Lung Cancer Treatment
At UT MD Anderson, some of the nation’s top lung specialists focus their extraordinary expertise on you. We customize your treatment to deliver the most advanced, effective and least invasive treatments available for lung cancer. And because your peace of mind is important to us, we specialize in techniques and therapies that can help preserve lung function and quality of life.
We’re constantly researching safer and more effective treatments for lung cancer with fewer side effects. This leads to a large number of active clinical trials at UT MD Anderson and ensures that our patients have access to some of the most cutting-edge therapy anywhere in the world.
If you are diagnosed with lung cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the stage and type of lung cancer; other lung problems, such as emphysema or chronic bronchitis; other prior or current medical conditions; and possible side effects of treatment.
Your treatment for lung cancer will be customized to your particular needs. It may include one or more of the following therapies to treat the cancer and help relieve symptoms.
Lung cancer surgery
Surgery is one of the primary treatments for lung cancer.
In some cases, patients get cancer drugs or radiation therapy before surgery to shrink the tumor. Patients may also get these treatments after surgery to kill any remaining cancer cells, including cells that have spread to other parts of the body.
During lung cancer surgery, part of the lung with the tumor is removed. Simple procedures remove just a small section of lung. More complicated surgeries remove larger sections or even the entire lung. In some cases, nearby structures are also removed.
There are different approaches to lung cancer surgery.
One method is open surgery. This is the traditional approach. Surgeons perform the procedure through a four- to eight-inch incision between the ribs.
Minimally invasive surgery is the other main approach. These procedures require several smaller incisions, typically between ? and ? inch. Minimally invasive surgery is usually less painful and has a shorter recovery time than open surgery. The two primary methods:
- Video-assisted thoracic surgery (VATS): VATS uses a small camera and instruments that are inserted into the chest cavity. VATS is typically performed on patients with small, early-stage lung cancers.
- Robotic-assisted Surgery: This technique uses robotic arms remotely controlled by the surgeon. Compared to VATS, it can offer better images of the surgical site. The surgical instruments also have more dexterity. These features enable procedures that are more complex than possible with VATS.
The most common types of lung cancer surgery are below, starting with the simplest surgery that removes the least amount of lung tissue.
Wedge Resection
During a wedge resection, the tumor and a wedge-shaped piece of the lung that includes the tumor is removed.
Wedge resections are typically used to cure the cancer. They are a good option for patients with small, early-stage tumors. They are also performed on patients who have limited lung capacity and can’t tolerate losing a larger section of the lung.
Wedge resections are performed under general anesthesia. In most cases, doctors can use a minimally invasive technique that requires only a few small incisions. The procedure usually takes around two hours. Patients stay one to two nights in the hospital.
Segmentectomy
Segmentectomy involves removing a segment, or part, of the lobe where the cancer is located. This segment is larger than the section of lung taken during a wedge resection. These procedures are generally used to cure the cancer.
Like the wedge resection, a segmentectomy is usually performed on patients who have limited lung capacity and can’t tolerate losing a large section of the lung. This procedure is also a good option for patients with early-stage tumors generally measuring less than two centimeters.
Patients undergoing a segmentectomy are put under general anesthesia. Most surgeries use minimally invasive techniques that only need a few small incisions. The procedure usually lasts four to six hours. Patients typically spend two to three nights in the hospital after a segmentectomy.
Lobectomy
In a lobectomy, surgeons remove the lung lobe where the tumor is located. This is the standard procedure for patients whose cancer has advanced past the earliest stages. It is usually meant to help cure the cancer.
Lobectomies are performed under general anesthesia. In most cases, doctors can use minimally invasive techniques that only require a few small incisions. Based on the extent of the cancer, though, doctors may need to perform an open surgery.
Lobectomies usually last four to six hours. Patients typically stay two to five nights in the hospital, though two to three nights is the target stay.
