Most lung cancers are found when they’re harder to treat, but breakthrough therapies are prolonging and improving patients’ quality of life.
If you’ve been diagnosed with advanced lung cancer, you’re probably feeling overwhelmed, scared, and have many questions regarding your condition. Can my lung cancer be treated? Can it be cured? What will my life be like from now on?
“Many patients don’t have a lot of information about lung cancer,” says Jorge Gomez, MD, a lung oncologist at Mount Sinai Hospital in New York City. “Some of them haven’t heard about the newer therapies that can prolong life, can improve quality of life, and have had a significant impact in the treatment of lung cancer.”
What Is Advanced Lung Cancer?
Lung cancer is divided into three different categories: localized lung cancer, locally advanced lung cancer, and advanced or metastatic cancer.
- Localized lung cancer is when patients have a small tumor and no lymph nodes in the center of the chest.
- Locally advanced lung cancer is when patients have lymph nodes in the center of the chest.
- Advanced or metastatic cancer is when the cancer has escaped the lungs.
When doctors use the term “advanced lung cancer” they’re often talking about stage III or stage IV lung cancer. Because lung cancer is often difficult to find in its early stages, most people are diagnosed after the disease has become advanced.
“About half of the patients who are diagnosed with lung cancer are diagnosed with metastatic or advanced disease. The other half are diagnosed with either localized or locally advanced disease,” says Dr. Gomez.
A stage III diagnosis means the cancer might be large, and/or it may have spread to lymph nodes in the middle of the chest, between the left and right lungs. There are two kinds of stage III lung cancers:
- Stage IIIA means the cancer has spread to lymph nodes on the same side of the chest as the tumor.
- Stage IIIB means the cancer has spread to lymph nodes above the collarbone or in the opposite side of the chest as the tumor
A stage IV diagnosis means the cancer is at the most advanced stage, and has spread to the other lung or to other parts of the body, such as the brain or bones, or it’s caused fluid to collect around the outside of the lungs.
How Advanced Lung Cancer Is Treated
There are many effective therapies for treating lung cancer. Choosing the right treatment depends on the stage of your cancer and what course of treatment works best for your lifestyle.
Stage IIIA and stage IIIB cancer are treated differently. “They’re both treated with the intent of curing the cancer, but in different ways,” says Dr. Gomez. “Patients with stage IIIA can have surgery, and patients with stage IIIB can have chemotherapy and radiation in an attempt again to cure the cancer, but the majority of those patients will not be cured.”
Stage IV lung cancer is widespread when it is diagnosed. There is no treatment that will cure stage IV lung cancer, but different treatments can reduce symptoms and help people with metastatic lung cancer live longer.
People with stage IV lung cancer can have one or more of the following treatments:
- Radiation therapy
- Targeted therapy. “Targeted therapies are oral therapies that treat very specific types of lung cancer,” says Dr. Gomez. “These drugs go to a specific site in the cancer to turn that cancer cell off; they’re extremely effective. They’re actually more effective than chemotherapy and they cost significantly less side effects than chemotherapy.”
- Immunotherapy. “Immunotherapies are newer therapies, that aren’t toxic like chemotherapy or don’t attack the cancer directly like chemotherapies. They activate the body’s immune system, so those immune cells can then attack the cancer cells and kill them,” says Dr. Gomez.
- Surgery to remove a cancer growth that is outside of the lungs.
- Palliative care, or treatment for symptoms caused by the cancer.
“Treatment that is being given [at stage IV] has the goal of prolonging the [patient’s] survival, meaning allowing the patient to live longer than they would if they did not have any therapy at all,” says Kevin Sullivan, MD, a lung oncologist at Monter Cancer Center, Northwell Health in New Hyde Park, New York.
“It also has the goal of palliation of their symptoms. They may be having symptoms related to their disease, and by palliating those symptoms or easing those symptoms, that can improve their quality of life,” says Dr. Sullivan.
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Lung cancer can be divided into
three broad different categories.
