Lung Cancer Treatment | Radiation Treatment For Lung Cancer

About Lung Cancer

Lung Cancer occurs when normal cells within the lungs themselves become abnormal and grow without regulation. It can be caused by smoking and other environmental causes. Other people develop lung cancer who have never smoked or been exposed to any of the lung cancer risk factors.

According to the American Cancer Society, lung cancer is the second most common cancer in both men and women, following prostate cancer and breast cancer, respectively. It accounts for approximately 15% of all new cancers. An estimated 219,440 new cases of lung cancer were diagnosed in 2009, and an estimated 159,390 people died from the disease during the year, accounting for about 28% of all cancer deaths.

Most statistics concerning lung cancer reflect both small cell and non-small cell lung cancers.

When it comes to radiation for lung cancer, the physicians, technicians and staff at Advanced Radiation Centers of New York (ARC) employ advanced state-of-the-art technology. Our Oncologists have the most experience with treatment for lung in the entire Metropolitan tri-state NY area.

Different Types of Lung Cancer

There are different types of lung cancer and lung cancer treatment. In general, they are first divided into two main types of lung cancers: small cell lung cancer and non-small cell lung cancer. The cancers are typically broken down in this manner because the way in which they grow, spread and respond to various treatments is very different.

Non-small cell lung cancer is further broken down into subtypes, based upon what type of cell from which it originally became malignant. For example: there are glandular types of cells in the lungs, which secrete mucous to help sweep away foreign particles from the bronchial linings. If these cells become malignant, they are called an adenocarcinoma. If the normal squamous cells that line the bronchial airways themselves become malignant, this is called asquamous cell carcinoma. Other types of non-small cell lung cancer include bronchoalveolar carcinoma and large cell carcinoma.

Signs & Symptoms

There are several signs and symptoms in patients that are found to have lung cancer, however, not all patients exhibit any or all of these symptoms. Physical symptoms which may be associated with lung cancer include changes in the respiration such as shortness of breath, either at rest or after mild exertion such as climbing stairs; a cough, sometimes with blood noted in the sputum; hoarseness; or unexplained weight loss. The most common medical sign is an abnormality on a routine chest x-ray, or if another type of scan was performed for another reason, such as a CAT scan. Other signs can include wheezing or abnormalities noted when your doctor listens to your lungs, or even abnormal swelling of the fingernail beds which is called “clubbing.” These signs, though, are less common than physical patient symptoms or chest x-ray changes.

Staging and What Happens After Lung Cancer is Diagnosed

Once a biopsy has proven that there is lung cancer present, a number of studies and tests will be ordered to evaluate the stage or extent (or non-extent) of the disease.  This typically involves a dedicated thin-slice CAT scan of the chest using intravenous contrast. A PET scan is usually also performed, or these two tests can be combined into a PET-CT scan. A scan of the brain, such as an MRI is used to rule-out spread to that area, and a bone scan may be performed to evaluate the skeletal system. A blood work-up will also be ordered and reviewed for any abnormalities.

How is Lung Cancer Treated?

Lung cancer can be treated either with surgery, chemotherapy or radiation and/or some combination of these three modalities. The preferred treatment for non-small cell lung cancer is surgery,  which is usually only possible in the earliest stages. Unfortunately the majority of patients initially present in more advanced stages and therefore surgery is not an option. Depending on the findings at surgery and subsequent evaluation by the Pathologist, treatment with either chemotherapy and/or radiation may be recommended afterward to help reduce the risk of cancer recurring elsewhere in the body. If surgery is not a feasible option, usually chemotherapy and radiation are used together as the primary treatment. The preferred treatment for small cell lung cancer is not surgery. Typically both chemotherapy and radiation therapy are used in conjunction with each other to treat this type of lung cancer, which tends to have a higher response rate to chemoradiation.

