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CANCER: LUNG


SOURCE: Mayo Clinic

Lung Cancer

Diagnosis

Testing healthy people for lung cancer

People with an increased risk of lung cancer may consider annual lung cancer screening using low-dose CT scans. Lung cancer screening is generally offered to people 55 and older who smoked heavily for many years and are otherwise healthy.

Discuss your lung cancer risk with your doctor. Together you can decide whether lung cancer screening is right for you.

Tests to diagnose lung cancer

If there’s reason to think that you may have lung cancer, your doctor can order a number of tests to look for cancerous cells and to rule out other conditions.

Tests may include:

  • Imaging tests. An X-ray image of your lungs may reveal an abnormal mass or nodule. A CT scan can reveal small lesions in your lungs that might not be detected on an X-ray.
  • Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.
  • Tissue sample (biopsy). A sample of abnormal cells may be removed in a procedure called a biopsy. Your doctor can perform a biopsy in a number of ways, including bronchoscopy, in which your doctor examines abnormal areas of your lungs using a lighted tube that’s passed down your throat and into your lungs; mediastinoscopy, in which an incision is made at the base of your neck and surgical tools are inserted behind your breastbone to take tissue samples from lymph nodes; and needle biopsy, in which your doctor uses X-ray or CT images to guide a needle through your chest wall and into the lung tissue to collect suspicious cells. A biopsy sample may also be taken from lymph nodes or other areas where cancer has spread, such as your liver.

Careful analysis of your cancer cells in a lab will reveal what type of lung cancer you have. Results of sophisticated testing can tell your doctor the specific characteristics of your cells that can help determine your prognosis and guide your treatment.

Tests to determine the extent of the cancer

Once your lung cancer has been diagnosed, your doctor will work to determine the extent (stage) of your cancer. Your cancer’s stage helps you and your doctor decide what treatment is most appropriate.

Staging tests may include imaging procedures that allow your doctor to look for evidence that cancer has spread beyond your lungs. These tests include CT, MRI, positron emission tomography (PET) and bone scans. Not every test is appropriate for every person, so talk with your doctor about which procedures are right for you.

The stages of lung cancer are indicated by Roman numerals that range from 0 to IV, with the lowest stages indicating cancer that is limited to the lung. By stage IV, the cancer is considered advanced and has spread to other areas of the body.

More Information

Treatment

  • Lung cancer surgery

You and your doctor choose a cancer treatment plan based on a number of factors, such as your overall health, the type and stage of your cancer, and your preferences.

In some cases, you may choose not to undergo treatment. For instance, you may feel that the side effects of treatment will outweigh the potential benefits. When that’s the case, your doctor may suggest comfort care to treat only the symptoms the cancer is causing, such as pain or shortness of breath.

Surgery

During surgery your surgeon works to remove the lung cancer and a margin of healthy tissue. Procedures to remove lung cancer include:

  • Wedge resection to remove a small section of lung that contains the tumor along with a margin of healthy tissue
  • Segmental resection to remove a larger portion of lung, but not an entire lobe
  • Lobectomy to remove the entire lobe of one lung
  • Pneumonectomy to remove an entire lung

If you undergo surgery, your surgeon may also remove lymph nodes from your chest in order to check them for signs of cancer.

Surgery may be an option if your cancer is confined to the lungs. If you have a larger lung cancer, your doctor may recommend chemotherapy or radiation therapy before surgery in order to shrink the cancer. If there’s a risk that cancer cells were left behind after surgery or that your cancer may recur, your doctor may recommend chemotherapy or radiation therapy after surgery.

Radiation therapy

Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing radiation to precise points on your body.

For people with locally advanced lung cancer, radiation may be used before surgery or after surgery. It’s often combined with chemotherapy treatments. If surgery isn’t an option, combined chemotherapy and radiation therapy may be your primary treatment.

For advanced lung cancers and those that have spread to other areas of the body, radiation therapy may help relieve symptoms, such as pain.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be given through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that you can recover.

Chemotherapy is often used after surgery to kill any cancer cells that may remain. It can be used alone or combined with radiation therapy. Chemotherapy may also be used before surgery to shrink cancers and make them easier to remove.

In people with advanced lung cancer, chemotherapy can be used to relieve pain and other symptoms.

Radiosurgery

Stereotactic body radiotherapy, also known as radiosurgery, is an intense radiation treatment that aims many beams of radiation from many angles at the cancer. Stereotactic body radiotherapy treatment is typically completed in one or a few treatments.

Radiosurgery may be an option for people with small lung cancers who can’t undergo surgery. It may also be used to treat lung cancer that spreads to other parts of the body, including the brain.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Many targeted therapy drugs are used to treat lung cancer, though most are reserved for people with advanced or recurrent cancer.

Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy treatments are generally reserved for people with advanced lung cancer.

Palliative care

People with lung cancer often experience signs and symptoms of the cancer, as well as side effects of treatment. Supportive care, also known as palliative care, is a specialty area of medicine that involves working with a doctor to minimize your signs and symptoms.

Your doctor may recommend that you meet with a palliative care team soon after your diagnosis to ensure that you’re comfortable during and after your cancer treatment.

In one study, people with advanced non-small cell lung cancer who began receiving supportive care soon after their diagnosis lived longer than those who continued with treatments, such as chemotherapy and radiation. Those receiving supportive care reported improved mood and quality of life. They survived, on average, almost three months longer than did those receiving standard care.

