Chemotherapy, radiation therapy, immunotherapy, surgery? A Vanderbilt expert explains lung cancer treatment options.
“When lung cancer patients come in initially to meet with one of our clinicians, a primary question they want answered is, How are we going to treat this?” said Dr. Eric Grogan, a thoracic surgeon with Vanderbilt Thoracic Surgery.
There’s a lot to learn, absorb and process when you’re newly diagnosed with lung cancer, but it’s important to know that each road is different. These are the three critical factors that your providers will weigh in order to guide you to the best treatment option for your specific case:
Type of tumor
The majority of lung cancer patients have non-small cell cancer, while around 15 percent of patients will have a small cell malignancy, which is typically more aggressive. Whether yours is non-small cell or small cell will play a larger role in determining your treatment plan. “Surgery is not often used in small cell cancer, except for very isolated cases where there is one small focus with no evidence of disease elsewhere,” Grogan said by way of example. “That’s why it is important to know the tumor type.”
It’s also become important to consider the genetics of the tumor itself, Grogan said. Molecular testing of your tumor will help your providers better understand how responsive your tumor will be to certain therapies.
Extent of disease
“Here, we’re asking if the tumor is contained within one area or if additional disease is present somewhere other than the lung — within lymph nodes, within the bones, etc.,” Grogan said. “That provides us more information about the biology of the disease: Does the tumor have the propensity to break apart and spread? If so, it’s a more vicious malignancy and typically requires combinations of care that may include traditional chemotherapy, or newer immunotherapies that may be also coupled with surgery or radiation therapy.”
Overall health
The final factor is your overall physiologic condition. Do you have ongoing medical conditions such as heart disease, diabetes, emphysema, obesity, etc., that could make an operation risky? Are you immunocompromised, or does a preexisting condition mean chemotherapy might be too dangerous? “These concurrent conditions really play into how we make the best and most appropriate decision for a patient’s care,” Grogan said.
Understanding both the long-term and short-term effects — as well as understanding why a certain treatment is a good fit for your case — will allow you to make the best decision you can.
Making an informed decision
After weighing these three factors, your provider will be able to recommend the best options for your treatment plan. For example, if your cancer is confined to one area and you’re a good candidate for surgery, an operation alone to remove the tumor will likely be the recommendation. Similarly, if your tumor is confined and yet your overall physiologic condition prohibits surgery or even chemotherapy, radiation therapy alone might be prescribed.
“Often, lung cancer treatment plans involve combinations of different therapies that could include two or three treatment strategies,” Grogan said. “One advantage of being at a National Cancer Institute-designated Cancer Center like Vanderbilt-Ingram Cancer Center is the multidisciplinary approach. A team of experts meets to discuss patient’s cases and personalizes the treatment plan to select the best therapies for cure.” Research trials that investigate promising new drugs to affect the disease are also available for consideration.
After an in-depth discussion of the key factors and a review of all options for treatment, your provider will offer recommendations and encourage you to choose based on the risks and benefits of the therapy. It’s important, then, to prepare a list of questions to ask about treatment and make sure you get answers. Understanding both the long-term and short-term effects — as well as understanding why a certain treatment is a good fit for your case — will allow you to make the best decision you can.
The Vanderbilt-Ingram Cancer Center is a national leader in patient care and research. Vanderbilt offers the region’s most complete range of oncology care, from advanced imaging to team-based treatment options to genetic cancer medicine and the latest in therapies being studied in clinical trials. Our lung cancer specialists provide advanced, effective care tailored to individual needs.