What Types of Radiation Therapy are Used for Lung Cancer

For treatment, radiation for lung cancer is used in several situations. The most common use for lung cancer is in inoperable situations. Radiation is either used in conjunction with chemotherapy or as a stand alone treatment.  Depending on the location of the tumor and the areas that need to be treated, the different forms of treatment for lung cancer can be used are: 3D Conformal Radiation Therapy, or 3D-CRT, which is the standard form of radiation that allows for the treatment of tumors in any location.  Our skilled Oncologists will determine the proper lung cancer treatment. New technologies such as Intensity Modulated Radiation Therapy, or IMRT have more ability to shape the radiation as shown next:

IMRT, or Intensity Modulated Radiation Therapy, is a very sophisticated method of treating Lung Cancer with radiation. It specifically allows for a very focused and shaped field of radiation to be delivered to the tumor and areas at risk, while at the same time, sparing normal, healthy tissue in the region. IGRT, or Image Guided Radiation Therapy, is another technology that can also be used to ensure better targeting of daily radiation treatments. IGRT or Image Guided Radiation Therapy is another technology that can also be used to ensure better targeting of daily radiation treatments.

Respiratory Gating for Lung Cancer

Respiratory Gating is an excellent treatment for tumors in the lungs because tumors here can move as the patient breathes. With Respiratory Gating, the Advanced Radiation Centers’ physicians measure the patients’ range of motion when they inhale and exhale and customize the treatment field based on the way the patient breathes. This technology is unique because it synchronizes the delivery of radiation to the patient with his/her own respiratory cycle, sparing healthy tissue from being zapped, thus reducing side-effects.

What are the Side Effects of Radiation for Lung Cancer?

Long-term side effects from radiation therapy for lung cancer may include permanent shortness of breath, difficulty swallowing, skin changes and fibrosis, or scarring of the lung tissue.

Risk Factors

The median age for patients with lung cancer is 70, however the range can be quite varied.

It is well known that certain environmental and habitual factors contribute to increasing ones’ risk. Cigarette smoking is obviously the main contributor to its development, where it is implicated in nearly 90% of lung cancer deaths worldwide. Cigarette smoke contains more than 60 known carcinogens and may also depress the immune system’s natural response to a newly formed cancer.  In the US, smoking is associated with 87% of lung cancers, and the risk of a smoker developing lung cancer in his/her lifetime is between 10-20%, and that figure is higher for men, compared to just 1.4% in non-smokers – so, clearly smoking is a huge risk factor.

The amount of time a person smokes is also related to his/her risk of developing lung cancer, and this risk quickly decreases with smoking cessation, as the damage to the lung tissue is repaired and the body slowly removes carcinogenic materials.

Unfortunately, never smoking does not mean one cannot develop lung cancer, and nearly 20% of adults who develop lung cancer have no history of smoking. In these cases, although a true risk factor may not be implicated, potentially the diagnosis seems to be due to a combination of many factors, including genetic factors and exposure to other airborne carcinogens such as asbestos, radon gas, air pollution and second hand smoke.

Diagnosing Lung Cancer

If a patient presents with any of the findings on this page, he/she is usually sent for further studies and evaluation. For example, if there is new shortness of breath or onset of a cough, a chest x-ray may be ordered. If an abnormality is noted on a chest x-ray, further radiographic studies may be performed such as a CAT scan or a PET scan, or a combination CT-PET scan. A bronchoscopy is often performed to see the inside of the bronchial airways using a long flexible scope (bronchoscope) during a procedure typically performed by a Pulmonologist or Thoracic Surgeon.

Once there is enough clinical suspicion that there is an abnormality in the lung, the diagnosis of lung cancer is made by a biopsy. The type of biopsy usually depends on the location of the abnormality. For example: if the lesion is located near or invading into the airway, it may be seen during the diagnostic bronchoscopy and a biopsy can be taken at this time. The bronchoscopist may take washings, in which water or saline is infused into the airways and then collected and examined for any abnormal cells. If a lesion is peripheral, lying on the outer edge of the lung, it may be reached by a needle biopsy, which is where an Interventional Radiologist guides the needle under the visualization of a CT scan.

If there are abnormalities in the center of the chest known as the mediastinum, a Thoracic Surgeon may be able to obtain a tissue sample using techniques such as a video assisted thoracoscopy, or VATS procedure, using only small incisions similar to laparoscopy in the abdomen. If the lesion is not accessible using one of these types of procedures or these have been non-diagnostic, often times a surgical procedure must be used to remove the lesion and obtain a diagnosis.