Sleeve lobectomy
The sleeve lobectomy is a more complex form of lobectomy. It is usually part of a plan to cure the cancer.
Sleeve lobectomies are typically used when the tumor is in a more central part of the lung. This location places them near key structures like the pulmonary artery, which carries blood from the heart to the lungs, or the central bronchus, which moves air in and out of the lungs.
During the surgery, doctors remove the lobe with the tumor, along with part of the bronchus. The bronchus is then connected to the remaining lobes.
A sleeve lobectomy may not always be possible. When it is an option, it is preferred over a pneumonectomy (complete removal of the lung) since it preserves more functioning lung tissue.
Patients getting a sleeve lobectomy are put under general anesthesia. Most procedures are performed as open surgeries. Select cases may be done with minimally invasive techniques.
The full surgery usually lasts five to six hours. Patients usually stay in the hospital for three to five nights.
Pneumonectomy
Pneumonectomy involves removing the entire lung. This surgery is rarely performed. It is used only when the tumor’s location rules out other surgeries.
Pneumonectomies are performed under general anesthesia. The procedure requires an open surgery most of the time. In select cases, minimally invasive surgery is possible.
Pneumonectomies usually take five to six hours. Patients typically spend four to five nights in the hospital.
Patients who undergo a pneumonectomy need to care for their remaining lung for the rest of their lives after surgery. This includes taking steps to prevent lung infections and limit exposure to toxins like tobacco smoke.
Lymph node dissection and lung cancer surgery
Lymph node dissections are not a separate type of lung cancer surgery. Instead, they are procedures done at the same time as the surgeries above.
During a lymph node dissection, the surgeon will remove lymph nodes from the chest. Since cancer often spreads through these nodes, doctors will examine them under a microscope to find out if the lung cancer has moved outside the lungs. This will help doctors decide if you need more treatment after surgery, such as chemotherapy, radiation therapy or targeted therapy.
Recovering from a lung cancer surgery
Surgery for lung cancer permanently impacts the patient’s lung function and, in some cases, their physical capabilities. Full recovery to the patient’s “new normal” usually takes two to three months, though most improvement occurs in the first few weeks after surgery. Despite these changes, patients typically don’t face major limitations after surgery.
After their procedure, patients should start walking as soon as they can safely do so. Research shows this activity can speed up recovery.
In most cases, there are few restrictions following surgery. Patients can perform daily tasks like cooking and cleaning as soon as they feel ready. Patients who undergo simpler procedures like a lobectomy can often carry out these tasks the day they leave the hospital. If the patient had a more complex surgery, such as a sleeve lobectomy or pneumonectomy, a few days of recovery is often needed first.
People who work a desk job can return to work as soon as they feel able. After simple surgeries this usually happens a few weeks following the procedure, though some people return to work just a few days later. If the patient had a more complicated surgery, it often takes a month before they can return to work.
Returning to a job that requires physical labor takes more time. For simple procedures, the return to work is usually a few weeks after the surgery. More complex surgeries often take two to three months of recovery time before patients can start working again. These patients should start with light-duty jobs when they return.
Surgery for lung metastases
Lung cancer can often spread from the original tumor to multiple spots within the lung. Surgery may be a treatment option in these cases.
The patient’s case should be carefully reviewed by a team of doctors to determine if they are a good candidate for surgery. This decision is based on many factors, including the patient’s overall health, the condition of their lungs and the locations of the growths inside the lungs.
These patients usually undergo a wedge resection, segmentectomy or lobectomy. These operations can be challenging, so they are more likely to be done as open surgery.
Radiation Therapy
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors use these to accurately target a tumor while limiting damage to healthy tissue.
Radiation therapy can be part of a plan to cure lung cancer. It can also be used to manage advanced disease and help relieve symptoms.
Learn more about radiation therapy.
Intensity modulated radiation therapy
Intensity modulated radiation therapy (IMRT) focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose. Volumetric modulated arc therapy (VMAT) is a type of IMRT that utilizes a rotating treatment machine to deliver radiation at multiple angles.