Health, Research Learning

CANCER: Proton Therapy

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SOURCE: Mayo Clinic

What is proton Therapy

Proton therapy is a type of radiation therapy — a treatment that uses high-energy beams to treat tumors. Radiation therapy using X-rays has long been used to treat cancers and noncancerous (benign) tumors. Proton therapy is a newer type of radiation therapy that uses energy from positively charged particles called protons.

Proton therapy has shown promise in treating several kinds of cancer. Studies have suggested that proton therapy may cause fewer side effects than traditional radiation, since doctors can better control where the proton beams deposit their energy. But few studies have directly compared proton therapy radiation and X-ray radiation, so it’s not clear whether proton therapy is more effective in prolonging lives.

Proton therapy isn’t widely available in the United States.

This is the machine that delivers the treatment.

Why it’s done

Proton therapy is used as a treatment for cancer and some noncancerous tumors. Proton therapy may be used as the only treatment for your condition. Or it may be used in conjunction with other treatments, such as surgery and chemotherapy.

Proton therapy is sometimes used to treat:

  • Brain tumors
  • Breast cancer
  • Cancer in children
  • Eye melanoma
  • Esophageal cancer
  • Head and neck cancers
  • Liver cancer
  • Lung cancer
  • Pituitary gland tumors
  • Prostate cancer
  • Sarcoma
  • Tumors affecting the spine
  • Tumors in the base of the skull

Clinical trials are investigation proton therapy as a treatment for a number of other types of cancer.

Risks

Proton therapy can cause side effects as the cancer cells die or when the energy from the proton beam damages healthy tissue.

Because doctors can better control where proton therapy releases its highest concentration of energy, proton therapy is believed to affect less healthy tissue and have fewer side effects than traditional radiation therapy. Still, proton therapy does release some of its energy in healthy tissue.

What side effects you experience will depend on what part of your body is being treated and the dose of proton therapy you receive.

In general, common side effects of proton therapy include:

  • Fatigue
  • Mouth, eating and digestion problems
  • Headaches
  • Hair loss around the part of your body being treated
  • Skin redness around the part of your body being treated
  • Soreness around the part of your body being treated

How you prepare

Before you undergo proton therapy, your health care team guides you through a planning process to ensure that the proton beam reaches the precise spot in your body where it’s needed.

Planning typically includes:

  • Determining the best position for you during treatment. During radiation simulation, your radiation therapy team works to find a comfortable position for you during treatment. It’s imperative that you lie still during treatment, so finding a comfortable position is vital. To do this, you’ll be positioned on a table that will be used during your treatment. Cushions and restraints are used to place you in the correct position and to help you hold still. Your radiation therapy team will mark the area of your body that will receive the radiation. Depending on your situation, you may receive temporary marking with a marker or you may receive permanent tattoos.
  • Planning the path of the protons with imaging tests. Your radiation therapy team may have you undergo magnetic resonance imaging (MRI) or computerized tomography (CT) scans to determine the area of your body to be treated and how best to reach it with the proton beams.

Consider the cost

Proton therapy is a newer form of radiation therapy that may be more expensive than traditional radiation therapy with X-rays. Not all insurance policies cover proton therapy. When considering your treatment options, work with your health insurance provider to understand what costs are covered by insurance and which costs you’ll be expected to pay.

What you can expect

During proton therapy

You typically undergo proton therapy five days a week for several weeks. However, in some cases, you may undergo only one or only a few treatments, depending on your condition. The actual proton therapy treatment may take only a minute or so, but expect to spend 30 to 45 minutes preparing before each treatment session.

You may also undergo weekly CT verification scans to see if the dose you receive needs to be recalculated based on changes in weight, or tumor size and shape, depending on your situation.

To prepare, you’ll be positioned on a table. Cushions and restraints will be used to hold your body still. Then you’ll undergo an imaging test, such as an X-ray or CT scan, to make sure your body is in the same precise position before each treatment.

Your radiation therapy team will then leave the room and go to an area where they can monitor you. They can still see and hear you.

What you experience next depends on the type of proton therapy machine your treatment team uses:

  • A proton therapy machine that rotates around you. If you’re undergoing proton therapy with a machine called a gantry, you’ll be placed on a table that is slowly slid into the circular opening of the machine. The machine rotates around you to direct proton beams at precise points on your body.
  • A proton therapy machine that doesn’t move. If you’re undergoing proton therapy with a fixed-beam machine, the table you’re positioned on will move and the proton therapy machine will remain still. The movement of your table during treatment is controlled remotely by your radiation therapy team. How often your table moves during treatment depends on your situation.

You won’t be able to feel the radiation during your proton therapy treatment.

After proton therapy

Once your treatment session is complete, you can go about your day. You won’t be radioactive or give off radiation.

Side effects of radiation usually develop over time. You may experience few side effects at first. But after several treatments you may experience fatigue, which can make it feel like your usual activities take more energy or that you have little energy for everyday tasks. You may also notice a sunburn-like skin redness in the area where the proton beams are directed.

Results

Your doctor may recommend periodic imaging tests during and after your proton therapy to determine whether your cancer is responding to the treatments. How often you’ll undergo scans depends on your situation.

ASK YOUR DOCTOR WHAT YOUR OPTIONS ARE BEFORE YOU DECIDE ON A TREATMENT.