Lung CANCER-Treatments
For the treatment of lung cancer, close coordination between different medical and paramedical disciplines is necessary. In fact, they associate, according to needs, surgery, radiotherapy, chemotherapy and new targeted treatments. These different treatments can be used alone or in combination.
The choice of treatment (s) depends on several factors, including:
The cellular nature of each cancer
Its location
Its degree of extension
The general condition of the patient, in other words the way his main vital organs work.
For lung cancers, treatments are divided into two broad categories according to the type of cancer, "Not small cells " or "small cells ".
On the other hand, the therapeutic strategy is never decided by a single doctor. Each patient suffering from lung cancer must undergo a multidisciplinary oncology consultation (COM), where doctors from different disciplines are brought together. The choice of treatment is the result of this COM. Each treatment is therefore individualized. By treatment you will find below an overview of the side effects.
1. Surgery
Surgery is performed by surgeons specializing in thoracic surgery. When they remove the tumor, they must take all around it a "margin" of safety, on which one verifies, by examination under a microscope, that there is no more tumor cell. This is called the "healthy margin resection". They should also remove the lymph nodes close to the tumor and that could be invaded by cancer cells.
Depending on the location and size of the tumor, the surgeon will remove all or part of the lung:
Lobectomy: A whole lung lobe is removed. This is the most common operation.
Segmentectomy: Only the part of a lobe in which the tumor is located is removed.
Pneumectomie: The entire lung is removed as well as the corresponding lymph nodes. The cavity left free will gradually fill with scar tissue in the weeks following the procedure.
However, if the patient is difficult to operate, radio frequency remains a solution. This technique consists of inserting an "electrode" probe through the thoracic wall (under anesthesia) until it is near the tumor. A high frequency current is then sent through this probe, which will result in a significant local warm-up and kill the cancer cells.
Radiofrequency and segmentectomy are interventions that concern only the tumor. These lung cancer treatments do not allow to control the surrounding lymph nodes.
Recovery after surgery
After pulmonary surgery, the patient usually stays between 24 and 48 h in intensive care, especially in order to fight pain best. Then, depending on the type of surgery, classical hospitalization lasts an average of 8 to 10 days, unless complications occur. A period of convalescence follows.
For radio frequency, it is advisable to spend a night under surveillance. Depending on the initial pulmonary capacity, doctors will be able to propose a cycle of respiratory rehabilitation, based on physiotherapy and a very well attended physical training. These approaches significantly improve post-operative recovery.
2. Radiation therapy
For lung cancers, radiation therapy can be used:
Only in adjuvant, i.e. after the operation to try to eradicate any tumor cell that would have remained (especially if the surgeon could not remove the entire tumor). It reduces the risk of local relapse.
Specifically on the brain, in preventing metastases which, in some forms of lung cancer, have a predilection for the brain (prophylactic radiation therapy).
The recent radiotherapy equipment allows to target very precisely the area to be treated. This increases the chances of success of the treatment, while limiting the side effects.
Radiotherapy can also be used in combination with chemotherapy (radiochemotherapy) to strengthen their respective effects. These combined treatments are heavier because of the side effects of chemotherapy on the one hand and rays on the other hand.
A treatment of radiotherapy usually lasts 6 to 7 weeks at the rate of one session per day. Studies are currently being conducted to determine if other management schemes could improve the effectiveness of the treatment.
Special case: Radiotherapy targeted
For small tumours located in difficultly operable individuals, the doctor may use stereotactic radiation therapy. This technique requires sophisticated equipment that delivers multiple beams of rays that meet at the level of the tumor. All the efficacy of the treatment is based on the precise determination of the tumor volume that will receive a high dose of rays. No hospitalization is required, but the procedure is applied in 3 to 5 sessions spaced for a few days.
Side effects of radiation therapy
Radiation therapy causes short and long-term side effects. The former are often passengers, and gradually disappear shortly after the end of the treatment and the latter are often definitive.
