Non-small cell lung cancer (NSCLC) is a more common type of lung cancer than small cell. Surgery, radiation, chemotherapy, targeted therapies and immunotherapy Series or used together to treat lung cancer . Each type of treatment may cause different side effects.
Treatment phase 0 NSCLC
- Because NSCLC stage 0 is limited to the lining of the airway only and does not invade deeper into lung tissue or other areas, it is usually only treatable with surgery. No need chemotherapy or radiation.
- If you are well enough to have surgery, you can usually be treated with surgical removal or wedge removal (partial removal of the lung lobe).
- Cancer in some places, such as the windpipe, divided into the left and right main bronchi can be treated with surgical removal of the sleeve, but in some cases, they can be difficult to completely remove otherwise. lobectomy or even entire lung.
- In some cases, treatments like photodynamic therapy (PDT), laser therapy or radiotherapy may be an option for stage 0 cancer surgery. If your cancer is really At stage 0, these treatments will cure you.
Treatment phase I NSCLC
If you have stage I NSCLC, surgery may be the only treatment you need. This can be done by removing a lump from the lung containing the tumor (lobectomy) or by removing a smaller piece of the lung. At least some lymph nodes in the lungs and in the space between the lungs will also be removed and screened for cancer cells.
- Stool removal or wedge removal is generally an option only for very small stage I cancers and for patients with other health problems that make the removal of the entire lobe dangerous. However, most surgeons believe that it is better to perform lobectomy if the patient can tolerate it, as it offers the best chance of treatment.
- For people with stage I NSCLC who have a higher risk of recurrence based on size, location or other factors, post-surgical adjuvant chemotherapy may reduce the risk that cancer will return. But doctors are not always sure how to determine who is likely to be helped with chemotherapy. New laboratory tests looking at models of certain genes in cancer cells may help. Studies are currently being done to see if these tests are accurate.
- After surgery, the removed tissue is checked to see if there are cancer cells on the edges of the surgical sample called the positive margin. This may be that some cancer cells remain, so a second surgery may be done to try to ensure that all cancer cells have been removed. This can also be treated with chemotherapy. Another option might be to use radiation after surgery.
- If you have a serious health problem that prevents you from having surgery, you can use stereoscopic body radiotherapy (SBRT) or another type of radiotherapy as the main treatment. Radiofrequency ablation (RFA) may be another option if the tumor is small and on the outside of the lung.
Treatment of NSCLC phase II
People who have NSCLC stage II and are healthy enough to have surgery usually remove the cancer with a lobectomy or a sleeve removal. Sometimes removal of the entire lung (pneumonectomy) is necessary.
- Any lymph nodes that are likely to have cancer in them are also removed. The degree to which lymph nodes are involved and whether cancer cells are found at the edge of removed tissue are important factors when planning the next treatment step.
- In some cases, chemotherapy combined with radiation therapy may be recommended before surgery to try to shrink the tumor to make the operation easier.
- After surgery, the removed tissue is checked to see if there are cancer cells on the sides of the surgical sample. It is possible that some cancer cells are left over, so a second surgery may be done to try to remove any remaining cancer cells. This can be treated by chemotherapy. Another option is radiation therapy, sometimes along with chemotherapy.
- Even if no positive benefits are found, chemotherapy is often recommended after surgery to try to destroy any cancer cells that may be left behind. As with stage I cancer, newer laboratory tests are currently being studied that can help doctors find out which patients need this adjuvant treatment and are less likely to benefit from it.
- If you have a serious medical problem that prevents you from having surgery, you may only be given radiation therapy as the main treatment.
Phase IIIA treatment NSCLC
Treatment for the IIIA NSCLC phase may include several combinations of radiation therapy, chemotherapy and surgery. For this reason, treatment planning for stage IIIA NSCLC often requires input from oncologists, radiation oncologists, and thoracic surgeons.
- Your treatment options depend on the size of the tumor, where it is located in your lungs, how far it has spread, your overall health and your tolerance to treatment.
- For patients who can tolerate, treatment usually begins with chemotherapy, often in combination with radiation therapy. Surgery may be an option later if the doctor thinks any remaining cancer can be removed and the patient is healthy enough.
- For those who are not well enough for surgery, radiation therapy, which can be combined with chemotherapy, is often used.
