Tests, Treatments & Therapies for Lung and Chest Cancers

Staging and Detection Tests

Once a cancer has been diagnosed, it is very important for doctors to find out where the cancer may have spread (the “stage” of the cancer) to determine the best possible treatment plan for you. To find out, doctors use staging tests, which include:

• Different types of scans
• Different ways to take tissue samples to look for tumor cells microscopically (biopsy tests)

Scans and other tests may also be used:

• In a “surveillance program” looking for any signs of relapse after treatment
• In a “screening program” to detect cancer early in individuals at high-risk
• To monitor responses to treatment

Types of scans include:

CT scan (computed tomography) –  An X-ray procedure that creates detailed, highly accurate cross-sectional body images.

PET scan (positron emission tomography) –  An imaging test used to light up cancer in different parts of the body. You get an injection of a short-lived radioactive substance before having the scan. Cancerous tissue will build up more of the substance and appear brighter than normal tissue on the PET images. Other non-cancerous tissues, such as areas of inflammation, can also sometimes “light up.”

PET/CT Scan (PET/CT fusion) –  An imaging test that combines or “fuses” the CT scan anatomical accuracy and the PET scan’s ability to highlight cancers. It is good at looking almost everywhere in the body, except the brain.

MRI (magnetic resonance imaging) –  A magnet, radio waves and a computer are used to make a series of detailed pictures of the brain and spinal cord. No X-rays are used. You receive an injection of contrast material called gadolinium through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Other tests that may be used include:

Ultrasound or CT guided biopsy –  The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. An ultrasound or CT is used to provide a clear image to target the biopsy.

Bronchoscopy –  A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for a biopsy.

Transesophageal Ultrasonography –  A tube with a device called a transducer is passed down the throat and into the esophagus (the “food tube” that connects the mouth to the stomach). Ultrasound waves are then passed from the transducer through the esophagus to create a clear image of the surrounding structures. This test is used to identify the lymph nodes that are close to the esophagus, located in the middle the chest, that can sometimes contain cells from a lung cancer. The ultrasound is used to guide a needle biopsy taken directly through the wall of the esophagus to diagnose cancer in these lymph nodes.

Mediastinoscopy –  Under an anesthetic, a tube is put down behind the breastbone (sternum) or through the side of the chest, and tissue samples are then taken from the lymph nodes in the middle of the chest.

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Treatment & Therapy for Lung and Chest Cancers

Surgery

Surgery is one of the best options for treating lung cancer if:

• The cancer’s stage (or how far it has spread) is suitable for removal through an operation, and
• You are healthy and fit enough to tolerate the operation, and
• You choose to have an operation.

Before surgery, other tests on the lungs and heart are required to establish whether you can tolerate the operation.

During the operation, a thoracic surgeon usually tries to remove all known cancer, but can also improve cancer symptoms, for example, by draining fluids that build up around the lung affecting breathing.

Afterward, physiotherapy often helps to improve breathing and speed recovery.

Radiation Therapy (“Radiotherapy”):

Radiation therapy involves using X-rays and other types of medical radiation aimed at specific parts of the body to:

• Kill cancer cells
• Prevent cancer cells from developing or recurring
• Improve many of the symptoms caused by cancer

Radiation therapy can be:

• Used before surgery to make the operation easier (this is called “neoadjuvant” treatment)
• Used after surgery to reduce the chances of the cancer coming back (this is called “adjuvant treatment”)
• Almost as effective as surgery in people who are not fit enough for an operation
• Better than surgery when used together with chemotherapy for certain cancers (this is called “chemo-radiotherapy”)

Chemotherapy and other drug-based treatments:

Anti-cancer drug treatments –  Chemotherapy-and new “targeted therapies"-involve using drugs that kill, slow down or damage cancer cells. Many new drugs are being developed. View current lung cancer clinical trials available at UCCC.

Anti-cancer drug treatments may involve:

• Single drugs or combinations of drugs
• Intravenous injections or tablets/capsules
• Taking the drugs in repeating patterns, called “cycles”, that usually last three to four weeks
• Taking some drugs every day or only on a few days within the cycles
• Taking other medicines to reduce or eliminate side effects associated with chemotherapy
• Taking targeted therapies, often with very little side effects, on their own or in combination with standard chemotherapy
• Access to new drugs or vaccines on their own, or added into standard treatments, in clinical trials

Chemotherapy and targeted therapies can:

• Be given before surgery to make the operation easier
• Be given in combination with radiotherapy to make both treatments more effective
• Be given after surgery to reduce the chances of cancer coming back
• Successfully control advanced cancer and many cancer-related symptoms

Clinical Trials

The goal of clinical research is to improve treatment outcomes and reduce treatment side effects or long-term toxicities. Clinical trials can provide access to the latest treatments by evaluating:

• New drugs
• New combinations of therapies
• New treatment delivery methods
• New radiotherapy and surgery techniques 

Because we’re the Rocky Mountain region's only National Cancer Institute (NCI)-designated Comprehensive Cancer Center—one of only 39 in the United States—your treatment will always include the latest and most comprehensive care options. If the best treatment is available only within a clinical trial, we aim to be leading or involved with that trial for our patients.

Learn more about clinical trials at UCCC.