Lung Cancer Treatment

Lung Cancer: Types & Stages

At Mat-Su Valley Cancer Center, our cancer radiation oncologists strive to make sure you understand both your diagnosis and the many different treatment options available to you. Based on your type of cancer, along with other factors such as the stage of your cancer, your age, overall health, and personal preferences, our board-certified radiation oncologists in Anchorage will consult with the other members of your medical team to develop the best treatment plan for you.

Types of Lung Cancer

Each type of lung cancer is treated differently, so it is very important to determine which type you have before evaluating treatment options. Your radiation oncologist will assess your lung cancer type i two ways: looking at the cells under a microscope, and discovering your molecular profile or the types of biomarkers found in the tissue. There are three broad categories of lung cancer that are described by the types of cells that the radiation oncologist sees under the microscope.

• Non-Small Cell Lung Cancer (NSCLC) – By far the most common type of lung cancer, about 85% of diagnosed lung cancer is attributed to this type. NSCLC usually grows and spreads at a slower rate than other types of cancer. Some tumors are made up of cells from more than one type of NSCLC, but the most commonly diagnosed types of NSCLC are:
  • Adenocarcinoma – Lung adenocarcinoma accounts for about 40% of all lung cancers. This type of cancer has gland-like properties and begins in early versions of the cells that make up the lining of the lungs. Glandular cells are found in the lungs and some other internal organs. Most cancers of the breast, pancreas, prostate, and colon are also adenocarcinomas. Only adenocarcinoma that begins in the lungs is considered lung cancer. It is the most common form of cancer for both men and women in the U.S. It occurs most often in smokers or former smokers, but it is also the most common type of cancer in nonsmokers and younger people. One type of adenocarcinoma, called adenocarcinoma in situ, is more treatable than the others.
  • Squamous Cell Carcinoma – These abnormal cells can usually be found near a main airway toward the central part of the lungs. Squamous cell lung cancer accounts for about 30% of all lung cancers. There are numerous treatment options available to people diagnosed with squamous cell lung cancer, and radiation oncologists are working hard to develop and improve these treatments.
  • Large Cell Carcinoma – This is a faster-growing form of NSCLC that can appear on any part of the lung and does not fit into the other categories. In the past, about 10% of all lung cancers were classified as large cell. However, as more exact ways of diagnosing lung cancer have come into use, this percentage is dropping. Many lung cancers that would have been considered large cell in the past are now being identified as adenocarcinoma or squamous cell lung cancer. Having this additional information is important for choosing treatment options. The majority of large cell lung cancers are found in men.
  • Large Cell Neuroendocrine Tumors – These fast-growing tumors make up only about 2% of lung cancer diagnoses.
• Small Cell Lung Cancer (SCLC) – These much faster growing and spreading cancer cells look flat and smaller than normal, healthy cells. Resembling tiny oats under a microscope, it is also called “oat cell” cancer. The cells in this neuroendocrine tumor are smaller in size than most other cancer cells. Small cell lung cancer (SCLC) accounts for about 15% of all lung cancers in the U.S. and is usually caused by smoking tobacco. Chemotherapy is often the best treatment for this type of cancer, but advanced radiation therapy treatments are providing favorable outcomes. In addition to existing treatment approaches, several promising new treatment approaches are being developed.
• Metastatic Lung Cancer – Any cancer which originated in the lungs, but the spreads through your blood or lymph nodes to other parts of your body is considered metastatic lung cancer. It is treated as lung cancer based on the type of lung cancer that it is. This can happen before or after treatment.This is different than recurrent cancer because it spreads to a different part of the body than was previously infected.

Non-Small Cell Lung Cancer (NSCLC) Stages

Radiation oncologists developed a rating system for cancer in order to help discuss and design treatment options and predict your prognosis. They use diagnostic tests to find out the cancer’s stage based on where the cancer is located, if or where it has spread and whether it’s affecting other parts of the body. One of the ways radiation oncologists decide on the stage is to find out if the cancer can be completely removed by a surgeon. Cancer stages are usually described in roman numerals.

