Ask an Expert: Lung cancer treatment

Q: “I was a lifelong smoker until last week, when I found out that I have lung cancer. Now I’m in fear for my life. What treatment approach do you recommend? Is there any hope for successful treatment?”

Answer from John R. Handy, Jr., M.D., co-director of Providence Thoracic Oncology Program and director of Providence Thoracic Surgery Program

Even though we know that smoking causes lung cancer, it doesn’t make the diagnosis any less shocking or frightening when it happens. Fear is a natural and understandable reaction. But don’t lose hope. Asking questions, exploring options and informing yourself, as you are doing, can reduce the fear of the unknown and can help you regain a sense of control over your life.

The answers to your questions depend mainly on the stage of your cancer and the way you define success. Stage is the word we use to quantify the amount of cancer that you have. If your cancer is caught in the earliest stages, then there is high hope that successful treatment will cure your cancer. In later stages, treatment is still successful in helping you have a longer, higher-quality life than you would be able to have without any treatment.

Current treatment approaches

To recommend a specific course of treatment for you, I would need to know a lot more about your general health and your specific type of cancer. Without those specifics, however, I can tell you what the recommendations and success rates are for most people at each stage of non-small-cell lung cancer (the most common form of lung cancer):

Stage I: Cancer that is localized to the lung.
Recommended treatment: Surgery to remove the cancer.
Reasons for hope: Stage I is the earliest, most curable stage of lung cancer, with about a 70 percent cure rate.

Stage II: Cancer that extends from the lung into the chest wall (ribs) or lymph nodes of the lung.
Recommended treatment: Surgery combined with chemotherapy.
Reasons for hope: Although the five-year survival rate for stage II lung cancer is not great – about 30 percent – the statistics are improving. In just the last three or four years, researchers have discovered that adding chemotherapy to the treatment for stage II lung cancer (and sometimes for stage I, as well) increases survival significantly over surgery alone.

Stage III: Larger or more numerous tumors in the lungs and/or the lymph nodes, chest wall or chest structures.
Recommended treatment: Chemotherapy and radiation therapy, sometimes followed by surgery.
Reasons for hope: As extensive as the cancer is at this stage, cure is still possible for some people. The five-year survival rate at this stage is about five to 15 percent.

Stage IV: Cancer that has spread more broadly from the lungs and chest to other parts of the body.
Recommended treatment: Palliative chemotherapy.
Reasons for hope: Although cure is not likely at this stage (the five-year survival rate is about two percent), chemotherapy has a very positive role to play with regard to quality of life. People who have chemotherapy at this stage generally live a little longer, but more significantly, they live better, with milder symptoms and fewer hospitalizations. Careful drug selection helps minimize the side effects of the chemo.

As I said earlier, these are all generalizations; specific recommendations and results may vary significantly from one individual to another.

In a specialized, multidisciplinary lung cancer program, such as Providence’s Thoracic Oncology Program, you would have a team of experts sharing their knowledge and working together to plan a course of treatment that would give you the best possible chance of cure or of extended, enhanced quality of life.

Hope on the horizon

Investigational research offers one additional reason to remain hopeful: It is possible that a newer, more effective treatment could become available within your lifetime.

Because Providence is a leading research center, your treatment options here might include participation in clinical trials of the newest investigational therapies. About 25 percent of patients in Providence Thoracic Oncology Program participate in clinical trials, compared to a national average of two to three percent.

Lung cancer treatment is always evolving. The combinations of chemotherapies, radiation therapies and surgeries used today are advancements over the standard treatments of just four or five years ago. Brand new chemotherapeutic agents are available today that weren’t available even a year ago. If you were to ask me what treatments I might be recommending ten years from now, we might be talking about a completely new set of options. Here are just a few of the exciting new avenues under investigation today: 

  • Genetic staging: Genetically analyzing a person’s cancer so that the most appropriate treatment can be targeted according to the biology of the cancer itself.
  • Biologic therapy: Replacing the generalized chemotherapies of today with gene therapies, or “smart bombs” – vaccines that are tailor-made to attack cancer cells while leaving other cells alone.
  • Tumor ablation: Using energy to destroy tumors, rather than removing lung tissue surgically.
  • Minimally invasive surgery: Removing tumors through tiny incisions, or perhaps even without any incisions at all, by going through the windpipe.

Stay hopeful, and keep doing your own research In asking your questions, you’ve already taken the first step toward being a proactive driver of your health care, rather than a passive participant in it. I encourage you to continue to learn as much as you can.

  • Start going through the health care system to figure out how much cancer you have and what your treatment options are.
  • Have frank conversations with your doctors and caregivers; ask them about the upside, as well as the downside, of each option.
  • Do research on the Internet, starting with the links on this website.

Our website includes information on our own treatment programs and outcomes, as well as links to the leading national sites, including the National Cancer Institute and the National Library of Medicine. We want to make it as easy as possible for our patients to learn as much or as little as they want to about the course of their disease.

I hope this helps answer your questions, and I wish you good luck.

July 2007

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Ask an Expert does not respond directly to your questions or provide personal medical advice, diagnoses, treatment recommendations or second opinions through our Web site or by e-mail. Please talk with your health care provider about any questions specific to your medical care.