Treatment methods for lung cancer
Treatment methods for lung cancer, Several methods are available to the treating physician to treat lung cancer. Treatment methods which are suitable for the therapy of lung cancer are:
How is lung cancer surgery?
If the tumor has not exceeded a certain size and has not yet formed any distant metastases, an operation is always attempted. The aim of the operation is to completely remove the tumor tissue as well as the lymph nodes affected by tumor cells. The operation plays an important role especially in the case of non-small-cell lung cancer but can also occasionally occur in small-cell type.
Extensive investigations are anticipated by the intervention. In particular, it must be ensured that, after the removal of a part of the lung, the remaining sections of the lung are able to adequately absorb the respiratory function. Precondition for an operation is a good general condition of the patient, severe accompanying diseases are an operative procedure. Furthermore, the removal of the tumor must not pose any danger to adjacent vital organs, Such as large blood vessels or the esophagus. If the expected stress and limitations are too great, another therapy must be chosen.
During the operation, the tumor with the tumor-bearing lung section and the local lymph nodes are removed. The most common procedure is the removal of a lung lobe (lobectomy). In the case of very large tumors the removal of an entire lung wing may be necessary (pneumonectomy). In many cases, however, it is possible to avoid the removal of the entire lung wing by special organ-preserving operations (“pulmonary tissue-saving operations”).
Possible side effects:
The operative removal of lung tissue is associated with a reduction in the respiratory area. However, when the lung function is adequate before the operation, the intervention usually does not lead to a severe respiratory disability. The loss of lung tissue can then be compensated for. Special breathing exercises help to improve the performance of the lung after the tumor therapy and to promote physical as well as psychological well-being. The first exercises can already be learned in the clinic under the guidance of a physiotherapist and later on at home. It is also important that smokers quit smoking immediately, ie before the operation.
What happens during irradiation?
More than two-thirds of the lung cancer patients can not be operated because of a spread of the tumor or because of accompanying diseases. Most of them then receive radiotherapy , often combined with chemotherapy . The effect of irradiation is that it destroys cancer cells. The irradiation takes place with energetic electromagnetic waves which are radiated from the outside to the tumor region.
In non-small-cell lung tumors radiotherapy is often combined with chemotherapy. The combination of both methods is more effective, but also leads to stronger side effects. For this reason, patients with a poor general condition or patients with significant concomitant diseases are often treated only with radiation therapy.
possible side effects
Side effects of radiation therapy can be hoarseness and swallowing difficulties. Also the skin is sensitive to the treatment. Especially when combined with chemotherapy, mucosal inflammations and pelvic diseases can occur in the oral cavity. A late episode is pneumonitis, an inflammation of the irradiated lung tissue. On the whole, the occurrence of side effects depends on the type and intensity of the radiation used.
How does chemotherapy work?
In the case of chemotherapy, cell-growth-inhibiting drugs, known as cytostatics, are used. They act primarily against fast-growing cells and thus primarily against cancer cells. Several chemotherapeutic agents are available for the treatment of lung cancer, which are selected according to individual requirements.
As a rule, two or three substances are combined with each other, either cisplatin or carboplatin being contained as the basic composition. Chemotherapy is the long-established systemic therapy of the lung carcinoma. The type of chemotherapy and the choice of medication depend on various factors such as the general condition and companion diseases.
Frequently used cytostatics are:
Possible side effects:
Chemotherapy affects all rapidly dividing lines. This includes not only malignant cancer cells, but also healthy cells such as the mucous membranes of the digestive tract and the hair root cells. The most common side effects of chemotherapy are therefore nausea, diarrhea and hair loss. Under chemotherapy, a reduction in the blood cells can also occur, which increases the susceptibility to infections. Through a good education as well as preventive and accompanying medication many of these side effects can be avoided or at least alleviate. As a rule, they sound again after the end of the chemotherapy.
