Acupuncture can help relieve pain.
A part of Chinese’ medicine system that depends on the balanced functioning energies of the body and involves very thin needles being inserted at specific points on the body’s surface. It can create long lasting pain relief.
Lung cancer
[Τreatment]
You may also respond differently to treatment, and this may be down to several factors, such as having an additional health condition or a different level of fitness. This means something that works for someone else may not be as effective for you, even though you both may have the same type of lung cancer and similar symptoms.
Your doctors will consider carefully the best options for you and talk them through with you. They may recommend one or more therapeutic options for you.
Many treatments have side effects, and some can be difficult to deal with, so you will need to weigh these up against the possible benefits.
Ask your medical team about possible benefits and side effects of any treatments offered to you. You may get offered more than one type of treatment.
Treatments are evolving all the time, and recently many promising therapies have been developed for lung cancer. When all effective treatments have been used to control or reduce the cancer, there are still many options to manage symptoms and maintain quality of life.
The decision to have any specific treatment is entirely yours, and it won’t start without your permission. Your medical team will talk to you in detail about their recommendations, but make sure you ask plenty of questions, so you fully understand what is involved.
Surgery
Surgery is usually suitable for people with early stage lung cancer, who are sufficiently fit for an operation. However, significant advances in robotic surgery for lung cancer, now means more people are able to have surgery if their lung cancer is diagnosed early enough.
Taking you step-by-step through your lung cancer surgery:
Successful surgery for lung cancer, with the chance of cure, may only be possible after the surgeon has considered the following points:
- You and your lungs must be fit enough generally to cope with surgery
- The tumour must not have spread to other parts of your body.
It is more common for non-small cell lung cancers to be surgically removed as they are generally slower growing. However, small cell lung cancer can occasionally be removed if the disease is at a very early stage of development. An experienced surgeon will always try to operate when at all possible.
Can I have surgery?
Your case should be discussed by a Multidisciplinary Oncology Team Board (MDT), that is a team of health professionals from all the different specialties that manage lung cancer. This team usually includes a pneumonologist, a thoracic surgeon, a pathologist and a molecular biologist, a medical oncologist and a radiotherapist. This team will review your CT scans, PET scans and lung function tests, to decide on the best treatment. They will also discuss the need for further tests to accurately diagnose and stage your tumour.
You will then see the appropriate specialist to treat your lung tumour, such as a thoracic surgeon or a medical oncologist. A medicaloncologist is a specialized physician, who supervises and guides all treatments for your cancer.
Who will carry out my operation?
Lung operations are done by thoracic surgeons. Your surgeon will have experience in lung cancer surgery, and should work as part of the multi-disciplinary team or MDT. Your surgery will be carried out at your nearest thoracic (lung) surgery department or unit.
Chemotherapy
Chemotherapy is a general term for the treatment of cancer using drugs. Patients with different types of lung cancer are likely to receive different combinations of chemotherapy drugs. After discussing treatment options with patients, doctors will decide which chemotherapy drugs are most suitable.
Chemotherapy can be used to treat lung cancer in several ways:
- Aim to cure early stage or locally advanced inoperable lung cancer in combination with radiotherapy (chemoradiotherapy)
- Attempt to shrink the tumour before surgery or radiotherapy (neo-adjuvant chemotherapy)
- Extend length of life when a cure is not possible (palliative chemotherapy)
- Remove any undetectable cancer cells that may still exist after successful surgery for lung cancer, or to help prevent recurrence (adjuvant chemotherapy)
- Reduce symptoms, such as breathlessness (palliative chemotherapy)
Chemotherapy for small cell lung cancer
If you have small cell lung cancer (SCLC), chemotherapy is usually the first type of treatment you receive. This is because SCLC can grow and spread quickly, and has often spread outside the lung when the lung cancer is detected, and also because it is chemosensitive, meaning it responds well to chemotherapy.
