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Lung Cancer

Treatments

How Is Lung Cancer Treated?

Specialists from medical oncology, radiation oncology, thoracic and cardiothoracic surgery, pulmonology, radiology, and other medical disciplines combine their expertise to provide each patient with an integrated, individualized treatment plan, which may include surgery, radiation, chemotherapy, or a combination of these treatments. Patients may be offered the opportunity to participate in clinical trials if an investigational lung cancer therapy is appropriate.

The Center’s specialists apply a wide array of state-of-the-art techniques to cure patients by removing and killing cancerous tissue. Surgeons also use the most advanced techniques to relieve the symptoms of patients with advanced disease so they may improve their quality of life.

Surgery and Minimally Invasive Surgical Procedures

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For cancer patients, the type of resection will be based on the tumor location, size, and type, as well as the patient’s overall health prior to diagnosis.

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How to Prepare for a Lung Resection

Lung resection is typically performed under general anesthesia, so the patient is asleep during the procedure. It is important to follow any physician instructions to prepare for surgery. These instructions generally include:

  • Avoid eating or drinking anything after midnight the night before.
  • Bring all of medications to the hospital.
  • Arrive one hour prior to the surgery time.

There may be a pre-admission appointment one to two weeks beforehand, for routine blood testing and consultation with the anesthesiologist.

If possible, patients should engage in some mild physical activity such as walking, and eat a balanced diet leading up to the scheduled surgery; this includes limiting alcohol consumption to 1-2 glasses per day. They should inform the medical team of the following in the week before surgery:

  • All the medications that they take, both prescription and over-the-counter, including herbs, supplements, aspirin, and corticosteroids
  • If they have asthma or emphysema

Smoking cessation must occur two to three weeks prior in order for surgery to be effective. Some operations will not be performed if the patient is still smoking.

What to Expect During a Lung Resection

On the day before surgery, the patient will receive a call from the Center, with information about the following day, including where to go and when to arrive. On arrival, they will be taken to a pre-surgery area to measure their temperature, blood pressure, pulse, and listen to their heart and lungs. They may have their blood tested, an x-ray, or be attached to a heart monitor in the surgery room. An intravenous (IV) line will be placed in their arm, so that medications may be administered before, during, and after the procedure.

Surgery may take several hours. Family members may wait in the Family Waiting Room.

Recovery after a Lung Resection

Patients are taken after surgery to the Post Anesthesia Unit and monitored for any changes in blood pressure, heart rate, and breathing. The IV line will remain inserted, to keep the patient hydrated and to administer pain medication, if necessary. Patients may also require the use of a ventilator to ensure air exchange and to prevent pneumonia for a period after surgery.

In most cases, if oxygen is required when the patient goes home, it is only for a few weeks. Before discharge, the patient’s nurse will instruct how to use any equipment they might need, how to care for the incision, and review any medications. Over a few weeks, patients regain strength and are able to return to work and participate in physical activity. Patients should take their medicine exactly as prescribed, and call their doctor if they have any questions or notice any of the following:

  • Bleeding
  • Infection
  • High temperature
  • Coughing up yellow, green, or bloody mucus
  • Allergic reaction, such as redness, swelling, trouble breathing
  • Pain

Photodynamic Therapy for Lung Cancer

Photodynamic therapy (PDT), also called photoradiation therapy, phototherapy, and photochemotherapy, has existed for about 100 years and is a type of cancer treatment that uses light to kill abnormal cells. A special drug called a photosensitizer, or photosensitizing agent, is circulated through the bloodstream.

After the agent has been absorbed by the cancer, usually over a period of a few hours to a few days, the tumor is exposed to a special kind of light which together with the agent destroys cancer cells. PDT is thought to potentially also destroy tumor-feeding blood vessels and stimulate the immune system to attack the cancer cells.

PDT is currently approved by the Food and Drug Administration to treat or relieve the symptoms of esophageal cancer and the most common form of lung cancer, called non-small cell lung cancer. A handful of photosensitizers are approved; the best one for each patient depends on their specific diagnosis.

PDT is a promising treatment for certain types of tumors because in some cases, it can cure cancer. It is also:

  • Less invasive and quicker than surgery and other procedures
  • Leaves little to no scarring and has no long-term side effects
  • Can be targeted very precisely to cancerous cells
  • Can be repeated many times at the same site

Treatment can make the eyes and skin especially sensitive to light for about six weeks. During this time, patients should avoid direct sunlight and bright indoor light. Because the basis of phototherapy is light, its treatment is limited to areas on or just below the skin. Newer, more sophisticated photosensitizing methods are in development.

