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21st February 2025
Management of lung cancer
Management of NSCLC
Treatment algorithms for non-small cell lung cancers are becoming increasingly complex, with choice of treatment depending on various factors including tumour stage, patient fitness and tumour molecular characteristics.
| Curative treatment | Palliative treatment |
|---|---|
| Stage I-IIIA lung cancers are potentially curable, and so patients should be assessed for fitness for surgery.
Lung function testing is an important part of this assessment. Radical chemoradiotherapy may be an option for those not suitable for surgery. In rare cases a stage IIIB tumour is downstaged with treatment to become resectable and therefore curable. |
Stage IIIB, IIIC and IV lung cancers are generally considered unsuitable for radical treatment. The presence of distant metastasis makes a tumour stage IV.
Systemic treatment may be offered, such as chemotherapy, immunotherapy and tyrosine kinase inhibitors. Tumour molecular characteristics are important in treatment decisions at this stage. |
Table 4 Overview of treatment of NSCLC
Prognosis varies significantly depending on the stage of disease, with 5 year survival rates of 67% for stage IA disease down to 1% for stage IV disease.
Management of SCLC
Small cell lung cancer can be broadly divided into limited and extensive stages, which define treatment options.
| Limited-stage SCLC | Extensive-stage SCLC | |
|---|---|---|
| Definition | Confined to ipsilateral haemothorax | Disease beyond ipsilateral haemothorax |
| Approach | Curative treatment may be considered | Treatment is palliative |
| Treatment options | Generally treated with concurrent chemoradiotherapy (typically etoposide + cisplatin/carboplatin).
Surgical resection with adjuvant chemotherapy ± radiotherapy is possible but infrequent. |
Generally treated with chemotherapy alone (again using etoposide + cisplatin/carboplatin).
Radiotherapy may be used for symptom management. |
Table 5 Overview of treatment of SCLC
SCLC often responds well to chemotherapy initially, but overall prognosis is poor, with a 5 year survival of <5% for extensive-stage and 12-24% for limited-stage disease.
Supportive management
Breathlessness is a common problematic symptom in lung cancer. Options for treating breathlessness include low-dose opiates, breathing control techniques and palliative oxygen therapy.
Chest drains and pleurodesis can be helpful in management of symptoms related to pleural effusions.
Radiotherapy can be effective in management of symptoms such as haemoptysis and chest pain.
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