Treatment stage IIIB NSCLC
Stage IIIB NSCLC has spread to lymph nodes near the lungs or to the neck, and may also have developed into important structures in the chest. These cancers cannot be completely removed with surgery.
- As with other stages of lung cancer, treatment depends on the patient’s overall health. If you are in good health, you may be able to get help with chemotherapy in combination with radiation therapy.
- Some people can even be cured with this treatment. Patients who are not physically fit for this combination are usually treated with radiation therapy alone, or, less frequently, chemotherapy alone.
- These cancers can be difficult to treat, so participating in a clinical trial of newer treatments may be a good option for some people.
Treatment of NSCLC phase IV
- Stage IV NSCLC spread when diagnosed. Because these cancers have spread to distant locations, they are difficult to cure. Treatment options depend on where the cancer has spread, the number of tumors and your overall health.
- If you’re in good health, treatments like surgery, chemotherapy, targeted therapies, immunotherapy, and radiation therapy can help you live longer and make you feel better by doing Relieve symptoms, although they are unlikely to cure you.
- Other treatments, such as photodynamic therapy (PDT) or laser therapy, may also be used to help relieve symptoms. In any case, if you will be receiving advanced NSCLC treatment, make sure you understand the treatment goals before you begin.
Treatment of lung cancer has spread to another part
- Cancer that is limited to the lungs and only spread to another location such as the brain is uncommon, but sometimes it can be treated and even potentially cured by surgery or radiation therapy to treat it. Cancer area spreads, followed by cancer treatment in the lung.
- For example, a single tumor in the brain can be treated with surgery or stereoscopic radiation, then radiation to the whole brain. Treatment for the lung tumor is then based on its T and N stages, and may include surgery, chemotherapy, radiotherapy or some of these combinations.
Treatment of lung cancer has spread
For cancers that have spread throughout the body, before any treatment begins, your tumor will be tested for common gene mutations (EGFR, ALK, ROS1 or BRAF). If one of these genes is mutated in your cancer cells, your first treatment could be a targeted therapeutic drug:
- For tumors with an altered ALK gene, an ALK inhibitor such as crizotinib ( Xalkori ), ceritinib ( Zykadia ) or alectinib ( Alecensa ) can often be the first treatment. Other ALK inhibitors, such as brigatinib (Alunbrig) or lorlatinib (Lorbrena), may be used if one or more of these medications stops working or is not well tolerated.
- For people with certain changes in EGFR genes, anti-EGFR drugs erlotinib ( Tarceva ), gefitinib ( Iressa ), afatinib ( Gilotrif ) or dacomitinib (Vizimpro) can be used as head treatments. first.
- For people with cancer who have changes in the ROS1 gene, an ALK inhibitor such as crizotinib can be used.
- For people with certain changes in the BRAF gene, a combination of drugs targeting dabrafenib ( Tafinlar ) and trametinib ( Mekinist ) can be used.
Your tumor cells may also be tested for PD-L1 protein. Tumors with higher PD-L1 levels are more likely to respond to certain immunological medications, so treatment with pembrolizumab (Keytruda) may be an option as a first line treatment. first.
For most other cancers that have spread, chemotherapy is usually at least part of the main treatment, as long as the person is healthy enough for it. Sometimes it can be used together with other medicines:
- The immunotherapeutic drug pembrolizumab ( Keytruda ) may be used along with chemotherapy.
- For people who are not at high risk of bleeding, the drug targeting bevacizumab ( Avastin ) may be taken along with chemotherapy.
- Some people with squamous cell carcinoma can still be given bevacizumab, as long as the tumor is not near the large blood vessels in the center of the chest. If bevacizumab is used, it is usually continued even after the chemotherapy is finished.
- Immune therapy drug atezolizumab ( Tecentriq ) can be used in conjunction with bevacizumab and chemotherapy in people with no squamous cell NSCLC.
- One option for people with squamous cell NSCLC is to take chemotherapy along with the necitumumab targeted drug (Portrazza).
- If the cancer has caused a buildup of fluid in the space around the lungs (malignant pleural effusion), fluid may drain. If it continues to return, options include pleurisy or inserting a catheter into the chest through the skin to allow fluid to drain.