Side effects are rare, but may include:

  • Burning, swelling, or pain on or below the skin's surface
  • Coughing
  • Trouble swallowing
  • Painful breathing
  • Shortness of breath

How to Prepare for PDT

It is important to follow any physician instructions to prepare for surgery.

What to Expect During PDT

Each session of PDT is relatively simple. Patients receive either a photosensitizer drug and wait until it has concentrated in the tumor, or they may have the drug administered and return days later for phototreatment. Phototreatment takes place on an exam table, and the patient receives local or general medicines for pain control and relaxation. The appropriate type of light is activated over the tumor in a strong, targeted beam. The procedure lasts as little as a few minutes, and up to two hours.

Recovery from PDT

Recovery from PDT is typically quite easy. Patients may experience some dryness or mild burning on the skin, but other effects are uncommon. Gentle skin products such as Vaseline can be helpful. Avoid the sun, as light sensitivity is increased for a time following PDT; even a few minutes of sun exposure can sometimes cause discomfort. Please follow any doctor's instructions regarding medications and physical activity, but most patients are able to return to normal activities right away.

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RFA can provide a cure for small cancers limited to the lungs. It can also slow the progression of larger tumors or be used in combination with other treatments for lung cancer. RFA has a very low rate of complications and is generally well tolerated. Since it is a local treatment, treating only tumors that are visible, it is preferred for patients that are unable to tolerate more standard types of surgery.

How to Prepare for RFA

Before treatment with RFA, patients have a physical examination and medical history, and the physician may order one or more of the following tests:

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Patients should mention all medications they take, including prescription, over-the-counter, herbs, and supplements, and any allergies. They will most likely be asked to avoid food and drink after midnight on the night before their scheduled procedure. Water is usually allowed up to two hours beforehand.

What to Expect During RFA

RFA is performed under general anesthesia and patients stay overnight. Sometimes, a mild sedative and local anesthetic are sufficient—and patients can resume normal activities typically within one week, as opposed to open surgery, which requires longer hospital stays, longer recovery, and more risk of infection and complications.

The RFA probe is guided by an imaging tool such as ultrasound or CT into the tumor. Once the probe is placed in the tumor, the radiofrequency energy is delivered, causing heating of the cancer and a small area of lung immediately surrounding this. Temperatures in the tumor can rise to 90° C (194° F). Cancer cells will start to immediately die at 60° C (140° F).

After the abnormal cells are killed, they shrink and turn to scar tissue over time. Unlike surgery where the cancer is removed, there will usually be a scar remaining in the area of the treated tumor. It is important that patients continue to follow up with their physician with repeated CT scans to make sure that there is no further tumor growth.

Recovery from RFA

Immediately after the procedure, the physician takes CT images to make sure the treatment was successful in destroying abnormal tissue. The patient is usually discharged the next morning, and should be able to resume normal activities within the week. Minor complications may include low-grade fever, bruising, pain, and/or infection. Patients should call the Center if they notice any of these symptoms or anything else of concern, or if they have trouble breathing.

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How to Prepare for Seed Implantation/Lung Resection

Seed implantation occurs at the same time as lung resection, which is typically performed under general anesthesia. It is important to follow any physician instructions to prepare for surgery. These generally include:

  • Avoiding eating or drinking anything after midnight on the night before
  • Bringing all of one’s medications to the hospital
  • Arriving one hour prior to surgery time

Patients may have a pre-admission appointment one to two weeks beforehand, in which they will have routine blood testing, any heart imaging, such as an electrocardiogram, and consultation with the anesthesiologist.

If possible, the patient should engage in some mild physical activity such as walking, and eat a balanced diet leading up to the scheduled surgery; this includes limiting alcohol consumption to 1-2 glasses per day. Smokers should make every effort to quit because it may complicate their surgery and can lead to new cancers. Patients should inform the medical team of the following in the week before:

  • If they have asthma or emphysema
  • If they take medications, both prescription and over-the-counter, including herbs, supplements, aspirin, and corticosteroids

What to Expect During Seed Implantation/Lung Resection

On the day before the procedure, the patient will be given information about the following day, including where to go and when to arrive. They should leave any valuables at home, and wear comfortable clothes.

On arrival, they will be taken to a pre-surgery area to measure their temperature, blood pressure, pulse, and to listen to their heart and lungs. Then, they may have their blood tested, an x-ray, or be attached to a heart monitor in the surgery room. An intravenous (IV) line will be inserted, so that medications may be administered before, during, and after the procedure.

To perform the wedge resection or segmentectomy, the surgeon may use thoracoscopy or thoracotomy.

  • For a thoracoscopy, the physician makes short incisions in the chest and then insert a fiber-optic camera called a thorascope as well as surgical instruments. As the physician moves the thorascope around, images that provide important information are projected on a video monitor. The portion of the lung where the tumor is located is removed.
  • For a thoracotomy, the surgeon makes a larger incision in the chest and removes the portion of the lung where the tumor is located.