IMRT is the most common type of radiation used to treat lung cancer. It can be part of a plan to cure the cancer in combination with other treatments. It is also used to control the growth of advanced cancers and help relieve symptoms.
IMRT patients with lung cancer typically get three to six weeks of treatment every Monday through Friday. Each session usually lasts less than 30 minutes.
Proton therapy
Proton therapy is similar to standard radiation treatments like IMRT, but it uses a different type of energy that may allow doctors to target tumors more accurately. This limits damage to nearby healthy tissue and allows for the delivery of a more powerful dose of radiation.
For lung cancer, proton therapy is typically part of a treatment plan to cure the disease.
Patients typically get three to six weeks of proton therapy. Sessions are held every Monday through Friday. Each treatment lasts around 30 minutes.
Learn more about proton therapy.
Stereotactic body radiation therapy
Stereotactic body radiation therapy (SBRT) uses dozens of tiny radiation beams delivered at different angles to accurately target tumors with a high dose of radiation.
This treatment can be used to cure the cancer or to help control symptoms in patients with advanced disease.
Patients typically get one to five sessions, all in consecutive days. In most cases, each session takes under 45 minutes.
Read more about SBRT.
3D conformal radiation therapy
3D conformal radiation therapy uses three-dimensional scans to determine the exact shape and size of the tumor. The radiation beams are shaped by tiny metal leaves that are arranged to fit the tumor dimensions. It is typically used on its own, to help manage symptoms in patients with advanced disease.
Patients usually get this treatment daily, Monday through Friday, for up to 10 days. Each session typically lasts less than 20 minutes.
Because the treatment is designed to relieve symptoms, it has minimal side effects.
Radiation therapy side effects
Radiation therapy side effects often depend on the location of the tumor and the exact treatment the patient receives.
Short term side effects include:
- Fatigue
- Cough
- Shortness of breath
- Irritation or inflammation of lung tissue
Long term radiation therapy side effects:
- Scarring of lung tissue
- A narrowing of the esophagus, which can cause swallowing problems
- Heart damage
- Pain in the chest wall
- Rib fractures
Doctors design radiation treatment plans to prevent or limit these problems and will recommend radiation only when it is the best treatment for the patient.
Patients should talk to their care team about any side effects they experience. These side effects can often be prevented or minimized with treatment.
Targeted therapy for lung cancer
Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them.
Targeted therapy can be used with surgery or radiation therapy as part of a treatment plan to cure lung cancer.
Learn more about targeted therapy.
Getting targeted therapy
Lung cancer targeted therapy drugs can be taken as pills or given as injections or IV infusions. The frequency of treatments depends on the patient’s specific needs.
Targeted therapy side effects
Side effects depend on the exact drug the patient is prescribed. Short-term side effects include:
- Dry skin and rash
- Changes to the fingernails and toenails
- Fatigue
- Diarrhea
- Liver inflammation
Long-term side effects include:
- Inflammation or infection of the skin around the nails
- Lung inflammation
- Cardiomyopathy. This is a rare side effect
In most cases, these side effects can be easily managed. Patients should talk to their care teams about any side effects they experience.
Read more about targeted therapy side effects.
Immune checkpoint inhibitors for lung cancer
Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off before cancer is completely eliminated. Patients may receive a single immunotherapy drug or multiple drugs in combination.
Immune checkpoint inhibitors can be used to help control the cancer. For patients whose cancer has metastasized, it can help manage symptoms and, in some patients, lead to remission.
Learn more about imune checkpoint inhibitors.
Getting immune checkpoint inhibitors
Immune checkpoint inhibitors are given by IV. Sessions usually last less than an hour.
Patients getting immune checkpoint inhibitors before surgery usually get three to four infusions, often with chemotherapy.