As with other stages, treatment of stage IV lung cancer depends on a person’s overall health.
- For example, some people who are not in good health may receive only one chemotherapy drug instead of two.
- For people who can’t get chemotherapy, radiation therapy is often the treatment option. Local treatments such as laser therapy, PDT or stenting may also be used to help relieve symptoms caused by lung tumors.
- Because treatment does not cure these cancers, participating in a clinical trial of newer treatments may be a good option.
Treatment of advanced or recurrent lung cancer after treatment
If the cancer continues to grow during or on return, subsequent treatment will depend on the location and extent of the cancer, which treatment was used, and the person’s health. and look forward to more treatment. It is important to understand the goal of any other treatment, if it is to try to cure cancer, slow its growth or help reduce symptoms as well as the potential benefits and risks.
If the cancer continues to grow during initial treatment such as radiation therapy, chemotherapy may be tried. If cancer continues to develop during chemotherapy as the first treatment, the second treatment usually includes a single chemotherapy drug such as:
- docetaxel or pemetrexed
- erlotinib targeting therapy ( Tarceva )
- plus chemotherapy with targeted drugs like ramucirumab ( Cyramza ).
If a targeted drug is the first treatment and is no longer active, another targeted or chemotherapy drug may be tried.
For some people with certain types of NSCLC, treatment with immunotherapy may be an option such as:
- nivolumab ( Opdivo ),
- pembrolizumab (Keytruda)
- atecolizumab ( Tecentriq )
Smaller locally recurrent cancers can sometimes be treated with surgery or radiation. Recurrent cancer in the lymph nodes between the lungs is usually treated with chemotherapy, possibly along with radiation if it has not been used before. For cancers that return in distant sites, chemotherapy, targeted therapy or immunotherapy is often the treatment of choice.
In some people, the cancer may never disappear completely. These people can be treated regularly with chemotherapy, radiotherapy or other therapies to try to help control cancer. Learning to live with cancer that doesn’t go away can be difficult and very stressful.
Watch more Lung Cancer videos – signs and symptoms of lung cancer
Reference Source for treatment of non-small cell lung cancer (NSCLC) in stages:
- Source webmd.com article Non-Small-Cell Lung Cancer Treatments by Stage : https://www.webmd.com/lung-cancer/non-small-cell-lung-cancer-treatment-stage , updated 17/4 / 2018.
- Source cancerresearchuk.org article Treatment for non small cell lung cancer (NSCLC) : https://www.cancerresearchuk.org/about-cancer/lung-cancer/treatment/non-small-cell-lung-cancer , update 7 / 8/2017.
- A reputable source index-china.com summarizes the article Treatment of non-small cell lung cancer (NSCLC) in stages : https://index-china.com/treatment-of-non-small-cell-lung-cancer-nsclc-in-stages/, updated 13/3/2020.
Assoc.Prof.Dr. Tran Ngoc Anh is currently Hanoi Medical University Hospital, Associate Professor, Department of Internal Medicine, Gastroenterology and Head of Department of General-Uematology of Hanoi Medical University. Consulting doctor at ThuocLP Pharmacy.
Professional qualifications, Academic degrees – Education:
Graduated from General Practitioner System, Hanoi Medical University
Graduated with a Master degree in Internal Medicine, Hanoi Medical University
Graduated from the training program specialized in Gastrointestinal, Henri Mondor Institute Center, University of Paris 6, French Republic 1996-1997; 1999
Graduated from the training program specialized in Gastrointestinal, North Royal Sydney Hospital, Australia; 2002
Graduated from a training program specialized in chronic liver diseases, Pizza, Italy 2009
Graduated with a PhD in Gastrointestinal, Hanoi Medical University
Associate Professor, Gastroenterology, Hanoi Medical University
Training and Scientific Research:
Published more than 200 articles in domestic and international specialized journals
Editor of many monographs and participates in compiling 2 textbooks.
Guide many students and graduate students of Hanoi Medical University
Manager of many grassroots research projects
Certificate of Good Clinical Practice (GCP: 2012, 2015), Ministry of Health
Specialized certificates: General gastrointestinal endoscopy, Interventional gastrointestinal endoscopy, General gastrointestinal ultrasound, Interventional gastrointestinal ultrasound (Bach Mai BV), Chronic liver disease.