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The first is localized lung cancer,
where patients have a small tumor and
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no lymph nodes in the center of the chest.
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The second is locally advanced lung
cancer, where patients have lymph
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nodes in the center of the chest, and the
third is advanced or metastatic cancer,
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where the cancer has escaped the lungs.
00:00:22,939 --> 00:00:26,253
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So about half the patients who are
diagnosed with lung cancer are diagnosed
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with metastatic or advanced disease,
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the other half were diagnosed with either
localized or locally advanced disease.
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Advance lung cancer comprises
usually stage III or IV disease,
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or what medical oncologist would consider
to be advanced stage lung cancer.
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A tumor that has spread to the regional
lymph nodes in the chest, or
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to some distant site in the body.
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So the locally advanced lung cancers,
or stage three, are two different ones.
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First there's IIIA, where patients
have lymph nodes on the same side
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of the chest as the tumor, and IIIB,
where patient have disease on the other
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side of the chest but
not in the other lung.
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Those two cancers are treated differently.
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They're both treated with the intent
of curing the cancer, but
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in very different ways.
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Patients with Stage IIIA can have surgery,
and patients with stage IIIB
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can have chemotherapy and radiation in
an attempt, again, to cure the cancer.
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But the majority of those
patients will not be cured.
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Stage IV lung cancer
is considered metastatic,
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where the tumor has spread
to a distant region.
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Where surgery would not be an option
in any curative intent purpose.
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And the mainstay of treatment for
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stage IV disease would be some
type of systemic therapy.
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The first is chemotherapy,
the second is immunotherapy, and
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the third is targeted therapy.
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And those are for different patients.
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We can also sometimes use radiation
therapy in patients with stage IV disease
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to try to alleviate symptoms, for example.
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When patients have disease in the bone,
which is causing significant pain,
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radiation can help significantly.
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When something is
not considered curable,
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usually offer them some type of
treatment for their disease, but
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that treatment is not going to result
in eradication of the disease.
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The treatment that being is given has
the goal of prolonging their survival.
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Meaning, allowing the patient to live
longer than they would than if they did
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not have any therapy at all.
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It also has the goal of
palliation of their symptoms.
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They may be having symptoms
related to their disease.
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And by palliating those symptoms,
easing those symptoms,
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that can improve their quality of life.
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So in the past 15 years, two very big
things have happened in lung cancer.
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The first is the advent
of targeted therapies.
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Targeted therapies are oral therapies that
treat very specific types of lung cancer.
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Approximately 15 or
20% of patients with lung cancer
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have this special type of lung cancer
which is generally found in never-smokers,
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although it can't happen in smokers.
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These patients are treated with these
drugs that go to a specific site in
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the cancer to turn that cancer cell off,
and they're extremely effective.
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They're actually more effective
than chemotherapy, and
00:03:14,050 --> 00:03:16,690
they cause significantly less
side effects than chemotherapy.
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The second big finding in lung
cancer has been immunotherapy.
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Immunotherapies are newer therapies
that aren't toxic like chemotherapy,
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or don't attack the cancer directly
like chemotherapy or targeted therapies.
00:03:32,200 --> 00:03:34,730
They activate the body's immune system so
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that those immune cells can then
attack the cancer cells and kill them.
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These obviously are very important things,
because these drugs have been
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proven to be better than chemotherapy
in certain specific scenarios, and
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are now approved in almost
every scenario in lung cancer.
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Many patients don't have a lot of
information about lung cancer.
00:03:55,190 --> 00:03:59,204
Some of them haven't heard about the newer
therapies that can prolong life,
00:03:59,204 --> 00:04:01,118
and can improve quality of life, and
00:04:01,118 --> 00:04:04,407
have had a significant impact
in the treatment of lung cancer.
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Non-Small Cell Lung Cancer Stages. American Cancer Association. (Accessed on July 26, 2018 at https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/staging.html)
Treatment Choices for Non-Small Cell Lung Cancer, by Stage. American Cancer Association. (Accessed on July 26, 2018 at https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/by-stage.html)