Lung cancer is the second most common cancer in men and women. It is the number one cause of death from cancer each year in both men and women. According to the American Cancer Society, 234,030 Americans will be diagnosed with lung cancer this year. Cigarette smoking is the most common cause of lung cancer. Exposure to asbestos, radon, environmental factors and secondhand smoke can also cause lung cancer.

TYPES OF LUNG CANCER

There are two main types of lung cancer, non-small cell lung cancer and small cell lung cancer. These names refer to how a cancer looks under the microscope.

Non-small cell lung cancer is the most common type of lung cancer and accounts for 84 percent of cases. There are different types of non-small cell lung cancer, including:

• Adenocarcinoma – a cancer that forms in the outer parts of the lung.
• Squamous cell carcinoma – a cancer that forms from a cell lining the airway.
• Large cell carcinoma – a kind of non-small cell lung cancer, but the cell it starts from may not be known.

Small cell lung cancer is less common and accounts for 14 percent of cases. Although the cells are small, they multiply quickly and can form large tumors that may spread throughout the body. This type of lung cancer is almost always due to smoking.

TREATING LUNG CANCER

Lung cancer treatment depends on several factors, including the type and stage of the lung cancer and your overall health.

Radiation Therapy
Radiation is a high-energy X-ray that can be used to treat lung cancer noninvasively. It passes through the chest to treat lung cancer and can be combined with surgery, chemotherapy or both depending upon the circumstances. Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.

In early-stage lung cancer, surgery has been the standard. However, in patients medically not able to tolerate surgery, focused radiation, called stereotactic body radiation therapy (SBRT) is a good treatment option. For large tumors or those involving lymph nodes, radiation (often combined with chemotherapy) may replace surgery as the main treatment. For more advanced cancers, your doctors may recommend radiation to manage symptoms such as cough, shortness of breath or pain.

Medical Therapy
Medical oncologists specialize in treating lung cancer using various drugs. Chemotherapy means drug treatment, but there are many different kinds of medications that can be used to treat lung cancer. New research is helping oncologists learn which drugs may be most effective. Often, chemotherapy is combined with radiation therapy to make the radiation more effective. However, such combined treatment (chemoradiation) can also increase the side effects of treatment. Ask your medical oncologist about what drugs may be best for you.

Surgery
Surgery is often a key part of lung cancer care. Even before treatment, surgery may be helpful in diagnosis and finding whether the cancer has spread to lymph nodes in the chest. This type of surgery is part of tumor staging, or understanding how advanced the cancer may be.

In early-stage tumors, surgery by itself can be curative. Your surgeon may remove part of the lung around the cancer. The amount of lung removed will vary based upon location, your health and other factors. If there are no signs of spread, additional treatment is often not needed.

In more advanced tumors, surgery is sometimes replaced by radiation and chemotherapy or can be combined with these treatments. Ask your surgeon or other doctors whether your tumor is early or advanced and whether surgery will be helpful for you.

EXTERNAL BEAM RADIATION THERAPY

External beam radiation therapy (also called radiotherapy) is the safe delivery of high-energy X-rays to your cancer. A linear accelerator focuses the radiation beam to a precise location in your body for an exact period of time. Radiation is given in a series of daily treatments, Monday through Friday, for several weeks. In small cell lung cancer, two treatments may be given each day. The full course of treatment varies but can span three to seven weeks.

Before beginning treatment, you will be scheduled for a planning session to map out the treatment area. This procedure is called a simulation. You will undergo a CT scan to design your treatment and small tattoos will be made on the skin to make sure your treatments are accurate.

Different techniques can be used to give radiation for lung cancer.

• 3-Dimensional Conformal Radiotherapy (3-D CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the lung tumor. Radiation oncologists are able to tailor each of the radiation beams to focus on the tumor while protecting nearby healthy tissue.
• Intensity Modulated Radiation Therapy (IMRT) is a specialized form of 3-D CRT that modifies the radiation by varying the intensity of each radiation beam. IMRT is still being studied for lung cancer.
• Stereotactic Body Radiation Therapy (SBRT) is a specialized form of radiation that delivers high doses of radiation to small and very precisely defined targets over a shortened course of therapy, usually in five treatments or less.
• Proton Beam Therapy is a type of external beam radiation therapy that uses proton beams rather than X-rays, which can give less radiation to normal tissue. The benefits of proton beam therapy over other external beam radiation therapies are still being studied.

CARING FOR YOURSELF DURING TREATMENT

It is important to care for yourself as well as possible during radiation therapy.

• A balanced diet, a mild amount of physical activity, and taking time to rest are all important parts of your cancer treatment.
• Nutrition is important. Eat a balanced diet. Let your doctor know if you have trouble swallowing, food tastes funny or you have trouble eating.
• Follow your doctor’s orders, and if you are unsure of anything, ask your nurse or doctor any question you may have about your treatment.
• Be sure to tell your radiation oncologist about any vitamins or dietary supplements that you are currently taking to make sure they are safe to take during radiation therapy.
• Treat the skin exposed to radiation with special care. Stay out of the sun, avoid hot or cold packs, and only use lotions and ointments after checking with your doctor or nurse.
• You should also be sure to clean the skin over the areas receiving radiation therapy with warm water and mild soap.

Completing treatment and recovery can be challenging. Seek out help from support groups and friends ahead of time. If you have a support network in place before and during treatment, it will be easier to get through side effects since people you can count on will be around to help you. If you need additional support, let your nurse or doctor know.

POSSIBLE SIDE EFFECTS

Side effects are different for everyone. Some patients feel fine during treatment while others may feel uncomfortable.

• Mild tiredness may develop. However, tiredness from radiation should improve within a few weeks after radiation treatment ends.
• Skin irritation may occur with external beam radiation. Clean the area regularly with mild soap and warm water.
• Shortness of breath or cough may be temporary or permanent depending on your cancer and its treatment.
• Difficulty or pain when swallowing may develop but will get better a few weeks after treatment is finished.
• Loss of chest hair may occur but only in the area being treated.

Some side effects can be controlled with medications and changes to your diet. Ask your doctor or nurse whether you should make any changes in your diet. Tell them if you experience any discomfort so they can help you feel better.

© American Society for Radiation Oncology, 2016.