cure rates are not 100%, even with apparent complete removal of the cancer, since some cancer cells may have spread out and be missed at surgery. The cancer may have been "understaged" by our conventional staging evaluation, since our radiologic techniques can only pick up an area of spread if it is larger than 1 cm. -- about 1 billion cells! Therefore, doctors have tried adding radiation therapy and/or chemotherapy after apparently successful surgery to see if this helps survival. This is called"adjuvant", meaning "extra" therapy. The results of combining surgery with radiation and/or chemotherapy, given either before (pre-operative) or after (post-operative) the surgery, are discussed after considering them separately.
Radiation Therapy has been used for 8 decades for lung cancer, the techniques have been advancing steadily. It is administered by a "radiation oncologist", a cancer physician specializing in radiation therapy. There are 2 standard methods of giving radiation-- "External Beam" and"Brachytherapy" . External Beam is the more common type and shines a beam of photons or electrons onto a pre-designated area of the patient's chest. Thus, it can cover a large area of possible cancer spread. Brachytherapy, also called "intracavitary", means putting an actual radiation source into the lung, either temporarily or permanently, to treat a limited area of tumor. Both techniques may be used in a given patient.
Radiation kills cancer cells by damaging their DNA, they die when they try to divide. Thus, damaged cancer cells die even after the treatment is complete. Radiation will also kill normal cells, which limits the amount that can be given. However, it usually takes more radiation to kill normal cells than cancer cells, and normal cells can often repair the radiation damage, while cancer cell can not. Nevertheless, it is important to be exacting as possible in the administration and dose of radiation, so as to minimize the injury to adjacent normal cells.
To receive therapy, a patient is first seen in "consult" by a radiation oncologist, who reviews the patient's medical record, complaints, and radiology films. After explaining the possible benefits and side-effects of radiation, the patient is scheduled for a "simulation" . This means the area to be treated is marked out on a replica treatment machine, and films are taken. Watercolor marks are painted on the patient to denote the treatment area, and eventually small, permanent tattooes are placed on the skin. Sometimes the patient is sent for a CT scan along with the simulation, the whole process takes less than 2 hours, and is painless. Information from the simulation and relevant scans is placed into a "treatment planning computer", which generates a"plan" . This plan tells how much radiation is going to the tumor area, and how much to adjoining normal tissues. For lung cancer, particular attention is paid for how much radiation is going to the spinal cord and heart. The plan is reviewed by the radiation oncologist and also by a specially licensed Radiation Physicist prior to starting therapy. The patient then comes in for their "treatment start". They are placed on a hard, flat table in a specially shielded room and aligned with laser lights. The actual treatments are given by "Radiation Therapists", or "R.T.T's", who are first certified for diagnostic X-rays and then get additional training to deliver therapy. For the first treatment, "verification films" are taken to ensure proper positioning; they do not tell anything about the cancer. The actual treatment only takes a couple of minutes and is given with a Linear Accelerator (or occasionally older Cobalt-60) which precisely aims a beam of photons at the treatment area. The head of the machine can swivel about the patient, to give the treatment from several angles. The patient needs only to lie still. Areas that are not to be treated can be "blocked" with special lead-type blocks in the head of the treatment machine. Normally, patients area treated 5 days a week, Monday through Friday, taking only several minutes each day.
The usual dose of radiation for lung cancer is 40 - 60 Gray (units of radiation) given at about 2 Gray per day over 4 to 6 weeks. Often, a larger area of the chest is treated initially, and then a "cone down" or "boost" is used to narrow the high dose treatment to the specific tumor area as seen on X-ray. Treatment itself is painless, the patient does not become sick, "radioactive" or lose their scalp hair from radiation to the chest. The side effects from chest radiation for lung cancer are divided into two general categories, "acute" and"late" effects."Acute" effects occur during the treatment period, and commonly resolve afterward. "Late" effects may occur months to years after treatment, and may improve very slowly or never resolve.