You may also hear about the TNM classification, because the stages below have been developed based on a combination of:

• T:  The size of the primary tumor
• N:  Whether and how regional lymph nodes are affected by the cancer
• M:  Whether there is distant metastasis

Radiation oncologists assign levels for each of the above factors and then combine these levels into stages. The stages of lung cancer are:

• Stage 0 – This is a non-invasive cancer when the disease is very small, remains in place (in situ), and has not spread into deeper lung tissue or to other surrounding tissue.
• Stage I – A lung cancer that includes a small tumor that might have spread into the underlying lung tissue, but that has not spread to any lymph nodes in other parts of the body. The surgeon is able to remove the tumor.
• Stage Ia – The tumor is smaller than 3 cm. wide.
• Stage Ib – The tumor is between 3 cm. and 5 cm. wide.
• Stage II – There are two substages of Stage II cancer. A surgeon may or may not be able to remove the entire tumor.
• Stage IIa – In this stage, the tumor is between 5 cm. and 7 cm. wide and has not spread to nearby lymph nodes; OR the tumor is less than 5 cm. and HAS spread to nearby lymph nodes.
• Stage IIb – If the tumor is between 5 cm. and 7 cm. as in the earlier stage, but it HAS spread to nearby lymph nodes, it is considered Stage IIb. Or, if the tumor is larger than 7 cm. wide but has not spread, it falls into this stage. The tumor may also be partially blocking the airways.
• Stage III – Stage IIIa lung cancers and almost all of stage IIIb cancers include a tumor that is difficult, sometimes impossible, to remove. The lung cancer may have spread into the lymph nodes in the center of the chest, but outside the lung. Or, the tumor might have grown into nearby structures in the lung. It is less likely, in these cases, that the surgeon can completely remove the cancer because it has to be taken out piece by piece.
• Stage IV – Surgery is not usually successful for most Stage III or Stage IV lung cancers. If the cancerous cells have become Stage IV and have spread to lymph nodes above the collarbone or if the cancer has grown into the fluid surrounding the lung, or vital structures within the chest like the heart, large blood vessels, or primary airways, it can be impossible to remove. If the cancer spreads to the blood, it can easily travel to the brain, bones, liver, and adrenal glands.
• Stage IVa – Cancer has spread within the chest.
• Stage IVb – Cancer has spread outside the chest to other parts of the body.
• Recurrent – This stage of cancer is used when the cancer returns to the originally infected place after treatment. Once that happens, radiation oncologists run more tests to establish a current stage.

Stages of Small Cell Lung Cancer (SCLC)

• Limited stage: There are cancerous cells found on just one side of the chest, affecting only one part of the lung and nearby lymph nodes.
• Extensive stage: Cancer has spread to other areas of the chest or other parts of the body.
• Lung Cancer – About Lung Cancer
• Lung Cancer – Detection and Treatment Options
• Lung Cancer – FAQs

In addition to lung cancer screening and treatment, our oncologists also provide the following services:

• Bladder Cancer Treatment
• Brain Cancer Treatment
• Breast Cancer Treatment
• Colon Cancer Treatment
• Esophageal Cancer Treatment
• Gynecologic Cancer Treatment
• Head and Neck Cancer Treatment
• Kidney Cancer Treatment
• Liver Cancer Treatment
• Lymphoma Treatment
• Pancreatic Cancer Treatment
• Prostate Cancer Treatment
• Sarcoma Treatment
• Skin Cancer Treatment
• Stomach Cancer Treatment

How Will Your Lung Cancer Be Diagnosed?

Finding lung cancer early is key to saving lives. Unfortunately, only 16% of lung cancers are diagnosed before the tumor has grown large and the cancer has spread or metastasized, to other parts of the body. One of the reasons it is so difficult to diagnose early is that the early symptoms are similar to those of a common cold. It’s not until later stages of lung cancer do patients begin to show serious symptoms that people take notice of. Conventional chest X-Rays also often miss early-stage lung cancer and radiation oncologists now insist on a higher resolution CT scan for screenings of high-risk patients. However, many people who develop lung cancer do not fit the high-risk profile, like never-smokers, people under the age of 55, or people who quit smoking a long time ago.

When lung cancer is found earlier, there is a good chance for survival. The American Cancer Society recommends lung cancer screenings for those who are more at risk to help find and beat the disease. After a medical examination and collection of family history, if you meet ALL of the criteria below, you and your radiation oncologist should discuss the benefits and potential harms of an annual lung cancer screening:

• 55 to 74 years old
• In fairly good health (discussed further on)
• Have at least a 30 pack a year smoking history (see previous section)
• Are either still smoking or have quit smoking within the last 15 years

Imaging Screenings For Lung Cancer

If your physical exam and medical history suggest you may have lung cancer, your radiation oncologist may order diagnostic screenings to look for the abnormal cell growth. Lung cancer screenings should only be performed at facilities that have years of experience using LDCT scans for lung cancer screening. Once you obtain your scans, our team of experienced radiation oncologists are available to follow up with possible treatment options should the need arise.

Treatment Options For Lung Cancer

Lung cancer treatment is based on a number of factors including: the stage of cancer, size and location of the tumor, your age and physical health. Mat-Su Valley Cancer Center offers a multidisciplinary approach to your treatment and has the availability of many of the most advanced non-surgical and non-invasive treatment methods available, as well as targeted therapies.

