Lung Cancer Research0

Researchers continue to look at new ways to combine, schedule, and sequence the use of chemotherapy, surgery, and radiation to treat lung cancer. For instance, in one large study, patients with non-small cell lung cancer that had spread to nearby tissues or lymph nodes took radiation and chemotherapy at the same time instead of sequentially. Their five-year survival rates rose from about 6 percent to 16 percent. Another study compared treatments given to two groups of people with small cell lung cancer. One group had chemotherapy plus two daily radiation treatments. The other had chemotherapy with only one daily radiation treatment. Researchers found that the group receiving two daily radiation treatments with their chemotherapy had better survival rates.

Newer chemotherapy drugs, known by brand names such as Navelbine®, Taxol®, Taxotere®, Gemzar®, Hycamtin®, and Camptosar® have produced improved response rates in tests of each drug alone. Various combinations of the new drugs with traditional agents, such as cisplatin and carboplatin, are now either in clinical trials or have reported early results of the trials. Other researchers are working to develop drugs called "molecularly targeted agents" which kill cancer cells by targeting key molecules involved in cancer cell growth. One of these drugs, called Avastin™, helped patients live a few months longer when it was combined with traditional chemotherapy.

New ways to schedule and deliver radiation therapy are under study, too. In conformal radiotherapy, doctors try to assess the tumor in 3 dimensions and focus the beam of radiation directly on the area of the tumor.

With brachytherapy doctors can deliver radiation directly to the tumor using radioactive pellets that are inserted into the site of the tumor.

These two techniques -- conformal radiotherapy and brachytherapy -- have the advantage of reducing damage to surrounding tissue.

Researchers are constantly trying to come up with new ways to find and diagnose lung cancer in order to catch it and treat it in its earliest stages. The chest x-ray is one of the most common tools used to test for lung cancer.

However, less than a third of lung cancer cases detected by chest x-ray are found early enough to be cured. A report from the National Cancer Institute's Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial found that chest x-rays can detect early lung cancer, but also can produce many false-positive results. That means that the tests will show that someone may have cancer, when they actually do not. Follow-up tests are needed to see if someone really has cancer.

One screening method that shows promise is spiral computerized tomography, known as spiral CT. Spiral CT can scan the lungs from the neck to the diaphragm in less than 20 seconds, or a single breath-hold. Preliminary studies show that it may help doctors find small tumors, but questions remain about the technology's risk and benefits as a screening tool.

Lung cancer prevention is another area that researchers are looking into. One possible treatment they are studying is chemoprevention -- the use of natural or man-made drugs to reverse, suppress, or prevent cancer growth.

Chemoprevention is an area of active clinical research, which is research involving direct observation of patients.

There are also clinical trials under way to find out how well some substances can work to prevent an additional, secondary form of cancer in patients who have had early-stage lung cancer.

An aerosol spray to deliver drugs directly to the lungs and a vaccine for nicotine addiction are among the treatments researchers are studying. Common use of these treatments may be years away, however.

Some other agents which researchers hoped might prevent lung cancer included 13-cis retinoic acid or CRA or isotretinoin, and retinyl palmitate. Both are derived from vitamin A, but both have been found to be ineffective.

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Lung Cancer Treatments0

If tests show that you have cancer, you should talk with your doctor and make treatment decisions as soon as possible. Studies show that early treatment leads to better outcomes.

A team of specialists often treats people with cancer. The team will keep the primary doctor informed about the patient's progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, a thoracic surgeon who is a specialist in operating on organs in the chest, including the lungs, and others.

Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it.

Some lung cancer patients take part in studies of new treatments. These studies, called clinical trials, are designed to find out whether a new treatment is safe and effective.

Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. People with lung cancer who are interested in taking part in a clinical trial should talk with their doctor.

Once lung cancer has been found, it is usually staged. Staging means determining how far the cancer has progressed.

Through staging, the doctor can tell if the cancer has spread and, if so, to what parts of the body. Lung cancer often spreads to the brain or bones. Knowing the stage of the disease helps the doctor plan treatment.

There are many types of lung cancer, but the two main types are "small cell" and "non-small cell." Small cell lung cancer is generally faster growing than non-small cell, but small cell is more likely to respond to chemotherapy.

Small cell lung cancer is divided into two stages. Limited stage is generally cancer confined to the chest and extensive stage is cancer that has spread outside the chest.

Non-small cell lung cancer is divided into four stages, I-IV. Most patients with stage I and II non-small cell tumors and some patients with stage III tumors can undergo surgery with the goal of cure.

Stage IV denotes cancer that has spread to other sites in the body, most often bone, brain, or liver. Most stage IV cancers cannot be cured, although treatment may be available to help prolong life.

Here are the tests doctors use to stage lung cancer:

• Computed axial tomography, also called CAT Scan or CT scan, is a computer linked to an x-ray machine that creates a series of detailed pictures of areas inside the body.
• Magnetic resonance imaging, or MRI, is a powerful magnet linked to a computer that makes detailed pictures of areas inside the body.
• Radionuclide scanning uses a mildly radioactive substance to show whether cancer has spread to other organs, such as the liver.
• A bone scan uses a small amount of a radioactive substance to show whether cancer has spread to the bones.
• A mediastinoscopy or mediastinotomy can help show whether the cancer has spread to the lymph nodes in the chest by removing a tissue sample. The patient receives a general anesthetic for this procedure.

The choice of treatment depends on the type of lung cancer, whether it is non-small or small cell lung cancer, the size, location, the stage of the cancer, and the patient's general health.

Doctors may suggest many different treatments or combinations of treatments to control the cancer and/or improve the patient's quality of life.

Here are the standard treatments for lung cancer:

• Surgery is an operation to remove the cancer. Depending on the location of the tumor, the surgeon may remove a small part of the lung, a lobe of the lung, or the entire lung and possibly even part of the ribcage to get to the lung.
• Chemotherapy uses anti-cancer drugs to kill cancer cells throughout the body. Doctors use chemotherapy to control cancer growth and relieve symptoms. Anti-cancer drugs are given by injection; through a catheter, a long thin tube temporarily placed in a large vein; or in pill form.
• Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. An external machine delivers radiation to a limited area, affecting cancer cells only in that area. Doctors may use radiation before surgery to shrink a tumor or after surgery to destroy any cancer cells remaining in the treated area.
• Photodynamic therapy, a newer technique, is laser therapy that is used in combination with a chemical to kill cancer cells. Doctors may use it to reduce symptoms of lung cancer, such as bleeding, or to treat very small tumors.

Doctors treat patients with non-small cell lung cancer in several ways, and surgery is a common treatment. Cryosurgery, a treatment that freezes and destroys cancer tissue, may be used to control symptoms in the later stages of non-small cell lung cancer. Doctors may also use radiation therapy and chemotherapy to slow the progress of the disease and to manage symptoms.

Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy.

Treatment for small cell lung cancer may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body, such as in the brain. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer.

Some patients with small cell lung cancer have radiation therapy to the brain even though no cancer is found there. This treatment, called prophylactic cranial irradiation or PCI, is given to prevent tumors from forming in the brain.

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