Treatment for lung cancer is decided by a multidisciplinary board that includes specialists in thoracic surgery, pulmonology, medical oncology, radiation oncology, pathology, radiology, and nuclear medicine, following international treatment guidelines. The type and stage of lung cancer, along with the patient’s overall health condition, are considered. Depending on these factors, some patients may undergo surgery, chemotherapy, targeted therapies known as smart drugs, immunotherapy, or radiation therapy, either alone or in combination.
Surgical Methods in Lung Cancer
Surgery for lung cancer is performed in stages 1, 2, and certain cases of stage 3. Surgery can be conducted via open or minimally invasive techniques.
Open surgery involves a large incision on the side of the chest to open the space between the ribs. Open surgery is only performed when minimally invasive surgery is not possible.
Surgery is considered the most effective treatment for lung cancer as it allows for the complete removal of cancerous lung tissue.
In the more commonly preferred minimally invasive method, the operation is performed using surgical cameras that project images onto a screen. Single Port VATS is a minimally invasive technique that causes less harm to the patient and is therefore frequently chosen. This method involves a single 5–7 cm incision, and patients are typically discharged after an average hospital stay of 4 nights. Depending on the size and location of the tumor, a portion of the lung and lymph nodes are removed during the operation. For more detailed information about lung cancer surgeries, visit this page.
Single Port VATS in Lung Cancer
This minimally invasive method, which causes minimal harm to the patient, is widely used worldwide. Some key benefits include:
- Performed through a single, small incision
- Shorter operation time
- Less postoperative pain
- Minimal surgical scarring
- Quicker recovery time and return to normal life
- Low complication rates due to experienced surgeons
- Minimal need for intensive care post-surgery
You can watch the entire treatment process of a lung cancer patient we operated on in the following video:
Chemotherapy in Lung Cancer Treatment
Chemotherapy involves the use of drugs that prevent the rapid multiplication of cells. Since lung cancer cells multiply quickly, chemotherapy is effective against them. However, because chemotherapy can also harm other rapidly dividing tissues such as hair follicles, the stomach lining, skin, and nerves, it cannot be administered indefinitely.
Medical oncologists determine the appropriate drugs based on the tumor type. Chemotherapy drugs are administered intravenously. Prior to treatment, detailed examinations and blood tests are conducted to minimize potential adverse effects. Medications are typically given every three weeks, but adjustments may be made based on the patient’s condition and laboratory results.
Chemotherapy is particularly effective for small cell lung cancers due to their rapid growth. In contrast, targeted therapies and immunotherapy are often more effective for non-small cell lung cancers.
Targeted Therapies (Smart Drugs) in Lung Cancer
Targeted therapies are often referred to as “smart drugs” because, unlike chemotherapy, they target cancer cells specifically without affecting all rapidly dividing cells in the body. However, not all lung cancers are suitable for targeted therapies. These drugs are only effective if the cancer cells have specific structures that can be targeted by the medication. Genetic analysis (e.g., EGFR, ALK, KRAS, ROS-1) of biopsy samples is conducted to determine if the cancer cells possess the necessary receptors.
These medications are taken orally in tablet form, rather than intravenously like chemotherapy. The duration of treatment is determined by the oncology specialist based on the patient’s condition and the cancer stage.
Immunotherapy in Lung Cancer Treatment
In recent years, significant advancements have been made in the field of immunotherapy for lung cancer treatment. The suitability of immunotherapy depends on the cancer cell type and the presence of receptors such as PD-1 or PD-L1. Like chemotherapy, immunotherapy is administered intravenously in a hospital setting.
Radiation Therapy (Radiotherapy)
Radiation therapy involves treating cancer with externally delivered specialized radiation. Advances in radiotherapy now allow for precise targeting of the cancer, minimizing damage to healthy lung tissue. Modern techniques such as SBRT (Cyberknife) have shown highly successful results.
Treatment Methods Based on Lung Cancer Stages
Treatment for lung cancer is determined based on its stage. Numerous scientific studies have identified the most effective treatments for each stage. Based on these studies, medical associations regularly update and publish treatment guidelines for doctors. The following information is prepared according to the 2023 National Comprehensive Cancer Network (NCCN) guidelines for lung cancer treatment. For the NCCN’s patient resource in English, click here.
Below, the treatments for non-small cell and small cell lung cancers are explained separately. Non-small cell lung cancer treatments are detailed for each stage, while general treatment principles for small cell lung cancers are summarized.
Non-Small Cell Lung Cancer Treatment
Stage 1 Lung Cancer
Stage 1 lung cancer is defined as cancer smaller than 4 cm that has not spread to lymph nodes or other organs. The sole treatment for this stage is surgery.
The preferred method for stage 1 treatment is minimally invasive surgery. Chemotherapy or radiotherapy is not required after surgery. For patients who are not suitable for surgery, SBRT (a specialized form of radiation therapy) can be applied.
Single Port VATS Surgery for Stage 1 Lung Cancer – Click to watch
Stage 2 Lung Cancer
Stage 2 lung cancer is defined as cancer larger than 4 cm but smaller than 7 cm or cancer that has spread to lymph nodes within the lung.
Treatment involves surgical removal of the cancerous lung tissue, preferably using minimally invasive techniques.
For patients unsuitable for surgery, radiation therapy can be applied if there is no lymph node involvement.
Post-surgery, patients should receive 4 cycles of adjuvant chemotherapy. Additionally, if test results are favorable, targeted therapies or immunotherapy may be used as adjunctive treatments.
Stage 3 Lung Cancer
Stage 3 lung cancer involves tumors larger than 7 cm, tumors affecting the ribs, pleura, diaphragm, or esophagus, or cancer that has spread to lymph nodes outside the lung.
Treatment options include chemotherapy, targeted therapies, immunotherapy, chemoradiotherapy, and surgery. In stage 3, these methods may be used individually or in combination.
In some cases, chemoradiotherapy is used to shrink the tumor and affected lymph nodes, followed by surgical removal. The full treatment process for a stage 3 lung cancer patient can be seen in the video below:
Stage 3 Lung Cancer Treatment
Stage 4 Lung Cancer
Stage 4 lung cancer refers to cancer that has metastasized (spread) to other organs. Treatment includes chemotherapy, and if genetic test results are favorable, targeted therapies and immunotherapy. Radiation therapy may be used to alleviate symptoms such as pain in metastasis sites.
Surgery is rarely performed and is only considered in highly selected patients after evaluation by a medical oncology specialist.
Small Cell Lung Cancer Treatment
Small cell lung cancer is often diagnosed at advanced stages, where surgery is not performed. Surgery is only an option for patients diagnosed at an extremely early stage.
Today, the primary treatment for small cell lung cancer is chemoradiotherapy, a combination of chemotherapy and radiation therapy. Additionally, immunotherapy is being increasingly used for certain small cell lung cancer patients due to recent medical advancements.
There is a significant risk of brain metastasis in small cell lung cancers. Therefore, brain MRIs are conducted, and if metastases are detected, treatments such as GammaKnife are employed. In some cases, surgery for brain metastasis may also be necessary.
Because small cell lung cancers grow rapidly, they respond quickly to treatment. In many cases, the cancer in the lung is completely eradicated. After achieving this, medical oncology specialists closely monitor the patient to prevent recurrence.