Surgery

Surgery is a common method for treating lung cancer, but only when the patient is healthy enough for surgery and the tumor has caught early. Lung cancer surgery may be used in combination with chemotherapy and/or radiation therapy to ensure patients achieve best outcomes based on national guidelines. Your medical team will individualize treatment recommendations that best fit your individual situation.

Types of lung cancer surgery include:

• A lobectomy, in which sections of the lungs (or lobes) affected by cancer are removed
• A pneumonectomy where the entire lung is removed if tumors cannot be fully eliminated from a lobectomy
• A wedge resection, the removal of a small, wedge-shaped piece of lung tissue
• A sleeve resection, in which tumors are removed from the lung and airway.

Radiation Therapy

Radiation therapy is often used to treat lung cancer, sometimes in conjunction with chemotherapy and surgery. It uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy is used in an attempt to cure cancer, control cancer growth, or relieve symptoms caused by the tumor, such as pain.

External Radiation Treatment Options

• Stereotactic Body Radiation Therapy, or SBRT,  also called Stereotactic Ablative Radiotherapy, or SABR – SBRT/SABR is the delivery of highly focused beams of high dose radiation therapy to the primary lung cancer with minimal dose to surrounding healthy tissue. It typically involves 3-5 treatment sessions delivered 2-3 times per week. At Mat-Su Valley Cancer Center out state-of-the-art radiation therapy delivery system is capable of delivering treatment up to 400% faster than most treatment systems available. SBRT/SABR’s 3-5 treatment program replaces the need for 30-35 treatments typical of standard, conventional radiation therapy. Our advanced technology allows us to track even the slightest movement of the cancer with each breath. This <1 mm accuracy not only ensures the highest possible safe dose of radiation therapy is delivered to the cancer for best outcomes, but it also minimizes the dose of radiation therapy to surrounding healthy tissue.
• 3D Conformal – This type of radiotherapy uses 3D images to plan treatment and to deliver a dose of radiation therapy that projects at the best angles for your tumor, avoiding surrounding healthy structures. Higher doses of radiation therapy can be delivered to the cancer while much lower doses are received by the healthy tissue. 
• Intensity Modulated Radiation Therapy (IMRT) –  This versatile radiation therapy treatment is used to treat nearly every type of cancer. IMRT allows us to ‘paint’ radiation therapy doses onto the tumor with pinpoint precision. Using 3-D scans of your body, the system beams radiation therapy to the tumor from many different angles. At each angle, the dose or intensity of the radiation therapy can be different, and the shape of the beam can be adjusted, based on your treatment needs, the shape of the tumor, and surrounding structures. These adjustments enable the prescribed amount of radiation therapy to be delivered to each part of the tumor while minimizing exposure to the surrounding healthy tissue.
• Image-Guided Radiation Therapy (IGRT) – Mat-Su Valley Cancer Center houses the most advanced equipment, capable of  IGRT which can track and capture your tumor using high-resolution, three-dimensional images as it moves or adjusts with every breath. IGRT allows us to track even the slightest movement in the tumor.
• Volumetric Modulated Arc Therapy (VMAT) – VMAT is a more advanced form of IMRT that delivers treatments two to eight times faster than our other dynamic treatments and it increases precision. Unlike traditional IMRT that requires multiple rotations around the patient or makes repeated stops and starts to treat the tumor from different angles, this volumetric arc therapy delivers precise 3-D doses with a single 360° rotation of the machine, typically in less than two minutes. 

Internal Radiation Treatment

• Brachytherapy (Endobronchial therapy) – This pain-free, extremely precise radiation therapy destroys lung cancer using an intense source of radiation therapy delivered through temporarily-placed applicators implanted into the tumor site. It is delivered internally via a computer-controlled machine typically in two to ten convenient treatments. HDR minimizes the risk of common side effects due to its ability to focus the radiation therapy directly on the cancerous cells. This also reduces the danger of radiation exposure to nearby vital structures like the heart. The radiation therapy is delivered into the applicators through a wire or cable inserted into a catheter and then removed between treatments. 

Lung Cancer FAQs

At Mat-Su Valley Cancer Center, our staff wants to make sure all of your questions are answered and every concern is addressed. Our professional, caring staff make your knowledge and comfort our number one priority as we work with you and your radiation oncologists to battle your lung cancer. Our board-certified radiaton oncologists at Mat-Su Valley are experts in treating lung cancer with a variety of radiotherapy technologies that are proven effective. We are happy to discuss your treatment options and make sure you receive every possible chance for the best outcomes. Here are a few of the most often asked questions.