Patients treated after surgery typically get one infusion every three to four weeks for about a year.
If the cancer has spread to distant parts of the body patients generally get treatment for about two years.
Immune checkpoint inhibitor side effects
Short-term side effects for lung cancer immune checkpoint inhibitors include fatigue. Long-term side effects can include adverse reactions of the immune system, such as hypothroidism.
Patients should talk to their care teams about any serious side effects they may encounter and any side effects they are experiencing.
Read about immune checkpoint inhibotor side effects.
Chemotherapy for lung cancer
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
In many cases, chemotherapy is part of a treatment plan to cure the cancer. For patients with metastatic disease, the treatment can help relieve symptoms and may lead to remission.
Learn more about chemotherapy.
Getting chemotherapy
Chemotherapy is usually delivered by IV. The number of treatments varies depending on the patient’s specific condition.
Chemotherapy side effects
Short-term side effects include:
- Nausea and vomiting
- Fatigue
- Low blood counts
- Mouth sores
Long-term side effects of chemotherapy include:
- Neuropathy, which causes pain, tingling or numbness in different parts of the body
- Damage to ear tissue, which can cause hearing and balance problems
- Kidney damage
These side effects can typically be managed with medications and other interventions. Patients should talk to their care team about any side effects they experience.
Learn about the side efffects of chemotherapy.
Featured Podcast:
How to talk to your children about vaping
Jennifer Cofer, Dr.P.H., executive director of EndTobacco?, and Mark Moreno, senior vice president for Governmental Relations and Health Policy at UT MD Anderson, share tips for talking to children and teens about these dangers.
UT MD Anderson lung cancer patients can get treatment at the following locations.
Featured Podcasts:
Lung cancer in young adults: A survivor’s story
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Ommaya reservoir and its role in cancer care
An Ommaya reservoir is a plastic, dome-shaped device inserted underneath the skin on your scalp. The dome is connected to a catheter placed in the ventricle of your brain where the cerebrospinal fluid (CSF) circulates.
Doctors often use Ommaya reservoirs in patients with leptomeningeal disease (LMD), specifically solid tumor LMDs, such as breast cancer, lung cancer and melanoma.
To learn about Ommaya reservoirs and how they’re used in cancer treatment, we tapped the experts: neuro-oncologist , and neurosurgeon
What is the purpose of an Ommaya reservoir?
Doctors can use an Ommaya reservoir to inject medicine into the fluid around your brain and spinal cord or aspirate the fluid for testing.
LMD occurs when cancer cells from primary tumors enter the CSF or leptomeninges, the inner lining of the brain and spinal cord. Cancer patients who develop LMD may receive intrathecal chemotherapy as part of their treatment.
“An Ommaya can be placed to allow the delivery of chemotherapy directly to the cerebrospinal space. Doing so allows us to bypass the blood-brain barrier,” says O’Brien. “It can be a more effective, direct way of delivering chemo to some patients with LMD.”
How is an Ommaya reservoir placed?
An Ommaya reservoir is placed by a neurosurgeon while you’re under general anesthesia.
“After the patient is asleep, we can use a stereotactic navigation system to select the location to guide the catheter into the patient’s ventricle,” says Weinberg.
The surgeon makes a large, C-shaped incision in the scalp and drills a small hole in the skull.
“We intentionally make the incision big because we cut all the nerves that bring pain to the flap overlying the dome,” explains Weinberg.
This means the patient will feel no pain any time chemotherapy is injected into the dome.
“We make a small nick in the brain tissue and then use the navigation system to guide the catheter through the hole we drilled and into the ventricle,” explains Weinberg. “Once it’s in the ventricle, we test to make sure we’re getting CSF flowing freely from the catheter.”
The Ommaya reservoir is secured with sutures to ensure it stays in place. The procedure typically takes 20 to 40 minutes.
Doctors will take a CT scan after the procedure to make sure the tip of the catheter is in the correct location and there’s no bleeding. Patients stay in the hospital overnight. If there are no issues, you can go home the following morning.???
