Last modified: April 5, 2021
Treatment can involve various forms of surgery, chemotherapy and radiation. When lung cancer is diagnosed, your doctor will explain the tumor’s histological type and assign it a stage. There are two main types of lung cancer — small cell and non-small cell.
Because small cell and non-small cell lung cancers grow, spread and react to treatments differently, your lung cancer’s histological type has a crucial impact on your treatment and outlook.
Exposure to asbestos is strongly associated with causing lung cancer, mesothelioma and several other severe respiratory diseases. Asbestos is the most common occupational risk factor for lung cancer, and workplace exposure significantly increases the chance of developing the disease.
Many times, treatment options will be limited by the stage of the patient’s cancer. Lung cancer spreads to the lymph nodes and distant organs as it progresses, which makes treatment increasingly difficult. Those diagnosed in the earliest stages of disease have the most treatment options and experience the greatest survival rates.
Non-small cell lung cancers are commonly classified with a four-stage system. A higher stage indicates more advanced disease.
Small cell lung cancer is staged using a two-stage system instead: Limited stage or extensive stage. In limited stage, the cancer is only found in one lung and possibly nearby lymph nodes. In extensive stage, the tumor has spread to the opposite lung or to other organs
The ideal goal of surgery is to remove a tumor and nearby cancerous tissue, thus completely eliminating the disease. The extent of tissue removal varies depending on the tumor’s size, its location and how far the cancer has spread. Doctors also consider pre-existing conditions, such as heart disease, which could make a patient ineligible for surgery.
There are several surgical procedures used to treat lung cancer:
- Resection: The removal of the tumor and a small portion of surrounding lung tissue.
- Lobectomy: An entire cancerous section, or lobe, of the lung is removed.
- Pneumonectomy: The surgical removal of an entire lung.
If the cancer is found in an early stage when spread is limited, curative surgery is preferred for its statistically high success rates. The majority of cases, however, involve advanced-stage cancer where a cure is unlikely. In this case, doctors perform palliative treatments that make symptoms more bearable while improving the patient’s outlook.
Doctors will look at the cancer’s histological type and extent of spreading before recommending surgery as a curative treatment option. If tumor growth is causing pain or undesirable symptoms, palliative surgery may be performed.
Surgery for Non-Small Cell Lung Cancer
In most cases, non-small cell lung cancers are removed through lobectomy. If the patient has poor lung function, however, doctors may remove only a small wedge of the lung via surgical resection.
Surgery for Small Cell Lung Cancer
Small cell lung cancer spreads much more aggressively than non-small cell, making surgery an option only in a few special cases. Although surgical treatment for small cell is rare, studies have reported positive results for the small percentage of patients with very limited disease.
When there is clear evidence that lung cancer has spread from the initial tumor, chemotherapy is recommended. This treatment is typically not curative for lung cancer, but has been known to reduce the size of tumors and kill cancer cells that have spread to the lymph nodes. For patients, this usually translates to a longer, more comfortable life.
Whether taken intravenously or in pill form, chemotherapy drugs target rapidly dividing cells. This kills cancer cells, but can also affect normal healthy cells including hair follicles, red and white blood cells and the cells that line the stomach. Because nearly half of all patients that have a tumor surgically removed will experience relapse, about 80 percent of all lung cancer patients are considered for chemotherapy during the course of their treatment.
Chemotherapy for Non-Small Cell Lung Cancer
In the earliest stages of non-small cell lung cancer, chemotherapy is sometimes given before surgery to reduce tumor size and eliminate early spreading. Doctors call this approach neoadjuvant chemotherapy. For patients with limited lymph node involvement, chemotherapy can also be given post-surgery to kill any remaining cancer cells. This is known as adjuvant chemotherapy and helps prevent the chance of cancer recurrence.
For later stage cancers when surgery is no longer an option, chemotherapy is often administered with simultaneous radiation therapy. Known as combined chemoradiation therapy, this option often boasts survival rates higher than either treatment given alone or one after the other. This treatment is common if the cancer has spread to the mediastinal lymph nodes, which are located outside of the lung near the trachea and esophagus.
Chemotherapy for Small Cell Lung Cancer
For early-stage small cell lung cancer patients in otherwise good health, doctors recommend combined chemoradiation therapy. Small cell cancers are highly responsive to chemotherapy, and survival is significantly improved when it is combined with early radiation therapy.
Once the cancer enters the extensive stage and spreads to distant organs, doctors typically prescribe a platinum-based chemotherapy regimen. This will involve platinum containing drugs like cisplatin or carboplatin with one or more additional chemotherapy drugs.
