Facing Lung Cancer: Making Treatment Decisions

Key Points

Your treatment options are determined by the type and stage of cancer you have and your treatment goals.
You may receive several different types of treatment.
You and your care team decide on treatment together.
Each treatment option has potential side effects, which usually can be managed.

Take action

Voice your concerns to your doctor. He or she can discuss the treatment options with you and address those concerns.

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Your Lung Cancer Care Team

How are Treatment Decisions Made?

Your Lung Cancer: Your Goals

Ablation therapies (a-BLAY-shun): Treatment involving destruction or removal of diseased tissue.
Adenocarcinoma (A-deh-noh-KAR-sih-NOH-muh): A form of non-small cell lung cancer often found in an outer area of the lung. It develops in the cells of epithelial tissues, which line the cavities and surfaces of the body and form glands.
Adjuvant therapy (A-joo-vunt THAYR-uh-pee): Treatment given after the main type of treatment to increase the chances of cure.
Advance directive (ad-VANS duh-REK-tiv): A legal document that tells the doctor and family what a person wants for future medical care should the person later become unable to make decisions for him or herself.
Alternative Therapy: Alternative therapy is used in place of standard medical treatments.
Anaplastic Lymphoma Kinase (ALK) gene rearrangement (A-nuh-PLAS-tik lim-FOH-muh KY-nays): In some cancer cells, a type of mutation called a gene rearrangement occurs that joins another gene to ALK and “turns it on,” telling cancer cells to multiply.
Anti-angiogenesis therapy [an-jee-o-JEN-uh-sis]: Angiogenesis is when cancerous tumors create new blood vessels, which helps them grow and spread. This therapy uses drugs to prevent the growth of new blood vessels to tumors.
Alveoli (al-vee-oh-lie).): Very small air sacs at the end of each bronchiole.
Biopsy (BY-op-see): The removal of a small piece of tissue for laboratory examination.
Bone scan (bone skan): A small, safe amount of radioactive substance is put into the vein. This substance builds up in areas of bone that may not be normal because of cancer. These areas show up as dense, gray to black areas, called "hot spots”. These areas may indicate cancer.
Brachytherapy (internal or implant radiation therapy) (BRAY-kee-THAYR-uh-pee): Sealed radioactive material is placed directly into or near the tumor.
Bronchoscopy (bron-KOS-koh-pee): A lighted, flexible tube (called a bronchoscope) is passed through the mouth or nose and into the larger airways of the lungs. This test can help the doctor see tumors, or it can be used to take samples of tissue or fluids to see if cancer cells are present.
Bronchus (BRON-kus): Either of the two major branches of the tracheas (windpipe) that lead to the lungs. The trachea divides to form the right and left main bronchi (pleural of bronchus) or bronchial tubes, which travel to each of the lungs.
Bronchioles (brong-kee-oles): The smallest tubes branching off from each bronchus.
Cancer survival rates: The percentage of people who survive a certain type of cancer for a specific amount of time. Cancer statistics often use an overall five-year survival rate. If the overall five-year survival rate of a certain cancer is 80 percent, that means that of all people diagnosed with that cancer, 80 of every 100 were living five years after diagnosis.
Capillaries (cap-ill-er-ees): Very small blood vessels.
Carcinoma in situ (car-sin-O-ma in sy-too): Cancer cells are found only in the innermost lining of the lung. The tumor has not grown through the lining.
Cellular Pathways: Complex systems of proteins and other molecules that, when turned on, change how the cells act. Sometimes these pathways tell the cell to do something abnormal, which leads to disease.
Cilia (sih-lee-uh): Tiny hairs that sweep fluids and foreign particles out of the airway so that they stay out of the lungs.
Complementary therapy (KOM-pleh-MEN-tuh-ree): Non-standard treatment used in addition to standard treatment.
Complete response, apparently cancer free or No Evidence of Disease (NED): On an imaging scan, the tumor looks like it is completely gone because of treatment.
Cryotherapy (KRY-oh-THAYR-uh-pee): Uses extreme cold to kill cancer cells
CT scan (computed tomography): A CT (or CAT) scan is a special kind of x-ray that takes many pictures as you lie on a table that slides in and out of the machine. A computer then combines these pictures into a detailed picture of a slice of your body.
Diaphragm (DY-uh-fram): The strong wall of muscle that separates the chest cavity from the abdominal cavity. By moving downward, it creates suction in the chest to draw in air and expand the lungs.
