Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.

Treatment for lung cancer depends on:

• the stage of the disease
• the location of the cancer
• the severity of symptoms
• your general health and wishes.

Treatment may involve the following.

Surgery

Early-stage non–small cell lung cancer (stages 0, I or II, and sometimes stage III) may be treated by surgery to remove the tumour. Some of the tests used for diagnosis and staging may be used to see whether the cancer has spread outside the lung. If it has spread, surgery might not be helpful. However, sometimes surgery is used to remove a metastasis in the brain or adrenal gland if there is only 1 tumour, provided that the tumour in the lung can also be completely removed.

Pulmonary function tests are often done before surgery to measure how well the lungs are working, so that the doctor can assess whether surgery is a good option.If lung function is poor, removal of part or all of a lung might not be possible.If lung function is good, the surgeon might be able to remove more of the lung tissue, to increase the chance of curing the cancer.

Types of surgery that can be used include:

• pneumonectomy: removal of an entire lung
• lobectomy: removal of 1 of the lobes of the lung (the right lung is divided into 3 lobes; the left lung is divided into 2 lobes)
• segmentectomy or wedge resection: removal of part of a lobe.

Nearby lymph nodes will also be removed during the surgery to see if the cancer has spread.

These operations usually involving a surgical incision between the ribs in the side of the chest (thoracotomy). Recovery from surgery can take weeks to months. Increasingly, lung cancer surgery is done with a ‘keyhole’ approach, known as video-assisted thoracic surgery (VATS). This involves the use of tubes inserted through small cuts between the ribs. Robotically-assisted thoracic surgery (RATS) uses a robotic system. VATS and RATS are associated with faster recovery, and less pain and blood loss, but require a high degree of surgical skill.

Surgery is rarely used as the main treatment for small cell lung cancer because the cancer has usually spread to lymph nodes or other organs by the time it is found.

In the few cases, where small cell lung cancer is found as a single lung tumour, with no spread to lymph nodes or other organs, surgery may be an option, usually followed by additional treatment (chemotherapy often with radiation therapy).

Radiofrequency ablation

Radiofrequency ablation uses high-energy radio waves to heat the tumour. It may be used to treat small lung tumours that are near the outer edge of the lungs.

Chemotherapy

Along with surgery, some people may receive chemotherapy.

Chemotherapy might be used either as the main treatment for lung cancer, especially for stage IV non–small lung cancer or after surgery to kill microscopic cancer cells that may remain but cannot be detected (adjuvant chemotherapy), or before surgery to shrink the tumour (neoadjuvant chemotherapy).

Chemotherapy is usually the main treatment for small cell lung cancer.

Radiotherapy

Along with surgery, some people may receive radiotherapy.

Radiation therapy might be used either as the main treatment for lung cancer, after surgery to kill cancer cells that remain, before surgery to shrink the tumour, or to relieve symptoms of advanced lung cancer.Radiation therapy can sometimes involve the use of new techniques that precisely target the cancer while reducing the amount of radiation exposure to surrounding tissues. Internal radiation therapy, where a small source of radioactive material is placed into the cancer or near it, is sometimes used.

Small cell lung cancer often spreads to the brain, and for some patients who have responded to initial treatment, radiotherapy to the brain might be used to reduce the risk that the cancer will cause problems there. This increases the chance of cure.

Targeted therapy

Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells with less harm to normal cells.

One type of medicine targets proteins that help tumours form new blood vessels. This type includes the medicines bevacizumab and ramucirumab.

Another type targets a protein (epidermal growth factor receptor) that helps cancer cells grow. This type includes the medicines erlotinib, afatinib, gefitinib, osimertinib and dacomitinib  With further research and development in cancer treatment, there are more mutations being detected in lung cancer, and newer medicines being developed to target these mutations.

Other medicines target cancer cells that have certain gene mutations that help them to grow and spread.

Immunotherapy

Immunotherapy involves treatment with medicines that boost the ability of the immune system to attack cancer cells. Immunotherapy can be used to treat some forms of non–small cell lung cancer and small cell lung cancer.

For example, nivolumab, pembrolizumab and cemiplimab are medicines that boost the immune response against cancer cells by targeting a protein on immune system cells (T cells) that normally stops these cells attacking the body’s normal tissues. This boosts the immune response against cancer cells.

Other treatments

Other types of treatment that may be used for non–small cell lung cancer are:

• laser therapy: a laser beam is used to kill cancer cells
• photodynamic therapy: a laser light, combined with a medicine that becomes active when it is exposed to light, is used to kill cancer cells
• cryosurgery: an instrument is used to destroy abnormal tissue by freezing it
• electrocautery: a needle heated by an electric current is used to destroy abnormal tissue.

These treatments are mostly used for advanced disease.

Follow-up

After treatment for lung cancer, you will need regular follow-up examinations and tests to look for return of the cancer or side effects from treatment. These might include X-rays or CT scans.

Advanced disease

Stage IV lung cancer is very hard to cure because tumours have spread to other parts of the body.Palliative treatment to control the symptoms of the disease may be the best option. Surgery, chemotherapy, radiotherapy and targeted treatments may relieve symptoms, slow the spread of the cancer and help you to live longer.

Specific treatments may also be used to:

• remove fluid buildup around the lungs, which can press on the lungs and make breathing difficult
• remove fluid buildup around the heart, which can press on the heart and affect its function
• relieve blockages in airways caused by the cancer.

Recurrent cancer

Lung cancer can recur (come back) after treatment. The cancer can recur in the lungs or somewhere else in the body, and is classified as local or distant (often called metastatic cancer).

Secondary cancer is when the cancer spreads to another part of the body.

Treatment of recurrent and secondary lung cancer will depend on where the cancer is, how large it is, what treatments have been used before and the person’s general health. It might involve surgery, chemotherapy, radiation therapy, immunotherapy or targeted treatments.