By Andrea McKee, MD, as told to Regina B. Wheeler.
As a radiation oncologist, I specialize in treating cancer with radiation therapy, and I’ve treated people with lung cancer for more than 25 years. When most people hear those words, they think it’s a death sentence. Thank
goodness that’s changing. Through early detection programs, we’re finding cancers when they’re highly curable. And for late-stage cancers, incredible therapies that are really changing the face of treatment.
Lung cancer, especially advanced disease, is truly a life-changing journey. But you won’t travel the path alone. Your team will likely include several doctors from different specialties, along with a go-to person called a patient navigator to help guide you every step of the way. Here’s what you need to know.
Diagnosis
Lung cancers are generally two types. Most — some 85% — are called non-small cell (NSCLC) and usually occur in people with a history of tobacco use. The rest are small cell (SCLC). Your oncologist, or cancer doctor, will tell you which kind you have.
An imaging test called a positron emission tomography (PET) scan tells your doctor where the cancer is and what stage it’s in. Cancer cells are active and use a lot of sugar, so you’ll get a shot of a radioactive sugar molecule. The molecules will meet where the cancer cells are and show if it has spread.
- Stage I (1): Cancer is only in the lung.
- Stage II (2): It’s spread to nearby lymph nodes.
- Stage III (3): Cancer is in more distant lymph nodes within the chest.
- Stage IV (4): It’s now traveled to other parts of the body. This may be called metastatic lung cancer and is advanced disease.
If you’re over 50 and a current or past heavy smoker, you may be eligible for computed tomography (CT) lung cancer screening. We often find stage I and II lung cancers with regular screening, which are highly curable. Lung screening is new and most people don’t know about it, so ask your doctor.
Treatment
Several factors will guide treatment. These include the kind of lung cancer you have, what stage it’s in, your overall health, and your preferences. Stage I and II NSCLC tumors are typically treated, or taken out, with surgery. Using high-dose beams of radiation from different angles to destroy the tumors is another option. You may be offered this stereotactic radiation if you can’t have surgery because of another health problem like chronic obstructive pulmonary disease (COPD) or a recent heart attack. Sometimes stage II tumors also are treated with chemotherapy drugs to kill cancer cells.
Stage III and IV are typically treated with a combination of surgery, chemotherapy, and radiation. If the cancer has traveled outside the lung, it may be called “inoperable,” which means surgery is not an option.
Small-cell lung cancers are almost always treated with chemotherapy and radiation.
Advances in Treatment
Every cancer has its own genetic makeup and a series of mutations, or changes, within a cell’s genetic code are responsible for cancer.
Your tumor may be tested to see if drugs developed for specific mutations may cure or control the cancer. These targeted drugs may be used alone or with traditional chemotherapy treatments.
Another remarkable advance is the use of drugs that use your body’s immune system to fight cancer. Cancer cells are sneaky and give off signals to duck your immune system. But immunotherapy drugs turn those signals off and allow your body to fight the cancer.
The Patient Navigator’s Role
It truly takes a village to get through treatment, especially if you have stage III or IV lung cancer. At that point, so many different specialists — oncologists, surgeons, pulmonologists (lung doctors), and radiation oncologists like myself — are involved in your care. At the center of this village is a patient treatment navigator who sort of acts like a traffic cop and directs you to important resources. A patient navigator can also:
- Schedule appointments or tests
- Tell you which doctor to call for a particular problem
- Remove barriers to care like insurance issues or transportation problems that keep you from getting to appointments
- Refer you to psychological or social services if you’re having an especially hard time dealing with having lung cancer
- Steer you to a smoking cessation program if you’re still lighting up
- Request that palliative care becomes part of your cancer care team
Palliative care — or supportive oncology, as I prefer to call it — can be vital to the well-being of patients. It does not mean you’re giving up or headed to hospice. Supportive oncology helps with pain control, nutrition issues, and side effects of active cancer treatment, among other things.
Learn to lean on your patient navigator. They’re a lifeline to people who are at their most vulnerable and may be dealing with the complicated health care system for the first time.
What Happens After Treatment?
For stage IV patients, treatment is a lifelong journey. But others who are no longer in active treatment will need CT scans at specific times to make sure the cancer hasn’t returned.
Five years ago, the overall 5-year survival rate was about 15%. It was 22% last year. That might not seem like much progress, but it hadn’t budged in so long. As more people live longer after lung cancer diagnosis, they can become advocates for the disease and show that it’s not a certain death sentence. That builds a bigger advocacy base, just like breast cancer has now.
People often ask me, “Am I a survivor now that I am done with treatment?” The answer is yes: If you were diagnosed with lung cancer and are still here, you are a survivor.