How do you care for an Ommaya reservoir after placement?
The most important thing is to make sure the wound heals properly.
“We don’t want the wound to get infected, so you must allow it to heal. That can take anywhere from 10 to 14 days,” says Weinberg. “Even then, the wound is still delicate, so make sure not to scratch or pick at it. You can exercise, but swimming is not recommended. It’s best to avoid contact sports for about a month following surgery.”
Check with your doctor to see when you can resume normal activities.
Are there any risks associated with an Ommaya reservoir?
Risks can include:
Wrong location
If the Ommaya reservoir is placed or ends up in the wrong location, you must see a neurosurgeon to get it repositioned.
Bleeding
If there’s a small amount of blood visible on a scan, your doctors may monitor for additional bleeding and do another CT scan. If bleeding is significant, you’ll need surgery to have the blood clot removed. This is extremely rare.
Infection
If the wound gets infected, you will need surgery to have the Ommaya reservoir removed.
How is an Ommaya reservoir used in leptomeningeal disease treatment?
MD Anderson’s Brain and Spine Center offers an Ommaya clinic for patients on Mondays and Thursdays. LMD patients with Ommaya reservoirs usually begin receiving chemotherapy twice a week.
When a patient visits the clinic, a neuro-oncology advanced practice provider (APP) cleans and sterilizes the area on the head. Then the provider inserts a needle into the reservoir and removes a small amount of fluid. This is known as an Ommaya reservoir tap.?
“The fluid is sent to the lab for testing, and some of the fluid is earmarked for research if the patient has consented to a research study,” says O’Brien. “After the fluid is withdrawn, the provider injects chemo into the Ommaya reservoir.”
CSF cytology identifies cancerous cells in the fluid and helps doctors assess how well patients are responding to treatment. Research testing helps doctors learn more about the underlying biology of LMD, in part by assessing the molecular profile of the tumor.
Some patients may experience headaches, neck pain or nausea after the procedure. Doctors work with patients to manage these symptoms by adjusting the amount of fluid taken or prescribing steroids to reduce inflammation that may occur from injecting chemo.
“Patients typically follow up with their neuro-oncologist every four weeks while on treatment, and we reassess with imaging of the brain and spine every eight weeks to make sure the treatment is effective,” says O’Brien. “At eight weeks, if the treatment is working and all parameters look good, we consider decreasing the frequency of the Ommaya reservoir taps. It may go from twice a week to once a week or from once a week to every other week.”????
Is an Ommaya reservoir the same as a shunt?
No. A shunt is commonly used in patients who have a blockage in their CSF pathway, causing fluid to accumulate in the brain.
“We will surgically place a shunt in the brain to help drain excess cerebrospinal fluid from the brain and transport it to another part of the body, where it gets reabsorbed back into the bloodstream,” says Weinberg. “The Ommaya reservoir – while we can attach a shunt to it, if necessary – is specifically placed to be used only when needed. There’s no continuous draining of fluid.”
How do you determine who is a good candidate for an Ommaya reservoir?
An LMD patient may have an Ommaya reservoir placed if doctors determine intrathecal chemotherapy is the best way to treat the disease. But it isn’t right for everyone.
“For instance, intrathecal chemotherapy only penetrates a few millimeters, so this therapy is not expected to help patients who have bulky or nodular LMD,” says O’Brien.
She carefully reviews the imaging to determine if the type of LMD the patient has can be appropriately treated by intrathecal chemo.
“If a patient functions well, doesn’t have any significant neurologic symptoms and has options to treat any active cancer outside of their leptomeninges, then they may be a good candidate for intrathecal chemotherapy via an Ommaya reservoir,” she says.
