Which treatment for advanced lung cancer?
This page tells you about treatments for advanced lung cancer. You can find information about
- A quick guide to what's on this page
- How your treatment is planned
- Controlling symptoms of advanced cancer
- Treating a blocked airway
- Treating fluid on the lung (pleural effusion)
- Treatment if the fluid comes back
Which treatment for advanced lung cancer?
You may have chemotherapy or radiotherapy for advanced lung cancer. These treatments can shrink the cancer or stop it growing and so can help to reduce symptoms and keep you well for longer. Doctors also sometimes use biological therapies called erlotinib (Tarceva) or gefitinib (Iressa) for some people with non small cell lung cancer. The best treatment for you depends on the type of lung cancer you have, where the cancer has spread to, and the treatment you have already had. Doctors also take into account any other medical conditions you might have.
Treating a blocked airway
If the cancer is blocking, or partly blocking, an airway and making you breathless your doctor may suggest one of several different treatment options to relieve the blockage. These may include radiotherapy, radiofrequency ablation, photodynamic therapy, cryotherapy or laser therapy.
Treating fluid on the lung (pleural effusion)
The treatment for a pleural effusion is to drain the fluid off the lung. Under local anaesthetic, the doctor puts a drainage tube into your chest through a small cut. They connect the tube to a bottle or a bag. If there is a lot of fluid it may take a day or so to drain and you will need to stay in hospital during that time.
Treating superior vena cava blockage (SVCO)
The vena cava is a large vein that carries blood from the brain, head and arms back to your heart. If cancer presses on or blocks this vein, it can cause swelling in your face. You have treatment to reduce the blockage and relieve symptoms. You may have steroids or you might have chemotherapy or radiotherapy. Sometimes doctors put a metal tube called a stent inside the vein to keep it open.
You can view and print the quick guides for all the pages in the Treating lung cancer section.
You may have chemotherapy or radiotherapy to treat advanced lung cancer. These treatments can shrink the cancer or stop it growing. This can help to reduce symptoms and keep you well for longer. Doctors may use biological therapies called erlotinib (Tarceva) or gefitinib (Iressa) for some types of non small cell lung cancer.
The treatment that is best for you depends on
- The type of lung cancer you have
- Where the cancer has spread to
- The treatment you have already had
- Any other medical conditions you might have
If the cancer has spread to just one area, for example in one or two bones, you may have radiotherapy. If your doctor thinks the cancer is in more than one area of the body, you may have chemotherapy or biological therapy. Chemotherapy and biological therapy treat the whole body and radiotherapy treats only the area it is aimed at. You may have chemotherapy as injections into a vein or as capsules that you swallow. For lung cancer, biological therapy is usually tablets.
If you have already had radiotherapy to a particular part of your body, you may not be able to have any more to that area. There is a maximum amount of radiation that you can have to any part of the body before it causes too many side effects. Your doctor may then suggest chemotherapy or biological therapy instead.
Advanced lung cancer often causes symptoms. Even if your cancer cannot be cured, there is treatment available to control your symptoms. The treatment you need will depend on what is causing your symptoms.
Common symptoms include a cough and breathlessness, these can be distressing and frightening. They may be caused by a blocked airway or fluid on the lung. Below you can find information about possible treatments if these are the causes. There are other possible causes and other treatments you may have such as antibiotics if you have an infection. Other treatments that can help to control them include steroids and other drugs such as muscle relaxants and pain killers. You can find out more about coping with breathlessness in the living with lung cancer section.
If the cancer is blocking, or partly blocking, an airway and making you breathless your doctor may suggest one of several treatment options. You may have
- Internal radiotherapy (endobronchial radiotherapy)
- Laser therapy
- Photodynamic therapy (light treatment)
- Radiofrequency ablation
- Cryotherapy (treatment with a freezing probe)
These are all ways of destroying the cancer that is causing the blockage.
If the tumour is squashing your airway and making it difficult for you to breathe comfortably, your doctor may suggest putting in a rigid tube to keep the airway clear. The tube is called a stent. There is detailed information about all these treatments on the page about treating a blockage in an airway.
It is quite common for people with lung cancer to develop a collection of fluid between the sheets of tissue covering the lung (the pleura). This is called a pleural effusion. It makes you breathless because it takes up space in your chest that your lung would normally fill when you breathe in.
The treatment is to drain off the fluid. This is called thoracentesis (thora-sen-tee-sis). Your doctor will ask you to sit comfortably, leaning forward onto a table or back of a chair. First, you have a local anaesthetic injection into one side of your back. When the anaesthetic has had time to work, the doctor makes a small cut in the area and puts in a needle called a cannula. This hollow needle is attached to a tube with a drainage bottle (or bag) at the end. Your doctor may put in the tube using a thoracoscope (a tube with a light and camera at the end) so that they can see inside the chest.
If you have more than a litre of fluid inside your chest, it needs to be drained off slowly. So the doctor will put in a stitch to hold the needle in place. Once it is secure, you can walk around carrying the drainage bottle. You may stay in hospital for a day or two while the fluid drains. When no more fluid drains out, you have a chest X-ray to make sure it's all gone. Then the doctor or nurse takes the drain out. Your nurse will put a dressing over the small wound site and then you can go home. If you had a stitch to hold the drain in, it is pulled tight when the doctor takes the tube out. You then have the stitch removed about a week later.