Typical acute effects are skin redness within the treatment area, difficulty or pain on swallowing as the esophagus (food pipe) is treated, and general fatigue. Possible late effects include damage to normal lung ("radiation pneumonitis") which causes cough, fever and shortness of breath. It only occurs in about 10% of patients and is often treatable with steroids. However, it is occasionally fatal. Treating large areas of lung, and/or giving chemotherapy along with lung radiation, increases the chance for radiation pneumonitis. Another feared complication of lung radiation is spinal cord damage, since the spinal cord is very close the the back portion of the lungs. This may manifest as a temporary sensation of "electric shocks" shooting down down the body with neck flexion ("Lhermitte's sign") which is scary but commonly resolves. Worse but very rare with modern techniques is "transverse myelopathy", which means severing the spinal cord from too much radiation-- this will cause permanent paralysis below the injury. The spinal cord tolerates about 45 Gray with less than 1% chance of damage, and this is a reason why careful "simulation" and review by a radiation physicist is crucial to ensure that the cord is not being overdosed. As mentioned, this is very rare with today's technology and training. Radiation can also cause heart damage, such as irritation of the fluid-filled sac around the heart ("pericarditis") which may cause chest pain and fever, and need a surgical proceedure to drain excess fluid. This is also very rare. Overall, external beam chest radiation is very well tolerated and of proven benefit for increasing survival in lung cancer, for patients who cannot tolerate surgery.
Brachytherapy is being used more commonly today, since it gives a high dose of radiation to a local tumor area with minimal side effects to surrounding normal tissues. In practice, it is usually given in conjuction with external beam therapy, since we are worried about cancer cells that may have escaped around the periphery of the tumor, and into local lymph nodes, which would not be adequately treated with any brachytherapy alone. Giving brachytherapy, or "intracavitary" therapy, can be done in several ways. One is surgical placement of permanent "iodine -125" seeds in the area of the tumor, often at surgery. These seeds have an effective life of about 90 days
during which they give potent radiation to their immediate area, but nearly none just a couple of centimeters away. Another option, especially for patients not getting surgery, is treatment with high-dose radioactive sources contained in a small tube ("catheter") placed with an endoscopy tube through the mouth, down the throat and into the lung.
Brachytherapy is particularly useful for tumors in the bronchi, since the endoscopy tubes travel through the bronchi and can place the catheter there. Thus, such tumors are usually more in the center of the chest, as opposed to the periphery. Multiple treatments may be given, 2 to 4 weeks apart, with high dose brachytherapy (HDR); the actual time of treatment is only a few minutes. If a segment of lung has recently collapsed owing to tumor, there is a good chance (up to 70%) that it can be re-opened using this "endobronchial brachytherapy", which is available at most Academic University Radiation Oncology departments.
The results of radiation alone depend upon the stage of cancer it's used for. In
general, the results are somewhat inferior than those for surgery, but radiation has cured lung cancer. Bear in mind that patients who don't get surgery, but radiation instead, are ofter older and sicker, so they wouldn't be expected to do as well given their overall medical condition. For stage I and II, survival at 5 years with radiation alone is about 40%, and for stage III about 10%. Nonetheless, radiation will more than double the percentage of people living 2 years with stage III lung cancer, to about 25%. Many of these patients actually have their disease controlled in the chest by the radiation, but succumb to spread of the disease elsewhere in the body. This is the same as for surgery, since ultimately both radiation and surgery are local therapies that do nothing about disease which has escaped to other body areas. Thus, to address this, chemotherapy has been looked at as a way to treat the entire body. There is no question that local radiation is very valuable in relieving symptoms of lung cancer, whether from pain from spread to ribs (or other bone) or helping reduce the coughing up of blood (hemoptysis) from the cancer. Thus, radiation therapy is almost always used in advanced cancer to relieve symptoms, with up to 90% effectiveness.