Treating it systemically with chemotherapy usually leads to relief of symptoms and longer survival. Radiotherapy may be given after chemotherapy to try to stop the cancer coming back locally.
There are a variety of different types of chemotherapy drugs for small cell lung cancer. The most common first line treatment is a combination of etoposide and a platinum (cisplatin or carboplatin). However, since last year, the combination of immunotherapy to the standard chemotherapy has become the new standard of care.
Radiotherapy
Radiotherapy has been an effective treatment for lung cancer. It is the most common treatment for non-small cell lung cancers because in general, they are slower growing tumours.
Radiotherapy is a type of cancer treatment which uses high energy x-rays (radiation) to destroy cancer cells while avoiding normal cells. It is given in small individual doses (fractions) aimed precisely at the tumour over a specified period. This can range from a few days to as many as six and half weeks (up to 33 treatments).
Small cell lung cancer can also be treated with radiotherapy when chemotherapy is not suitable. Also radiotherapy is used in combination with chemotherapy in early stage small cell lung cancer (limited disease). Furthermore, radiotherapy is used prophylactically to the brain and the chest, in cases where the tumor has responded well to the initial chemotherapy.
Radiotherapy is usually given externally (external radiotherapy) by directing x-rays at the area needing treatment. The machines that are most commonly used for this are called linear accelerators. However, radiotherapy can also be given by putting a small amount of radiation directly inside the lung (brachytherapy).
Radiotherapy doctors (radiotherapists) will know which treatment is best for the patient. Radiotherapy is only given in specific radiotherapy departments usually connected with cancer centres because the treatment is very specialised and expensive. This may involve long journeys to the nearest cancer centre, depending on where the patient lives.
Targeted therapy
Depending on the type of lung cancer you have, you may be able to have a targeted therapy to treat your lung cancer.
Targeted therapies are giving people with lung cancer more treatment options
Targeted therapy drugs for non-small cell lung cancer come as a tablet, which you take orally , every day, at home. You should take them at the same time/s each day. You can keep taking a targeted therapy for as long as it keeps working for you.
There are various types of targeted therapies used to treat lung cancer. However, targeted therapies do not work for everyone, they are an option only for patients whose tumours carry the specific ‘target’, a molecular change that can be detected with specific molecular tests. Your healthcare team will have to do a biopsy to find out if a targeted therapy may be suitable for you.
The doctors are looking for specific characteristics that are different in some NSCLC cancer cells, and show up in the genes within the cells. These are called mutations, and the test is called a mutation test or molecular analysis.
Patients whose tumours test positive for these mutations, and who have been given matched targeted treatments, gain significantly more benefit than from standard chemotherapy, a treatment they may also get at a later date.
Since today there are many targeted agents available for different types of mutations, especially for patients with adenocarcinoma histology, it is very important that a comprehensive molecular analysis is requested by your medical oncologist and the result is awaited prior to making the decision of your first-line treatment.
The molecular analysis is investigating specific biomarkers in your tumour which, if present, will be targeted by the therapeutic targeted pills.
The biomarkers for which we have available targeted therapies are at least 6, so, most oncologists today will recommend a molecular analysis simultaneously for all of them, with a technique called NGS (Next Generation Sequencing).
Immunotherapy
Immunotherapy is a relatively new type of lung cancer treatment. It is currently available to people with certain types of lung cancer.
What is immunotherapy?
Immunotherapy, or immune-oncology (IO) as it is sometimes referred, is a type of treatment for non-small cell lung cancer (NSCLC) and recently also for SCLC. It works by helping the body’s immune system to recognize and destroy cancer cells.
Cancer cells can sometimes find ways to trick the immune system into thinking they are normal cells and should not be attacked. This allows them to grow and spread. One way this happens is through proteins called checkpoint proteins.
