The type of treatment you have for lung cancer depends on:
- the type of lung cancer you have (non-small-cell or small-cell)
- the size and position of the cancer
- the stage it's at and if it has spread
- your age
- your general health
Types of treatment
The most common types of treatment for lung cancer are:
- surgery
- radiotherapy
- chemotherapy
- immunotherapy
- targeted therapy
You may have more than 1 treatment.
You can also ask if you can take part in a clinical trial.
Your treatment plan
You will have a team of specialists that includes doctors, nurses, specialists, and other health professionals.
They are here to support you throughout your treatment.
Your cancer treatment team will recommend the treatment they think is the best option for you. But the final decision is yours.
You can ask them about the risks and benefits of the treatment.
Tell them about any concerns you have or if you want more help to make a decision.
They'll start to plan your treatment when you give your consent to treatment.
Surgery
You may have surgery if your general health is OK and you have:
- non-small-cell lung cancer in 1 lung only
- small-cell lung cancer that was found very early
You may have other treatment after surgery.
Types of lung cancer surgery
There are 3 main types of lung cancer surgery.
Lobectomy
A lobectomy is where a surgeon removes 1 of the large parts of your lung (lobes). Your doctors will suggest this surgery if the cancer is just in 1 section of 1 lung.
Pneumonectomy
A pneumonectomy is where a surgeon removes your whole lung. You may have this surgery when the cancer is in the middle of a lung or has spread throughout a lung.
Wedge resection or segmentectomy
Procedures a surgeon can use to remove a small piece of your lung are either:
- wedge resection
- segmentectomy
These are only suitable for a small number of people. Your doctors will only use them if they think your cancer is small and limited to 1 area of your lung. This is usually if you have very early-stage non-small-cell lung cancer.
Breathing after lung surgery
You may be worried about being able to breathe if some or all of your lung is removed.
Usually surgery does not make your breathing worse. You can breathe normally with 1 lung.
Your doctors will do a test before surgery to check your breathing. This will help them know what your breathing may be like after surgery.
But if you have breathing problems before surgery, you will likely still have them. Your doctors may recommend inhalers to help you breathe.
Tests before surgery
Before surgery, you'll have some tests to check your general health and how your lungs are working.
These may include:
- an electrocardiogram (ECG) - a test to check your heart's rhythm and electrical activity
- a full pulmonary function test (PFT) - a test to measure how much air your lungs can breathe in and out
- an exercise test
How lung surgery is done
During lung surgery your surgeon removes:
- a piece of your lung
- nearby lymph nodes - this is called a sentinal mediastinal lymph node dissection (SMLND)
There are 2 ways to do lung surgery.
Open surgery
Lung surgery usually involves a surgeon making a cut (incision) in your chest or side.
They remove a section or all of the affected lung. This is called a thoracotomy.
Keyhole surgery
Another way to do lung surgery is a video-assisted thoracoscopic surgery (VATS). This is a type of keyhole surgery. Your surgeon makes small cuts in your chest.
A small camera is inserted into 1 of the cuts, so your surgeon can see the inside of your chest on a screen as they remove the section of affected lung.
In some cases they may do a robotic assisted thoracoscopic surgery (RATS). This is similar to VATS. Your surgeon uses their own hands to control surgical instruments that move like a human hand.
After surgery
You may stay in hospital for 5 to 10 days after your surgery. But it can take many weeks to recover fully from lung surgery.
After your surgery, you'll be encouraged to start moving as soon as possible. Even if you have to stay in bed, you'll need to keep doing regular leg movements. These help your circulation and prevent blood clots from forming.
A physiotherapist will show you breathing exercises to help prevent complications.
Recovering at home
When you go home, you'll need to exercise gently to build up your strength and fitness.
Walking and swimming are suitable for most people after treatment for lung cancer.
Talk to your care team about which types of exercise are suitable for you.
Radiotherapy
Radiotherapy is where radiation is used to kill cancer cells. There are a number of ways it can be used to treat lung cancer.
When radiotherapy and chemotherapy are used together this is known as chemoradiation (chemoradiotherapy).
You may have radiotherapy or chemoradiation if you have lung cancer and:
- surgery is not suitable
- the cancer has not spread far
Contact your specialist nurse if you’re concerned about your symptoms.
Urgent advice: Ask for an urgent GP appointment or phone your specialist nurse if:
- you are concerned about side effects or symptoms
During evenings or weekends, you can contact a GP out-of-hours service.