Chemotherapy is the only treatment which goes to the entire body, with the rare
exception of using whole body radiation to relieve symptoms (but not to cure). Lung
cancer tends to spread very quickly to other body areas, but it will be a while before this spread ("micrometastasis") grows enough to become apparent. If this spread can be prevented or controlled while still small, it will increase the chance for cure. Unfortunately, chemotherapy alone has been very disappointing for lung cancer, and the side effects are often worse than the cancer's symptoms! There is often an initial shrinkage of the tumor, over the first several "cycles" of chemotherapy, followed by rapid growth as the cancer becomes resistant to the chemicals. Furthermore, no current chemotherapy alone is sufficient for controlling local, large tumors. If chemotherapy is to be useful, it must be combined with an effective local treatment, that is surgery, radiation, or both. Occasionally, chemotherapy alone is used to try to relieve symptoms of advanced disease, but it should never be used alone to "cure" non-small cell lung cancer-- it just doesn't work!
The most effective current chemotherapy agents for lung cancer are adriamycin, platinum, etoposide, vinblastine and cytoxan, used alone or in combination. Each of these agents has it's own particular toxicity. Worth noting isadriamycin's propensity to cause heart damage and increased redness of the skin with radiation, along with hair loss and sterility.Platinum compounds cause nerve damage, kidney damage and hearing loss, and all of the agents lower blood counts causing anemia and possible overwhelming infection. Nausea, vomiting, and sore throat are also common with chemotherapy, since the rapidly dividing normal cells in the digestive tract are also killed. Fortunately, advances in supportive care over the past decade have made aggressive chemotherapy easier to take. Specifically, the anemia and low white blood cells counts caused by chemotherapy agents can be treated with "growth factors" that
promote formation of new red and white blood cells (Epogen and Neupogen). The nausea and vomiting which has classically been part of chemotherapy treatment is much reduced with agents that turn off the nausea perception center in the brain (Zofran). Nonetheless, any patient developing a fever while on chemotherapy must report for medical attention immediately, owing to the risk of overwhelming infection due to low white blood cell count ("febrile neutropenia"). Obviously, any patient getting chemotherapy must be under close monitoring, with frequent blood counts, by a competent Medical Oncologist.
Combined Modality Treatment means using more than one approach in the same patient to kill cancer cells, and increase the chance for cure. Many studies have been done to determine the optimum sequencing of therapies, and the best results for most non-small cell lung cancer patients have come from a "multimodality" approach. However, the first thing to note is that not every addition of another therapy has been of proven benefit. Specifically, for patients with very early disease (stage I) the addition of radiation after surgery has not improved survival, and another major study (LCSG) showed no improvement in adding radiation after surgery for stage II and III lung cancer, if the disease completely taken out (resected) at surgery. This is because most deaths in these patients are from distant spread, so even though radiation to the chest can help control local disease there, it doesn't help ultimate survival. Nonetheless, most radiation oncologists will treat patients with stage II or III lung cancer after surgery since they suspect that some (microscopic) cancer remains in the chest. Certainly, if gross disease remains in the chest, adding radiation is of proven benefit for local control, and many feel for survival. Another approach is doing the radiation before surgery; pre-operative radiation can help shrink the tumor and make it easier to remove at surgery. It may also help prevent the tumor from "seeding" at surgery to other body areas, as a result of being disturbed. However, the only proven role for pre-operative radiation is is forsuperior sulcus tumors, that is at the apex of the lung. With these tumors, there is often spread into the local ribs and even into the vertebrae to the spinal cord. Giving pre-operative radiation helps remove the tumor from these structures, allowing it to be removed ("resected") more easily. Otherwise, pre-operative radiation is out of vogue since it has not improved survival.
We tell you everything you need to know to make the right choices today to deal with Lung cancer. Newer treatments offer more hope of survival and comfort than ever before
Selecting the right treatment can literally make the difference between life and death. It is important to have the peace-of-mind knowing that you have done everything possible to help fight lung cancer successfully.