PD-L1 and PD-1 are types of checkpoint proteins. PD-L1 is found on normal tissue surface and healthy cells, while PD-1 is often found on a type of white blood cells called T-cells, which are responsible for our immune defense. Some cancers disguise themselves by making their own PD-L1. When this happens, it binds to PD-1 on T-cells.
These cells are then not spotted by the checkpoints which means the immune system does not destroy them. Undetected, the cancer cells can continue to grow without being slowed down or stopped.
Immunotherapy treatment with agents inhibitors of PD-1 or PD-L1, reactivates the immune system, helping it to recognize and attack the abnormal cancer cells. Some checkpoint inhibitors work by binding or sticking to the PD-1 on T-cells or PD-L1 on tumor cells.
Immunotherapies stop PD-1 from binding to the PD-L1 on cancer cells. When this happens, the cancer cells can no longer trick the immune system. Another important feature of immunotherapy, is that it creates an immune memory. Therefore, if cancer recurs after initial treatment, our immune system ‘remembers’ and attacks the newly- relapsing cancer cells, thus preventing the cancer to come back. This is how immunotherapy has revolutionized lung cancer treatment: it can achieve a response by reducing or destroying the tumor but most importantly it can maintain that response for a long time, offering significant survival benefits to lung cancer patients.
Today, immunotherapy is approved for the first-line treatment of advanced NSCLC, either alone or in combination with chemotherapy. The decision if immunotherapy alone is the best option for you, is based on the detection of one specific biomarker called PD-L1, which if it is very high (≥50%) means that your tumor would be very sensitive to immunotherapy alone. In this case your doctor might decide not to give you chemotherapy, or to combine immunotherapy with chemotherapy. Today, almost all patients will receive immunotherapy as part of their first-line treatment unless they have specific contraindications.
Also today, immunotherapy is given as a standard maintenance treatment in earlier stages (stage III which cannot be operated) following successful chemo-radiotherapy.
Complementary therapies
Sometimes also known as alternative therapies, complementary therapies may help you to control your symptoms and enhance your quality of life. They may be used along with conventional cancer treatments.
Complimentary, or alternative treatments can improve your quality of life. Complementary therapies work by using the healing power of nature, stimulating the body’s natural healing ability.
There is a huge variety of complementary therapies advertised on the open market. Many are well known and proven to be helpful. However, there are also some therapies that have doubtful or unproven benefits.
It is important to also consult your doctor before starting any complementary therapy as it may affect some treatments or other medication you may be taking.
Types of complementary therapies
- Acupuncture
- Aromatotherapy
It uses massage and inhalations combined with essential herbal oils, to promote health and healing of the body.
- Bowen Technique
A light tissue manipulation is considered to help balance the body’s energies.
- Hypnotherapy
It uses the hypnotic trance to overcome limitations by controlling the body and mind.
- Massage
Massage can help you release tension and stress. It uses from gentle to intense pressure to stimulate the blood flow around the body, helping a person relax.
- Reflexology
A form of ancient Chinese medicine including the use of message to reflex areas that are located in their feet and hands as a treatment.
- Reiki
It uses life energy that is passed by gentle touch, from the trainee to the person receiving this relaxation treatment which in the future they may have the opportunity to practice themselves as self-healers.
- Spiritual Healing
Conveys healing energy from a spiritual source to the patient through the hands of the healer.
- Tai Chi
Tai Chi Chuan is a martial art of gentle practice, sometimes used for therapeutic purposes. It is an intense and gentle martial art technique with longevity exercises.
It is important to stress that there is no convincing scientific evidence that such treatments can reduce (shrink) or cure cancer.
You should also be very wary of unusual (possibly illegal) and often costly therapies advertised in the media such as the internet. Trust information from reliable sources and be wary of links shared on social networks claiming miracle cures.
If you are in any doubt, talk to your doctor or a hospital team about whether it benefits you. They may even have a complementary therapy service they can refer you to.
Source: roycastle.org
Source: https://www.roycastle.org/
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