Cancer Research UK : Lung Cancer symptoms and treatment

Lung Cancer symptoms and treatment

This page presents information on the symptoms and treatment of lung cancer, including non-small cell lung cancer, small cell lung cancer.

Patients present with a variety of symptoms usually relating to the primary tumour. The commonest symptoms include cough, dyspnoea (breathing difficulties), weight loss and chest pain. Haemoptysis (coughing up blood) and bone pain are also relatively common symptoms. Less frequently (0-20% of patients) finger clubbing and fever may be present.1

Treatments for small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are very different and therefore accurate histological diagnosis is essential. Guidelines on the management of lung cancer have been published.1,2

Non- small cell lung cancer (NSCLC)

Surgery is the main curative treatment for NSCLC and is generally accepted as the treatment of choice for early stage patients ( Table 5.1), provided that they are medically fit.3

Table 5.1: Brief description of the main stages of non-small cell lung cancer

Download this table (23.5KB)

Early assessment of the patient to see if the tumour is operable is essential. Factors affecting operability include tumour size and position, nodal or distant spread and presence of mediastinal disease.4

Unfortunately, only 20-30% of patients may be eligible for radical surgery.5 In England, less than 20% of patients diagnosed in 2000 had surgery for NSCLC.6

Five-year survival rates for early stage patients treated with radical surgery are over 60% and can be as high as 80% for very early squamous cell carcinomas.4

For lung cancer patients with resectable disease, adjuvant chemotherapy provides an additional survival advantage.7 Drug combinations used usually include cisplatin and a vinca alkaloid, and more recently, a taxane. Pre-operative neo-adjuvant chemotherapy is currently only given in clinical trials.1

Another potentially curative treatment is radical radiotherapy. This is suitable for stage 1 and 2 patients who are medically inoperable or unwilling to undergo surgery, and for stage 3A and 3B patients, provided they are fit enough.

Radical radiotherapy may constitute a 4 to 7 week course of daily treatment2 or CHART (continuous hyperfractionated accelerated radiation therapy) over a shorter period, which has been shown to improve survival by 9% at two years compared with conventional radical radiotherapy.8

Patients with inoperable stage 3 NSCLC suitable for radical radiotherapy should be offered sequential chemoradiotherapy.1 Studies have shown slower tumour progression and improved survival without significant increase in toxicity.9,10

In advanced disease, chemotherapy prolongs survival and may provide effective palliation for local symptoms. Palliative radiotherapy may also help to control symptoms and assist in providing good quality of life. Research into newer, biological therapies is ongoing, but as yet, none are considered standard treatment.

There are a number of options for relieving breathing difficulty and bronchial obstruction, including photodynamic therapy,11,12 cryotherapy,13 laser treatment and radiofrequency ablation.14

Small-cell lung cancer (SCLC)

SCLC tends to progress rapidly, with about two-thirds of patients presenting with extensive disease.4 It is a systemic condition so surgery is rarely an option but it is highly chemosensitive. Platinum-based multi-drug therapy is the usual recommendation for all SCLC patients, for example, cisplatin and etoposide.

Patients with several adverse factors, for example, extensive stage, poor performance status and elevated lactate dehydrogenase4, can still gain significant increased life expectancy with treatment, as well as gaining symptom relief.15

SCLC is also sensitive to radiotherapy and its use in limited disease reduces recurrence. The optimal timing or sequencing of chemotherapy and radiotherapy is not yet known.16 Prophylactic cranial irradiation reduces the risk of brain metastases and is considered for those who have had a good response to treatment for limited disease.17

Overall, response to treatment is good, with up to 85% response rates to combination chemotherapy reported.4 However, response is often of relatively short duration, with two-year survival achievable in up to 20% of patients only.4

Chemotherapy and radiotherapy are also useful in advanced or recurrent lung cancer, to control symptoms and improve quality of life.1

References

National Institute for Clinical Excellence, Lung cancer. The diagnosis and treatment of lung cancer., in Clinical Guidance 24. 2005.
SIGN. Scottish Intercollegiate Guidelines Network, Management of patients with lung cancer. 2005.
Smythe, W.R., Chest, 2003. 123(1 Suppl): p. 181S-187S

Souhami R and Tobias J, Cancer and its management (5th edition). 2005: Blackwell publishing.
Carney, D.N. and H.H. Hansen, Non-small-cell lung cancer--stalemate or progress? N Engl J Med, 2000. 343(17): p. 1261-2
National Audit Office, Tackling cancer in England: Saving more lives. Report by the comptroller and auditor general. 2004: London: Stationery Office.
Sedrakyan, A., et al., Postoperative chemotherapy for non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2004. 128(3): p. 414-9
Saunders, M., et al., Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial CHART Steering committee. Radiother Oncol, 1999. 52(2): p. 137-48
Wolski, M.J., et al., Multivariate analysis of survival, local control, and time to distant metastases in patients with unresectable non-small-cell lung carcinoma treated with 3-dimensional conformal radiation therapy with or without concurrent chemotherapy. Clin Lung Cancer, 2005. 7(2): p. 100-6
Huber, R.M., et al., Simultaneous chemoradiotherapy compared with radiotherapy alone after induction chemotherapy in inoperable stage IIIA or IIIB non-small-cell lung cancer: study CTRT99/97 by the Bronchial Carcinoma Therapy Group. J Clin Oncol, 2006. 24(27): p. 4397-404
National Institute for Clinical Excellence, IPG 087 Photodynamic therapy for advanced bronchial cancer - guidance. 2004.
National Institute for Clinical Excellence, IPG 137 Photodynamic therapy for localised inoperable endobronchial cancer. 2005.
National Institute for Clinical Excellence,IPG 142 Cryotherapy for malignant endobronchial obstruction. 2005.
National Institute for Clinical Excellence, ,IPG 185 Percutaneous radiofrequency ablation for primary and secondary lung cancers. 2006.
Agra, Y., et al., Chemotherapy versus best supportive care for extensive small cell lung cancer. Cochrane Database Syst Rev, 2003(4): p. CD001990
Pijls-Johannesma MCG, DRD, Lambin P, Rutten I, Vansteenkiste JF, Early versus Late Chest Radiotherapy in patients with limited stage small cell lung cancer. Cochrane Database Syst Rev. 2005 Jan 25;(1)
Auperin, A., et al., Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med, 1999. 341(7): p. 476-84

Lung Cancer symptoms and treatment

Non- small cell lung cancer (NSCLC)

Small-cell lung cancer (SCLC)

References

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