Lung Cancer Treatment Options for Small Cell and Non-Small Cell

Lung cancer treatment methods and choices can be evaluated by surgeons, radiologists, radiotherapists, and pulmonologists. They can take into consideration different aspects such as the side effects, the stage of cancer, the general health condition of the patient, the traits and characteristics of the tumor; then, offer alternative treatment methods; lung cancer treatment methods can be combined like radiotherapy and chemotherapy or can be applied separately.  

Treatment of Small Cell Lung Cancer

Statistics have shown that more than %50 of small cell lung cancer cases are diagnosed when the tumor has already metastasized and invaded other structures or organs in the body. This situation actually limits the lung cancer treatment methods because it is not localized; which increases the possibility to benefit from chemotherapy.

If the small cell lung cancer cells are located in the chest and haven’t metastasized yet; doctors can combine radiotherapy with chemotherapy and deliver it to the tumor with the aim of reducing the speed of invasion and limit the acts of cancerous cells. Literature in this field shows that there are not many indications for operative treatment; radiotherapy and chemotherapy are mostly preferred by the oncologists.

If the tumor has already metastasized and affected other structures in the body; oncologists generally prefer chemotherapy. Moreover, they may deliver immunotherapies to the patients in some situations. Targeted therapies have not been delivered for small cell lung cancer treatment yet; however, there are some studies to investigate whether it can be applied under some circumstances.

Non-Small Cell Lung Cancer Treatment

Doctors can practice surgery for the early stages such as stage 1 and stage 2. It can remove the tumor and clean it; that’s why surgical operations may be the first choice. However, chemotherapy and radiotherapy can be delivered in the late stages such as stage 3 and stage 4; they can be delivered separately or in a combined way. Non-small cell lung cancer has more alternatives.

Surgery

Lung cancer treatment is a hard process and each technique has some necessaries. Surgery is one of those main techniques and it has some types and necessaries, too. One of the surgical operations is “posterolateral thoracotomy” which is the most practiced way of incision for chest surgery. It offers some advantages; firstly, surgeons can easily access the lungs and the affected region to clean the tumor and it also makes it possible to keep blood vessels safe. (Mehran and Deslauriers, 2003)  But, it also offers some disadvantages; the patients find it painful and it can affect the respiratory systems in a negative way for a while; the operation may disturb them. The point is that modern medical methods can reduce these side effects to a great extent.

The extent of the operation is decided by the characteristics of the tumor, its size; and, its extent. The area which will be under the surgical operation is tried to be kept minimal thanks to newly developed technologies for lung cancer treatment such as thoracoscopy and video-assisted surgery. After the operations, regular follow-ups are provided and the patient can recover relatively in a faster way. If needed, doctors can deliver chemotherapy or radiotherapy after the analysis of surgical operation.

In some cases, doctors don’t practice surgical operations since it seems to be dangerous to practice for the health of the patients. In such a case, they can prescribe stereotactic radiotherapy which can act on the tumor directly and limit its capabilities; in this respect, these two techniques are equal to each other because they both limit the acts and the capabilities of the tumor.

Targeted Therapies

Targeted therapies aim to attack only targeted cancer cells while chemotherapy can act on both cancerous and healthy cells. In this respect, targeted therapies for lung cancer treatment are better for the overall health situation of the patient. When some molecular abnormalities have been diagnosed such as EGFR, MET, and BRAF, ALK and ROS1; doctors can deliver targeted therapies to the patients since some drugs can target these abnormalities directly thanks to the current developments in the field. This treatment technique is unique for that specific patient regarding its characteristics.

Biotherapies are not perfect; they are relatively weak and costly; and are not able to kill cancerous cells in a great extent (Lu, 2015). Targeted therapies for lung cancer treatment can extend the lifetime of the patient and act on the affected tissues. While targeted therapies deliver some drugs into the body and act on the cancerous cells to limit their capabilities, biotherapies try to enable the immune system to overcome cancer.

Chemotherapy, radiotherapy
Chemotherapy and radiotherapy are the leading lung cancer treatment techniques.

Immunotherapy

After the analysis of the tumor, some tissues such as PD-L1 can be detected. in this case, doctors may deliver immunotherapy to the patient. They can do this immediately after the diagnosis or in some cases they prefer to use it after delivering chemotherapy. Immunotherapy has the aim of triggering the immune system and keep it strong to fight against the cancerous cells. The advantage of immunotherapy is that it includes less toxic substances than chemotherapy does.

Specific immunotherapy

It has a goal to act on unusual foreign components and construct a strong immune system to raid cancerous cells. The reason why it is called “specific immunotherapy” is that they also have monoclonal antibodies; however, they act anti-angiogenic monoclonal antibodies in a different way, which makes them specific.

Chemotherapy

As it has been said before, the experts regard late stages such as stage 3 and stage 4 as the inoperable stages. Thus, they prefer to deliver radiotherapy and chemotherapy for these patients; these two treatment techniques are generally combined as long as the patient tolerate them. For stage 4 lung cancer, doctors can practice immunotherapy and targeted biotherapies beside chemotherapy and radiotherapy; surgical operations cannot be practiced since the tumor has already metastasized and affected other parts of the body.

Chemotherapy is the primary treatment technique for non-small cell lung cancer patients. Doctors can combine chemotherapy with other treatment techniques like targeted therapies, biotherapies and immunotherapy or with anti-angiogenic treatment; the tumor is going on to be supplied by the vessels and anti-angiogenic treatment deconstruct those vessels to make it have a deficient supply of oxygen and lose its capabilities, which is called “asphyxiation” in medical language.

Chemotherapy delivers some drugs into the body through venous or oral route. These drugs include toxic substances and act on not only cancerous cells but also some healthy cells, too. Because of that, this lung cancer treatment technique is practiced for a while and there are some breaks between the practices since healthy cells need time to become fully functional again.

Radiotherapy

Radiotherapy is one of the leading treatment techniques for both small cell lung cancer and non-small cell lung cancer. Statistics have shown that more than %60 of non-small cell lung cancer patients get radiotherapy during their treatment process. The advantage of radiotherapy is that it can be delivered at any stage of lung cancer. Stereotactic radiotherapy radiochemotherapy and radical radiotherapy can be used for different stages regarding the characteristics of the tumor. For instance; Stereotactic radiotherapy is delivered if the patient is not appropriate for the surgery; and, radiochemotherapy and radical radiotherapy are delivered if it is a relatively advanced stage. (Maciejczyk, 2014)

Resources

Gastroenterol Clin Biol. 2009 Aug-Sep;33(8-9):672-80. doi: 10.1016/j.gcb.2009.07.019. Epub 2009 Aug 29.
https://www.ncbi.nlm.nih.gov/pubmed/19717258

Jean Deslauriers, Reza John Mehran, May 2003. Laval University, Sainte-Foy, Quebec, Canada; and University of New Mexico, New Mexico, NM.
https://doi.org/10.1016/S1522-2942(03)70019-1.

Da-Yong Lu, in Personalized Cancer Chemotherapy, 2015.
https://www.sciencedirect.com/book/9780081003466/personalized-cancer-chemotherapy.

Maciejczyk, A., Skrzypczyńska, I., & Janiszewska, M. (2014). Lung cancer. Radiotherapy in lung cancer: Actual methods and future trends. Reports of Practical Oncology and Radiotherapy19(6), 353–360. http://doi.org/10.1016/j.rpor.2014.04.012

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