Targeted drug therapies
The classical chemotherapeutic agents act as cell toxins not only on tumor cells, but attack also healthy tissue. Novel therapeutic approaches, which are referred to as “targeted therapy”, are directed to attack exclusively or preferably cancer cells. These are active substances which are directed, for example, against tumor growth, which prevent the blood supply of the tumor, repair defects in the genetic material, or repair their consequences or prevent the signal transmission between tumor cells. Targeted therapies are currently used exclusively in advanced (metastasized) non-small-cell lung carcinomas. As intensive research is conducted in this area, it is to be expected that in the near future further targeted drugs will be approved for the treatment of lung cancer.
Tyrosine kinase inhibitors of the epidermal growth factor (EGFR tyrosine kinase inhibitor)
Active substances from this group of substances are directed against binding sites of growth factors on the surface of cancer cells. These binding sites are often formed in excess by the tumor cells. The growth of these cells is the signal for uninhibited growth. Tyrosine kinase inhibitors prevent signal transmission, which blocks the growth of the tumor cells. Three EGFR tyrosine kinase inhibitors are currently approved for the treatment of lung cancer: erlotinib, gefitinib and afatinib. These drugs are available in tablet form. The therapy can therefore be carried out by the patients at home, which for many is a gain in quality of life. EGFR tyrosine kinase inhibitors can delay the progress of the disease and alleviate the associated discomfort. However, healing is not possible.
Tyrosine kinase inhibitors of ALK and ROS1 kinases
Tyrosine kinase inhibitors of this active substance group are directed against proteins in the cell, which stimulate cell growth. By binding the active substances to the proteins, certain signaling pathways are blocked and the uncontrolled cell growth in the tumor is inhibited. At the moment, the tyrosine kinase inhibitors crizotinib and ceritinib are approved for the treatment of non-small-cell lung cancer.
Angiogenesis means the formation of blood vessels. These blood vessels require the tumor to provide oxygen and nutrients. Ultimately, angiogenesis leads to tumor growth and spread of the tumor in the body.
Angiogenesis inhibitors inhibit the blood supply of tumors by blocking vascular endothelial growth factor (VEGF). Studies have shown that the cancer cells can grow less, while at the same time given chemotherapies have a higher potency. Such angiogenesis inhibitors are bevacizumab and ramucirumab. The antibodies are used in combination with chemotherapy for the initial treatment of suitable patients with non-small-cell, non-epithelial lung carcinoma who are not surgically, locally advanced or metastasized or are a relapse (recurrence). After completion of the first-line chemotherapy, antibody therapy is continued until a new tumor growth is detected.
possible side effects
There is an increased risk of bleeding in the therapy with bevacizumab, which is why good monitoring should be carried out. Frequently there is the occurrence of hypertension. Other typical but rarely occurring side effects are blood vessel occlusions (embolisms), increased protein excretion in the urine (proteinuria) as well as wound healing disorders.
Immunotherapy To reactivate the immune system in such a way that it recognizes the tumor and combats it accordingly is the goal of an immunotherapy. To date, only one immunotherapeutic agent has been approved for the therapy of advanced non-small-cell lung cancer. Pembrolizumab is a monoclonal antibody that enhances the ability of the immune system to detect tumor cells.
Treatment of bone metastases
Lung tumors tend to form daughter tumors ( metastases) in bone . These can cause considerable pain and increase the risk of bone fractures. The bone can solidify again by irradiation of the metastases. Also, the administration of radioactive substances that accumulate in the diseased bone and irradiate it from the inside can lead to a reconstruction of the metastases (radionuclide therapy). Both methods are also effective means of pain control. In addition, administration of substances that inhibit bone degradation (bisphosphonates) can reduce the risk of bone metastasis complications and relieve pain. The antibody denosumab is based on another principle of action, which can also be used in bone metastases. A combined radiation / bisphosphonate therapy is also suitable for effectively improving pain due to bone metastases.
In the advanced stage of lung cancer, the patient often experiences pain. They influence their quality of life more strongly than the tumor itself. One of the most important measures in this case is effective pain control .
With the drugs and methods available today, tumor pain can be alleviated in most cases. In the foreground is the treatment with painkillers, in the case of very severe pain also with morphine. The pain therapy is tailored as far as possible to the pain situation of the patient.