With either approach, once the diseased portion of lung has been removed, the surgeon will complete the procedure by implanting the seeds in the cut margin. The entire procedure takes about 1 hour.

Recovery from Seed Implantation/Lung Resection

After surgery, patients are taken to the Post Anesthesia Unit and monitored for any changes in blood pressure, heart rate and breathing. The IV line remains inserted, to keep the patient hydrated and administer pain medication, if necessary. The patient may also use a ventilator or other breathing assist device, such as an incentive spirometer (which encourages deep breaths), to ensure air exchange and to prevent pneumonia. If an endotracheal tube was inserted during surgery to control breathing, it may remain in place for a brief time.

Before the patient is discharged, the patient’s physician or nurse will instruct on how to use the oxygen device, if applicable, and how to care for the incision. Gradually, over the course of a few weeks, patients regain their strength and are able to return to work and participate in physical activity. Patients should take their medicine exactly as prescribed, and call their doctor if they have any questions or notice any of the following:

  • Bleeding
  • Infection
  • High temperature
  • Coughing up yellow, green, or bloody mucus
  • Allergic reaction, such as redness, swelling, trouble breathing

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How to Prepare for Microwave Ablation

Before treatment with microwave ablation, the patient has a physical examination and medical history, and the physician may order one or more of the following tests:

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Patients should tell their doctor about any allergies to medication or if they have had problems with anesthesia. The surgeon will give specific instructions about dietary or activity restrictions, and will also instruct whether it is safe take any regular medications prior to the procedure or on the day of the procedure. Patients also may be asked to not eat or drink after midnight on the night before their procedure, and they may wish to ask a friend or family member to drive them to their procedure.

What to Expect During Microwave Ablation

Microwave ablation may be performed on an outpatient basis and may not require general anesthesia—a mild sedative and local anesthetic are often enough. The patient will be positioned on an examining table, and will be connected to machines that monitor heart rate and blood pressure during the procedure. A nurse or technologist will insert an intravenous (IV) line in the patient’s hand or arm to give sedatives and other medications and fluids.

The physician will use a CT scan to precisely locate the tumor. A small incision is made, and an antenna is advanced through the incision to the site of the tumor using CT guidance.

Once the antenna is in place, the energy source will be activated. The heat also helps close small blood vessels and lessens the risk of bleeding. After the abnormal cells are killed, they shrink and turn to scar tissue over time. Each ablation takes between 10 and 30 minutes, and the entire procedure typically takes between one and three hours.

Recovery from Microwave Ablation

Following the ablation procedure, patients are taken to an anesthesia recovery room where their vital signs will be monitored. In addition, they will have a chest x-ray to ensure that their lung has not collapsed from an air pocket created in the space between their lungs and chest wall (called a pneumothorax). If the physician finds a pneumothorax, which is rare, they may have insert a tube to remove the air.

Once stabilized, the patient may be transferred to a hospital room, and may stay overnight. Typically, patients are discharged within 24 to 48 hours after tumor ablation. Recovery is usually quick, and patients are able to resume normal activities within a few days. They may experience discomfort from the ablation needle site, and may experience fatigue, muscle ache, and possibly a low-grade fever (up to 102° F) for several days following the procedure.

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Integrative Therapy: Integrative medicine practices have been shown to reduce cancer-related symptoms such as pain, anxiety, nausea, and fatigue. The Program for Integrative Medicine and Health Care Disparities in the Department of Family Medicine at BMC combines conventional medical treatments with evidence-based complementary therapies. Free therapeutic massage to decrease preoperative anxiety and postoperative pain in cancer patients undergoing surgical procedures is available. In the Moakley Building, where BMC conducts much of its cancer care, a registered yoga instructor holds free biweekly yoga classes, and a licensed acupuncturist offers free acupuncture to cancer patients. Participants in these sessions have gained notable clinical benefits, reporting decreases in pain, depression, anxiety, nausea, and fatigue. Services to individual patients complement group activities. Consultations that focus on stress management, nutrition, and coordination of complementary therapies are also available.

Follow-Up Care

Periodic follow-up care is very important after treatment for lung cancer to make sure the patient remains free of tumors. At BMC, each patient’s treatment plan includes services that go well beyond the procedures to remove the cancer. A patient’s plan will include

  • Services and guidance to relieve side effects
  • Procedures to monitor and control pain during and after treatment
  • Guidance and follow-up on the details of home care

Management of care continues over the weeks, months, and years following treatment. And for out-of-town patients, this care includes collaboration with local health care providers for follow-up, using the hospital’s nationwide network of health care institutions.