Non-urgent advice: Phone 112 or 999 or go to your nearest emergency department if:
- you have heavy bleeding
Cancer medicines
Lung cancer can be treated with cancer medicines that can either kill or slow the growth of cancer cells.
These include:
- chemotherapy
- immunotherapy
- targeted therapy
Tests before treatment
You may have tests to check if a targeted therapy or immunotherapy would work for you.
These are called biomarker tests. They check for certain gene changes in the tumour that may be causing your cancer.
How medicine is given
Ways that medicine to treat lung cancer can be given include:
- through a drip in your arm or chest (intravenously)
- an injection that's given under your skin directly into a vein
- a tablet or capsule
You may have more than 1 treatment.
Ask your care team for more information about your treatment and the possible side effects.
How long treatment with medicine lasts
Your cancer medicine treatment may take several months. You will have a course of treatment that is usually made up of a number of cycles.
Ask your team about the number of cycles you need to treat the cancer.
Each cycle is a number of sessions of treatment followed by a rest period.
The rest period helps:
- your body recover from the side effects
- healthy cells in your blood to go back to normal
After your first cycle, you will have a better idea of what to expect.
If the cancer has not improved after these cycles, your doctor will tell you if you need a different type of medicine. You and your doctor may decide on a new treatment plan.
Cancer medicines are sometimes given continuously for several weeks or months without a rest period. This is known as continuous cancer treatment.
Chemotherapy
Chemotherapy uses anti-cancer medicines (cytotoxic medicines) to kill cancer cells.
There are many types of chemotherapy medicine, but they all work in a similar way.
Ways chemotherapy can be used to treat lung cancer include:
- before surgery to shrink a tumour, to help increase the chance of successful surgery
- to reduce the risk of cancer coming back after surgery
- if the cancer starts to grow again
- palliative chemotherapy
- with radiotherapy - this is called chemoradiation
Chemotherapy and infection
Chemotherapy can weaken your immune system. This makes you more vulnerable to infection.
Urgent advice: Ask for an urgent GP appointment or phone your specialist nurse if:
- you have signs of an infection
For example if you have a high temperature, or you suddenly feel generally unwell.
During evenings or weekends, you can contact a GP out-of-hours service.
Immunotherapy
Immunotherapy medicines are treatments that:
- use your immune system to find and kill cancer cells
- help your immune system to work better to fight cancer cells
There are different types of immunotherapy. Some types are also a type of targeted therapy.
Immunotherapy can be used on its own or with chemotherapy.
Immunotherapy may be used to treat:
- non-small-cell lung cancer that is locally advanced (nearby lymph nodes and tissues are affected)
- non-small-cell lung cancer that has spread to another part of the body (metastatic)
- small-cell lung cancer that has spread to lymph nodes that are further away and to other parts of your body (extensive disease)
It depends on:
- any treatment have had already
- if your cancer has changes (mutations) in certain proteins or genes
Targeted therapy
Targeted therapy medicines find and attack cancer cells.
They slow the spread of non-small cell lung cancer in advanced stages.
You might have a targeted therapy medicine for non-small-cell lung cancer that:
- is locally advanced (nearby lymph nodes and tissues are affected)
- has spread to another part of the body (metastatic)
It depends on:
- any treatment you have had already
- if your cancer has changes (mutations) in certain proteins or genes
Non-urgent advice: Find your patient information leaflet
Your patient information leaflet is the leaflet that comes with your medicine. You can find a digital version of the leaflet online.
If you have side effects
Tell your treatment team if you have any side effects from any cancer medicine treatment - they can help.
They can give you medicines to prevent or treat some side effects.
Report side effects
You can report any suspected side effects to the Health Products Regulatory Authority (HPRA): report an issue - hpra.ie
Clinical cancer trials
A clinical trial is a research study that tests a new type of treatment on a group of people. It compares the effects of the new treatment against existing treatments. It may involve people with a condition, healthy people who volunteer, or both.
A clinical cancer trial:
- can help you access new lung cancer treatments
- is the best way to test if a new cancer treatment works better than the current treatment
For some people, it may be the best treatment choice.
But there's also a chance that the new treatment turns out to be no better, or worse, than the standard treatment.
How to take part in a lung cancer clinical trial
Ask your treatment team if they know of any clinical trials that you may be eligible to join. If a clinical trial is relevant for you, they will discuss this with you.
If you're invited to take part in a trial, you'll be given information about it. If you want to take part, you'll be asked to sign a consent form.
You can refuse or withdraw from a clinical trial without it affecting your care.