There are two basic types of lung cancer, small cell lung cancer and non-small cell lung cancer. Metastatic cancer is lung cancer of either type that has spread beyond the lung of origin to the second lung or distant organs such as the brain, bones or liver. According to the American Society of Clinical Oncology, or ASCO, metastatic lung cancer is rarely curable, thus treatment is aimed at controlling symptoms and prolonging life. Treatment of metastatic lung cancer of any type, as described by the American Cancer Society, depends on the patient's state of health and the extent of spread of the cancer. There are several treatment options.
Chemotherapy
Chemotherapy is the main treatment modality for metastatic lung cancer. It involves the use of drugs to kill cancer cells or stop their growth. Chemotherapy alone, says the ASCO, is able to improve quality and length of life in advanced lung cancer patients. In select cases targeted therapy may be added to chemotherapy for increased effectiveness.
Drugs used in chemotherapy for lung cancer are paclitaxel, docetaxel, cisplatin, carboplatin, premetexed, gemcitabine, vinorelbine, etoposide, vinblastine and irinotecan. Metastatic non-small cell lung cancer is best treated with combinations of cisplatin or carboplatin with one other drug. Another combination mentioned by the American Cancer Society is gemcitabine with paclitaxel or vinorelbine. Metastatic non-small cell lung cancer responds better to combinations such as cisplatin or carboplatin on one hand combined with etoposide or irinotecan on the other.
According to the ASCO, because metastatic lung cancer has a very high likelihood of recurrence if cleared the first time, chemotherapy is given for life. Even then, there may be several changes in the drugs used in chemotherapy to achieve the goals of treatment.
Surgery
Surgery is rarely used in metastatic lung cancer. According to the ASCO, surgery is limited to situations in which the metastasis is limited to a single, operable focus in the brain or adrenals. In such cases, the primary tumor if still localized can be removed by surgery and/or chemotherapy.
Surgery can also repair or reinforce certain bones damaged by cancer deposits. Blocked airways may also be opened by surgery.
Radiation Therapy
Radiation therapy, the use of high-powered radiation to kill cancer cells, is used the same way as surgery in metastatic lung cancer. A solitary metastasis in the brain can be removed by a type of radiation therapy called Gamma knife or laser surgery, says the American Cancer Society. Further external beam radiation to the head may follow with surgery and/or chemotherapy for the primary tumor in the lungs. Radiation therapy may also be used to relieve symptoms when the metastasis affects the brain or bones.
Targeted Therapy
Certain drugs designed to target specific structures and functions in cancer cells are also used to treat metastatic lung cancer. One of such drugs, bevacizumab, according to the American Cancer Society, can be added to chemotherapy to increase the chances of achieving treatment goals. Other options are cetuximab and erlotinib.
Other Treatments
Bisphosphonates, says the ASCO, can be used to treat bone pain and prevent fractures in patients with metastases in the bones from lung cancer. Steroids such as prednisolone and methyl prednisolone can be used to treat pain, inflammation and difficulty in breathing in metastatic lung cancer. Morphine can also be used to control painful symptoms in such patients.
References
- American Society of Clinical Oncology: Lung Cancer Treatment
- American Cancer Society: Treatment Choices by Stage for Non-Small Cell Lung Cancer
- American Cancer Society: Treatment Choices by Stage for Small Cell Lung Cancer
- American Cancer Society: Lung Cancer - Small Cell Chemotherapy
- American Cancer Society: Lung Cancer -Non-Small Cell Chemotherapy
