July 17, 2020

Chemotherapy, radiation therapy, immunotherapy, surgery? A Vanderbilt expert explains lung cancer treatment options.


There’s a lot to learn, absorb and process when you’re newly diagnosed with lung cancer, but one question will likely be top of mind.

“When 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 Jon Nesbitt, M.D., a thoracic surgeon at Vanderbilt University Medical Center. And while it may seem rather straight-forward initially — chemotherapy, radiation therapy and surgery are the standards of care — it’s important to understand that there are three critical factors that your providers weigh in order to guide you to the best treatment option for your specific case:

1. Type of tumor.

The majority of patients present with non-small cell cancer, while around 15 percent of those diagnosed 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,” Nesbitt said by way of example. “That’s why it is important to know the tumor type.”

In the past decade, Nesbitt said, it’s also become important to consider the genetics of the tumor itself. Molecular testing of your tumor will help your providers better understand how responsive your tumor will be to certain therapeutic agents.

2. Extent of disease.

“Here, we’re asking if the tumor is contained within one area or if there is distant disease, meaning additional disease is present somewhere other than the lung — within lymph nodes, within the bones, etc.,” Nesbitt 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 chemotherapy coupled with surgery or radiation therapy.”

3. 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,” Nesbitt 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. And in some circumstances novel chemotherapeutic agents called targeted therapies or immunotherapy are considered. Lastly, research trials that investigate promising new drugs to affect the disease are available for consideration.

After an in-depth discussion of the key factors in determining care and a review of all options for treatment, your provider will provide 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.

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