Endobronchial ultrasound (en-doh BRON-kee-ul): For endobronchial ultrasound, a bronchoscope (a thin, lighted, flexible tube) is fitted with an ultrasound device (a device that uses sound waves to make pictures of the inside of your body) at its tip. It is passed down into the windpipe to look at nearby lymph nodes and other structures in the chest. This is done with numbing medicine (local anesthesia) and light sedation. A hollow needle can be passed through the bronchoscope and guided by ultrasound into an area of concern to take biopsy samples.
Endocannabinoids: A chemical substance in the body belonging to a group resembling organic chemicals found in cannabis.
Endoscopic esophageal ultrasound (en-doh-SKAH-pik ee-SAH-fuh-JEE-ul): This test is much like an endobronchial ultrasound, except that an endoscope (a lighted, flexible tube) is used. It is passed down the throat and into the esophagus.
Epidermal growth factor receptor (EGFR) inhibitors (eh-pih-DER-mul grothe FAK-ter reh-SEP-ter in-HIH-bih-ter): Drugs that block receptors of proteins that aid in cancer cell growth.
Epidermal growth factor receptor (EGFR) mutation (eh-pih-DER-mul grothe FAK-ter reh-SEP-ter myoo-TAY-shun): A modification of a normal tissue receptor (attachment for a molecule) which may promote abnormal cell growth leading to cancer.
External beam radiation (external beam): Doses of radiation are aimed at lungs or surrounding areas.
Fine needle biopsy (FNA): A long, thin (fine) needle is used to remove a sample of cells from the area that may be cancer. The sample is looked at in the lab to see if there are cancer cells in it.
First-line therapy: Initial cancer treatment
Guidelines: Guidelines are created by experts in the field. They review all of the science and create a grading system for recommending treatments. Guidelines help doctors present the best treatment options for your situation.
Hospice (HOS-pis): Refers to a system of care for dying people and their families. Most hospice care is administered at home but some hospice facilities exist. Hospice care is recommended when life expectancy is six months or less.
Integrated medicine: The combined use of standard and complementary therapy.
Intensity Modulated Radiation Therapy (IMRT) (in-TEN-sih-tee-MAH-juh-LAY-tid RAY-dee-AY-shun THAYR-uh-pee): Radiation beams are shaped to match the tumor. The intensity of the treatment can be changed throughout the session.
KRAS: A protein that signals for the cell to grow. A KRAS mutation can lead to uncontrolled cell growth.
Large Cell Carcinoma (...KAR-sih-NOH-muh): A form of non-small cell lung cancer that can occur in any part of the lung and tends to grow and spread faster than adenocarcinoma or squamous cell carcinoma.
Late Effect: A side effect from treatment that occurs months or years after a diagnosis of cancer.
Lobe: The right lung is divided into three lobes, or sections. The left lung is divided into two lobes. Each lobe is like a balloon filled with sponge-like tissue. Air moves in and out through one opening -- a branch of the bronchial tube.
Lobectomy (loh-BEK-toh-mee): A lobe of the lung is removed.
Lymph (limf): An immune system fluid that helps collect unwanted materials for removal from the body.
Lymph nodes (limf nodes): Small ball shaped organs of the immune system distributed all over the body.
Malignant (muh-LIG-nunt): A term used to refer to cancerous cells or tumors. Malignant cells are abnormal and grow uncontrollably. They may invade and destroy other parts of the body.
Mediastinoscopy and mediastinotomy (MEE-dee-uh-sty-NOS-koh-pee): Both of these tests let the doctor look at and take samples of the structures in the area between the lungs (this area is called the mediastinum).
Metastasis (meh-TAS-tuh-sis): The spread of cancer from its primary site to other places in the body.
Monoclonal antibodies (MAH-noh-KLOH-nul AN-tee-BAH-dee): Proteins made in a laboratory that can attach to tumor cells and tell the cell what to do. There are many types of monoclonal antibodies, each made to find one substance. They can be used alone or they can destroy the cell by carrying toxins to the tumor.
MRI scan (magnetic resonance imaging) (mag-NEH-tik REH-zuh-nunts IH-muh-jing): MRI scans give detailed pictures of soft tissues in the body using radio waves and strong magnets. MRI scans are useful in finding lung cancer that has spread to the brain or spinal cord.
Mucus (MYOO-kus): A thick, slippery fluid made by the membranes that line certain organs of the body, like the lungs. It collects unwanted matter like dust and germs.
Multi-modality or combined modality: Treatment using a combination of therapies.
Mutation (myoo-TAY-shun): A permanent change in the DNA sequence of a gene.
Neoadjuvant therapy (NEE-oh-A-joo-vant THAYR-uh-pee): Treatment given before the main type of treatment to increase the chances of successful response.