Some people have a tube in for weeks or months – this is called an indwelling catheter. Sometimes the pleura stick together again after a while and the fluid stops building up. You can then have the tube taken out.
Remember that if your tube is connected to a bag or bottle, don't lift it above where the tube goes into your chest. If you do the fluid could drain back in.
Unfortunately, the fluid can build up again. You can have it drained more than once. But it isn't a good idea to keep on doing it, as you are likely to get an infection there in the end. If the fluid keeps building up, or your doctor thinks that it will, you may have treatment to try to stop it. This treatment is called pleurodesis (ploo-ro-dee-sis). The fluid collects between the 2 pleural membranes that cover the lung. Pleurodesis aims to stick the pleura together, so there is no space for the fluid to collect. This won't make your breathing worse in any way.
The procedure is the same as for draining a pleural effusion. Sometimes you have it done using video assisted thorocoscopy. But after the fluid has drained off, your doctor injects a sterile powder (talc) through the cannula. The powder irritates the pleura and makes them stick together. Once the powder is in, the doctor clamps off the tube for an hour or so. Your doctor may ask you to shift position every 10 minutes or so (side to side and front to back). This helps to move the talc around inside so that it coats the pleura all over.
After the hour is up, your doctor may connect a suction tube, as this helps the pleura to stick. Then the doctor can take the tube out, pull the stitch together and put on a dressing. You have the stitch taken out about a week later.
Small cell lung cancer more often spreads to the brain than non small cell lung cancer. Cancer spread to the brain may make you drowsy and confused. Or you may have severe headaches and sickness. It is most likely to be diagnosed with a brain scan – either a CT scan or MRI scan.
To treat brain secondaries, you are most likely to have radiotherapy to the head, together with steroid tablets to control symptoms. You may have short term side effects for a few weeks, including tiredness, headaches and feeling or being sick. Your doctor can give you medicines to help.
If you are too unwell to have radiotherapy you will have steroid treatment on its own. If you are very tired you may need to rest a lot and have help and support from your family or friends.
There is detailed information about dealing with the side effects of brain radiotherapy in the brain tumour section.
Advanced lung cancer can sometimes block a large vein that carries blood from the brain, head and arms back to the heart. The vein is called the superior vena cava. When it is blocked it is called superior vena cava obstruction. If the cancer squashes or blocks this vein, there is a build up of pressure behind the blockage. Fluid then seeps out from the bloodstream and collects in the tissues of the face.
People developing SVCO might notice swelling around their eyes, particularly first thing in the morning. SVCO can happen quite quickly or may take several weeks to develop.
Treatments are aimed at reducing the blockage of the vein and relieving symptoms. Steroids, such as prednisolone or dexamethasone can often reduce swelling. Other treatments depend on the type of lung cancer you have. Chemotherapy might be used for small cell lung cancer and radiotherapy for non small cell lung cancer.
Sometimes doctors put a metal tube (stent) inside the vein to keep it open. They might use a stent if SVCO develops rapidly, particularly if the cancer has not yet been fully diagnosed. Or they may use it if chemotherapy or radiotherapy does not help to relieve symptoms.
When cancer spreads to the bones it can cause pain and weaken them. When the bones are weaker they break more easily. To help strengthen your bones, lower the risk of fractures and control pain you may have drug treatment. You will have painkillers if you have pain and you may also have drugs that help to strengthen your bones.
Bisphosphonate drugs slow down the damage to the bones that the cancer causes. This helps to lower the risk of fractures and controls pain. There are different types of bisphosphonates. You have some as a drip into your bloodstream but others can be taken as a tablet. You can find out more about bisphosphonates in the main treatment section.
Another drug that can help to strengthen your bones is a monoclonal antibody called denosumab. It works by helping to stop the breakdown of the bones. You have it as an injection just under your skin (subcutaneously).
Trials of experimental treatments are going on and you may be able to take part in one. Some trials are for new chemotherapy drugs or new combinations of drugs.
Doctors are researching biological therapies for advanced lung cancer. Some stop cancers from making new blood vessels. These are called anti angiogenesis drugs. Without its own blood supply a cancer cannot continue to grow. Bevacizumab (also called Avastin) is an anti angiogenic monoclonal antibody (MAB) in trials for advanced non small cell lung cancer. Doctors have also been testing it with chemotherapy or other biological therapies. Many other new drugs are being researched.
You can look at the lung cancer research page for information about other areas of research. If you would like to find a particular trial, or see which trials are open, you can look at the clinical trials database in our cancer research section. Pick 'lung' from the dropdown menu of cancer types. There is information about the clinical trial process, including information about taking part in trials.
It can be difficult to decide which treatment to try, or whether to have treatment at all, when you have an advanced cancer. You will need to consider your quality of life while you are having the treatment. This includes possible side effects as well as stresses such as travelling to the hospital and back. Most importantly, you will need to understand what the treatment can do for you.
Your doctor will discuss the treatment options with you. There may also be a counsellor or specialist nurse at the hospital you could chat to. You may also want to talk things over with a close relative or friend.
If you would like to talk to someone outside your own friends and family, you can phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. Look at our lung cancer organisations page for organisations that can help. To find out more about counselling look in the counselling section.
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