The goal of intrathecal chemo is to keep LMD under control, not manage symptoms. It’s important to have honest, realistic conversations with your doctors about your goals. Some patients want doctors to do whatever’s possible to help them make it to a special milestone in their lives. Other patients place more importance on quality of life and do not want to travel back and forth to a clinic twice a week to receive chemo.
“LMD can be tough to treat, so we must consider our options carefully,” says O’Brien. “A nice thing about intrathecal chemotherapy is it only treats the leptomeningeal compartment, so patients can often continue receiving systemic therapy without concerns of their treatments interfering with one another.”
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What is a lobectomy?
A lobectomy is the surgical removal of one of the five lobes — or main sections — of the lungs. It is the most common type of operation used to treat lung cancer, and it may be performed on patients with various stages of the disease.
But is a lobectomy considered major surgery? How long does it take to fully recover? And will you feel short of breath after having one?
Read on for the answers to these questions and more.
What is a lung lobe?
Think of your airway as an upside-down tree. The trachea, or windpipe, is the trunk. The first two branches leading off of it go to the left and right lungs. Branches further down lead to the upper, middle, and lower lobes on the right, and the upper and lower lobes on the left.
We have five lung lobes in all: two on the left side and three on the right. These lobes can be further subdivided into 19 smaller units called “segments.” A segmentectomy is the surgical removal of a segment rather than an entire lobe.??
How long does it take to fully recover from a lobectomy?
That varies widely. It depends on many factors, including:
- Which surgical approach is being used
- Your overall health status
- How well the rest of your lung lobes are functioning
On average, you can expect to spend two to three nights in the hospital afterward and have several chest X-rays taken to monitor your progress.
A chest tube will be inserted at the time of the operation. It will be left in place to allow the lung to re-expand and drain any air or fluid that accumulates. The tube is usually removed within a day or two of surgery when the volume of fluid draining is minimal and there is no longer any air bubbling from it.
In some circumstances, you may be ready to leave the hospital before that happens. In those situations, you’d likely return to the clinic within a few days to have the tube taken out.
What will my life be like after a lobectomy? Will I always feel short of breath??
No. A lobectomy would not be performed if it would leave you unable to breathe adequately or feeling permanently short of breath.
That being said, you might feel slightly short of breath for the first few weeks after a lobectomy while your body adjusts to its new anatomy. You may also experience some discomfort when taking deep breaths, but that should improve over time.
You will be assessed for your lung function before a decision is made to perform lung surgery. We calculate your eligibility based on pre-operative lung function and what percentage of lung tissue would be removed.
Is a lobectomy considered major surgery?
Yes. Any lung surgery is considered major surgery.?
Is a lobectomy considered a high-risk procedure??
No. We might describe certain tumors or patients as high-risk?based on their anatomy or overall health status. But it’s a very common operation. Even in complex situations, risks can be reduced by going to an experienced center of excellence like MD Anderson, where thoracic surgeons do it every day.??
What are the risks of a lobectomy??
The greatest risks associated with lung surgery are:
- Prolonged air leaks: when the lung continues to leak air for more than a few days after surgery, requiring ongoing management with a chest tube
- Pneumonia: an infection of the lungs, which can be treated with antibiotics
- Atrial fibrillation (A-fib): an abnormal heart rhythm seen in roughly 8-10% of lobectomy patients, which is treated with medications
Fortunately, most of these conditions are temporary. Air leaks, in particular, are usually self-limiting. Pneumonia can often be prevented, too, with deliberate coughing, deep breathing, and a lot of walking after surgery.
What’s the difference between a pneumonectomy and a lobectomy??
A pneumonectomy is the removal of an entire lung. A lobectomy is the removal of just part of it (a single lobe).
What’s the most important thing to know about lobectomies?
Lobectomies are the most commonly performed operation on the chest. So, it’s important to have yours done well. That’s why you should go to a place like MD Anderson, where surgeons perform these procedures all the time.?
, is a thoracic surgeon who specializes in the treatment of lung cancer.
or call 1-877-632-6789.