In the short term
Radiation therapy can cause:
Skin burns similar to sunburn in the irradiated area
Irritation of the Esophagus
An annoyance to the Déglutissement
Nausea, vomiting
Progressive fatigue
These disorders usually disappear after the end of the treatment.
Long-term
The possible late toxic effects of thoracic radiotherapy have now become scarce thanks to technical advances and a better knowledge of physiology. Nonetheless, they have not completely disappeared.
This may include chronic pneumonia (Deradix pneumonitis). It results in the onset of shortness of breath increasingly marked in the months following the end of radiotherapy, due to inflammation and then fibrosis of the pulmonary region irradiated. His treatment is mainly based on cortisone.
Respiratory infections can also occur. Chest radiation can weaken the lungs and predispose to bronchial or pulmonary infections. Antibiotics and respiratory physiotherapy are generally effective. Annual influenza vaccination is highly recommended after the end of the treatment
A pleurisy (liquid appearing in the pleura, enveloping the lung) or a pericardium (liquid appearing in the pericardium, enveloping the heart) may occur, sometimes several years after treatment with radiotherapy. A pleural or pericardial puncture may be necessary in order to evacuate and analyze the liquid.
It should be noted that the new radiotherapy techniques, much more precise than in the past, make it possible to reduce these side effects very clearly. Drainage-effusion-pleural
3. Chemotherapy
In the case of lung cancer, platinum-based medications are common, usually associated with other cytostatic and/or targeted treatments. A chemotherapy regimen consists of a number of cures, alternating with recovery periods. The type of lung cancer influences the choice of medications used.
Side effects of chemotherapy
Chemotherapy attacks fast-dividing cells, which is the case for cancer cells. But it can also have an effect on other fast-dividing cells, such as bone marrow, oral and intestinal mucosa, and hair roots.
These effects depend on the medication used, the dose and the duration of the treatment. They can be translated as:
Increased risk of infection (due to reduced number of white blood cells)
Bleeding and bleeding (due to a reduction in the number of blood platelets)
Fatigue (due to the reduction in the number of red blood cells)
Inflammation of the oral mucosa
A loss of appetite
Nausea and vomiting
Diarrhea
A fall of the hair
These disorders usually disappear after the treatment is stopped. Many of them, such as vomiting, can be prevented or treated with medications.
Some chemotherapy, including platinum-based ones, can also cause nerve damage (neuropathy). The consequences are hearing loss or symptoms located in the hands and feet such as pain, burning sensation, stinging, hypersensitivity to cold or warm, a sensation of weakness. These disorders usually disappear at the end of the treatment, but may persist in some people. In some cases, it is necessary to reduce the dose of chemotherapy or even to postpone or even stop the treatment.
4. Targeted Therapies
Recent medications allow cancer cells to be attacked by selectively interfering with certain key steps in their operation. These so-called "targeted" therapies (sometimes also referred to as biotherapies) are often used in combination with classical chemotherapy. Recent studies have shown that not all cancer cells present the same "targets" for targeted treatments. These must therefore be chosen on a case-by-case basis, depending on the biological characteristics of each cancer.
In the case of lung cancer, it is generally used at present to erlotinib or gefitinib, provided that a mutation is present in a particular gene (called EGFR). Other targeted treatments are still the subject of clinical research.
These medications are usually used after chemotherapy, or in case of recurrence, or if the cancer continues to progress despite chemotherapy. In some tumors with a particular mutation, they are introduced in the first line of treatment. These medications are in the form of tablets.
Side effects of targeted treatments
The arrival of targeted therapies has aroused the hope that these drugs, of more selective action, would be free of side effects. Unfortunately, that is not the case. Some of them are even the cause of intense reactions (allergies, skin reactions, etc.).
However, the good news is that these side effects are often predictive of their efficacy, which is not the case with chemotherapy. Other possible side effects include headaches, fatigue, fever and diarrhea.
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