When lung cancer patients are not eligible for surgery, radiation is often recommended. Radiation therapy uses high-energy targeted radiation to stop cancerous cell division and reduce the size of tumors. The amount of radiation administered is thousands of times greater than the amount used in X-ray imaging, but treatment is divided into doses to limit the damage done to healthy tissues.
Like surgery, radiation therapy is a local treatment that only affects cells in the treatment area. Response rates for radiation therapy are significantly high, but relapse is common so it is more often used as a palliative treatment. In this case, radiation is administered in small doses to lessen pain in areas where cancer has spread, such as the bones. It can also be given to prevent or treat lung cancers that spread to the brain.
For small cell lung cancer, radiation therapy is much less effective – especially if spreading to distant organs has occurred. The radiation can help with local control, but does nothing for small cell lung cancer’s primary threat of aggressive spreading.
While surgery, chemotherapy and radiation therapy are longtime pillars of lung cancer treatment, doctors are constantly conducting clinical trials to test new drug combinations. The primary goal is to improve current success rates while minimizing undesirable side effects. Many of the experimental lung cancer treatments described below are also used to treat mesothelioma, a rare asbestos-related cancer that affects the lining of the lungs. Clinical trials for these treatments will often accept both lung cancer and mesothelioma patients.
Targeted therapies prevent lung cancer from growing and spreading by interfering with specific molecules that control tumor growth, and these therapies normally have no negative effects on healthy cells. One FDA-approved targeted therapy is Avastin, an anti-angiogenesis drug. Avastin interferes with a crucial step in angiogenesis that stimulates the growth of blood vessels. Without a fresh supply of oxygen and nutrients supplied by the blood, tumors cannot grow past a small size.
Recent advancements in the understanding and manipulation of the immune system have allowed the development of immune checkpoint inhibitors such as nivolumab and pembrolizumab. These agents take advantage of the growth regulation of the cells and the immune system and have shown very promising results.
Gene therapy advances have opened the possibility of altering a person’s genetic material to fight or prevent cancer. In gene therapy, doctors introduce genetic material into a patient’s cells to fight disease. Several approaches are being tested in clinical trials.
The following examples of treatments are experimental, but may become commonplace if they prove to be safe and effective in ongoing clinical trials:
- Chemotherapy regimens
- Gene therapy
Asbestos Lung Cancer Doctors
If you have been diagnosed with asbestos-related lung cancer, you likely will be treated by more than one doctor. Leading cancer facilities recommend a multidisciplinary approach to treatment, meaning several doctors specializing in different areas will work together to treat one patient. Some of the specialists who help formulate your treatment strategy and who execute it include:
- Medical Oncologist: An oncologist treats patients with chemotherapy, targeted immunotherapies or a combination of these. Some stage 1 and 2 and most stage 3 and 4 non-small cell lung cancer patients will receive treatment from a medical oncologist as part of multimodal treatment.
- Radiation Oncologist: A radiation oncologist or radiologist specializes in treating lung cancer patients with radiation. Some stage 2 and most stage 3 and 4 non-small cell lung cancer patients receive radiation.
- Thoracic Surgeon: A thoracic surgeon performs operations on the chest.
- Pulmonologist: A pulmonologist, or pulmonary therapist, specializes in diseases of the lung and bronchial tubes.
- Pathologist: Although this is a physician the patient will probably never meet, the pathologist examines tissue samples to determine if someone has asbestos lung cancer and what type.
Because lung cancer is so prevalent — the second-most diagnosed cancer in the United States — there are no shortage of doctors who treat it. The number of doctors who specialize in asbestos-related lung diseases is much smaller. Treating asbestos lung cancer comes with a special set of circumstances and challenges. Here is a breakdown by region of some treatment centers and specialists who tackle asbestos-related lung diseases.
Doctors in the Northeast
In addition to New York state, the northeastern corridor is home to a number of regarded doctors who treat asbestos lung cancer and other asbestos-related diseases.
Doctors in the South
An increasing number of specialists who treat his disease are cropping up in the Southeastern part of the United States.
Doctors in the Midwest
Doctors in the Southwest
The American Southwest is home to a number of qualified surgeons who treat asbestos lung cancer.
Doctors in the West
California is home to a number of highly regarded lung cancer treatment centers and doctors.
Doctors in the Northwest
Like the South, the Northwestern part of the United States is seeing a growth in the number of doctors who treat asbestos lung cancer and mesothelioma.
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