Lung Cancer Treatment

Interventional pulmonology involves minimally invasive techniques to treat lung cancer. The therapeutic procedures for lung cancer include:

Rigid bronchoscopy

The use of a rigid bronchoscope allows the interventional pulmonologist greater visualization and access to the airways with larger instruments. This is helpful when treating airway narrowing with a stenting procedure, removing obstructions, removing cancers or treating bleeding.

Balloon dilatation and stenting procedures

Balloon dilation can treat airways that have narrowed due to a variety of reasons, such as Wegener’s disease, sarcoidosis, airway tumors or the effects of radiation therapy. Airway stents can be permanent or removable, and they protect narrowed or damaged airways.

Electrocautery and argon plasma coagulation (APC)

Using a flexible or rigid bronchoscope, a probe using electricity can be used to remove scar tissue, remove obstructive airway cancers or treat bleeding in the airway. 

Nd:YAG Laser (neodymium-doped yttrium aluminum garnet)

Laser therapy uses a targeted beam of powerful light energy to reduce the size of the airway tumor or abnormal tissue (called debulking) so that patients can breathe easier. Laser therapy can also be used to stop airway bleeding, remove granulation tissue, remove endobronchial airway cancer, remove recurrent respiratory papillomatosis (RRP) and relieve tracheal stenosis. 

Percutaneous tracheostomy

Percutaneous tracheostomy is a less-invasive way to help a patient breathe or maintain an open airway if they’re on long-term mechanical ventilation or have other illnesses. The incision is smaller than from traditional surgical tracheostomy procedures, so it leaves less of a scar once the tube is removed.

PleurX catheter placement

For patients with recurrent pleural effusions that result in a large build-up of fluid within the lining of the lungs making breathing difficult, a tunneled drainage catheter can be used. The drainage system is easily managed by the patient at home, rather than having to come to the hospital for multiple thoracentesis procedures to drain the lungs.

Transtracheal oxygen catheter

For patients who need long-term oxygen use, a transtracheal oxygen catheter provides an alternative to wearing a traditional nasal cannula. It feels and looks very similar to wearing a necklace. Because the oxygen is delivered directly into the trachea, patients can have a lower oxygen dose than with a nasal cannula.

Depending on the type of lung cancer, it can be treated with surgery. Surgery may be an option for early stage non-small cell lung cancer (NSCLC) and early stage small cell lung cancer (SCLC). Surgery for lung cancer may remove part or all of the lung.

• Segmentectomy is the removal of part of a lung lobe. A “wedge resection” removes a wedge-shaped piece of the lung. 
• Lobectomy involves removing an entire section (lobe) of a lung.
• Pneumonectomy is the removal of the entire lung.
• Sleeve resection is the removal of part of major air passages of the lungs.
• Lymph node biopsy is the removal of lymph nodes during surgery. The lymph nodes will be examined to determine if cancer has spread beyond the lungs and if additional treatment is needed.

These surgical procedures can be performed through different approaches, depending on several factors, including the location of tumor or tumors and the patient’s health.

Minimally invasive robotic surgery

Whenever possible, Scripps surgeons use minimally invasive robotic surgery, which provides greater range of mobility and dexterity than the human wrist. Robotic surgery requires extensive training and certification, and Scripps is one of the only San Diego health care providers to offer this procedure as an option for lung cancer surgery, with the goal of shorter hospital stays and reduced pain for patients.

Video-assisted thoracoscopic surgery (VATS)

VATS lung surgery is a minimally invasive surgery performed through small incisions by surgeons aided by use of a small video camera inserted in the patient’s chest cavity.

Thoracotomy

Also referred to as open chest surgery, thoracotomy is performed through an incision between the ribs in the side of the chest. It typically requires a hospital stay of five to seven days.

Our expert radiation oncologists offer state-of-the-art radiation therapy options to treat lung cancer while minimizing radiation to other areas of the chest. This treatment may be used prior to surgery to reduce the size of tumors, or following surgery to eliminate cancer cells that may be remaining. Radiation therapy is also sometimes combined with chemotherapy.

There are two types of radiation therapy for lung cancer:

• External radiation therapy, which comes from a machine outside the body
• Internal radiation therapy, which places materials that produce radiation through thin plastic tubes into the area where the cancer cells are found

External radiation therapy

3-D conformal radiotherapy uses advanced computer software that allows physicians to visualize a patient’s anatomy in 3-D, thereby more closely matching the radiation dose to the shape of the tumor while minimizing exposure to surrounding healthy tissues and organs.

Stereotactic body radiotherapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), treats lung tumors with multiple high-dose radiation treatments (typically two to five).

Intensity-modulated radiotherapy (IMRT) is an advanced form of radiation therapy that allows the radiation oncologist to specify the radiation dose for the tumor while restricting the dose to surrounding healthy tissues.

Internal radiation therapy

Brachytherapy administers radiation internally by placing radioactive beads or other sources directly into the body through catheters or small plastic tubes. 

Systemic approaches use drugs that identify and attack cancer cells throughout the body. Your Scripps medical oncologist may refer you to our infusion center locations throughout San Diego for one or more systemic treatments for lung cancer, including the following.

Chemotherapy

Chemotherapy may be the first treatment option for small cell lung cancer, or for lung cancer that has spread to other parts of the body. It also may be an option for patients who cannot have surgery. 

Chemotherapy may be given in a pill or liquid, or it may be put into the body by a needle in a vein. Scripps Health offers chemotherapy in several locations throughout San Diego County, including Scripps hospitals, outpatient infusion centers and in Scripps affiliated physicians’ offices. All treatments are managed by physicians and nurses specially trained in oncology.

Targeted therapy

As the name implies, this therapy targets specific proteins and receptors on cancer cells, or the blood vessels that support the cells, to stop them from growing. Targeted therapies also may help the body’s own immune system attack and fight the cancer.

Laser therapy uses a targeted beam of powerful light energy to destroy airway cancers or abnormal airway tissue growth. Laser treatment can be used to clear the trachea or bronchial tubes of abnormal tissue, in order to open a patient's airway.

Laser therapy can also be used to stop airway bleeding, remove granulation tissue and remove certain cancers. 

Some lung cancer treatment plans involve clinical trials. Talk with your physician about whether a clinical trial is right for you. 

For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop an individualized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your lung cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your multidisciplinary lung cancer care team comprises experts from a range of specialties to make sure you have comprehensive expertise and support. Your team may include:

• Physicians
• Pulmonologists
• Nurse navigators
• Surgeons
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Dietitians
• Social workers

For details, refer to our section covering your cancer care team. 

In support of our lung cancer patients, survivors, their family members and the community, we host a range of health and wellness events and classes throughout San Diego County.

We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps Cancer Center offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:

• Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
• Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life. 
• Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
• Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
• Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
• Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
• Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
• Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
• Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.

For the full spectrum of offerings, please visit our cancer patient support services section.