Non-Small Cell Lung Cancer: About 85% to 90% of lung cancers are non-small cell lung cancer (NSCLC). There are three main subtypes of NSCLC, which look different under a microscope but are treated similarly.
Occult stage non-small cell lung cancer (uh-KULT): Cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging tests or bronchoscopy, or the tumor is too small to be checked.
Palliative care (PA-lee-uh-tiv kayr): Care aimed at making the patient more comfortable and improving quality of life. Hospice care always includes palliative care but palliative care can be administered at any stage of a disease.
Palliative therapy (PA-lee-uh-tiv): Treatment to relieve symptoms but not treat the disease.
Partial Response: The tumor has shrunk in size by at least 30%.
Pathologist (puh-THAH-loh-jist): A doctor who identifies diseases by studying cells and tissues under a microscope.
PET scan (positron emission tomography): For a PET scan, a form of radioactive sugar is injected into the blood. Cancer cells in the body absorb large amounts of the sugar. A special camera can then spot the radioactivity. This test can help show whether the cancer has spread to the lymph nodes or other parts of the body.
Photodynamic therapy (PDT) (FOH-toh-dy-NA-mik THAYR-uh-pee): A special chemical is injected into the blood stream that stays in cancer cells longer than regular cells. A laser activates the chemical in the cancer cells and kills them.
Pleura (PLOOR-uh): The pleura are the two membranes that surround each lobe of the lungs and separate the lungs from the chest wall.
Pneumonectomy (NOO-moh-NEK-toh-mee): The removal of the entire lung affected by cancer.
Power of attorney: A written document often used when someone wants another adult to make decisions on their behalf.
Prognosis (prog-NO-sis): A prediction of the probable course and outcome of a disease.
Progressive disease: The tumor continues to grow in spite of treatment.
Radiofrequency ablation (RAY-dee-oh-FREE-kwen-see a-BLAY-shun): Uses thermal (heat) energy to kill cells.
Second-line therapy: Treatment that follows if the first is not successful.
Sleeve resection (...ree-SEK-shun): Surgery to remove a lung tumor in a lobe of the lung and a part of the main bronchus (airway). The ends of the bronchus are rejoined and any remaining lobes are reattached to the bronchus. This surgery is done to save part of the lung. Also called sleeve lobectomy.
Small Cell Lung Cancer: About 10% to 15% of all lung cancers are small cell lung cancer (SCLC), named for the small cells that make up these cancers. SCLC often starts in the bronchi near the center of the chest, and it tends to spread widely through the body early in the course of the disease.
Sputum cytology (SPYOO-tum sy-TAH-loh-jee): A sample of mucus you cough up from the lungs (called sputum or phlegm) is looked at under a microscope to see if cancer cells are present.
Squamous Cell Carcinoma (SKWAY-mus sel KAR-sih-NOH-muh): A form of non-small cell lung cancer usually found in the center of the lung next to an air tube (bronchus).
Stable Disease: The tumor did not change size much.
Stereotactic Radiosurgery (SRS or STRS) (STAYR-ee-oh-TAK-tik RAY-dee-oh-SER-juh-ree): Uses a very high dose of radiation delivered very accurately to tumors in the body in a one-day session or over time (fractionated). It is often used as an alternative to therapy for patients who cannot tolerate more invasive procedures.
Thoracentesis (THOR-uh-sen-TEE-sis): This test is done to check whether fluid around the lungs is caused by cancer or by some other medical problem. A needle is placed between the ribs to drain the fluid. The fluid is checked for cancer cells.
Thoracoscopy (THOR-uh-KOS-koh-pee): A small cut is made in the chest. The doctor then uses a thin, lighted tube connected to a video camera and screen to look at the space between the lungs and the chest wall. The doctor can see small tumors on the lung or lining of the chest wall and can take out pieces of tissue to be looked at under the microscope. Thoracoscopy can also be used as part of the treatment to remove part of a lung in some early-stage lung cancers.
Thoracotomy (THOR-uh-KAH-toh-mee): An incision is made across the side of the chest. The ribs are spread apart so the surgeon can access the lung.
Tumor: A tumor is an abnormal growth of body tissue.
Vaccine Therapy: Tumor cells are used to develop a vaccine and then injected into the person. The vaccine aims to make the immune system recognize the tumor as foreign and attack the cancer cells.
Video-assisted thoracic surgery (VATS): A new type of surgery that allows doctors to make very small incisions to view the inside of the chest cavity and remove tumors to test them for cancer.
Wedge resection (wej ree-SEK-shun): Surgery to remove a small portion of the lung along with healthy tissue that surrounds the lung.