Lung cancer

Treatment

Treating lung cancer used to be simpler — because there simply were not as many treatments available. Today, people facing this disease have more options, and significantly higher survival rates, than they did even a few years ago. 

Recent advances allow us to precisely tailor your treatment based on the particular features of your cancer. Newer options mean increased complexity, which is why it’s essential to receive care from doctors who specialize in this disease.  

At Seattle Cancer Care Alliance (SCCA), we have been personalizing lung cancer care for decades. Our experts offer comprehensive care — from prevention, screening and diagnosis to treatment and surveillance.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group.
Dr. Michael Mulligan discusses lung cancer treatment at SCCA.

Lung cancer expertise at SCCA

Everything you need is here

We have thoracic surgeons, medical oncologists, radiation oncologists, pulmonologists, chest radiologists and pathologists who specialize in lung cancer; the most advanced diagnostic, treatment and recovery programs; and extensive support. Managing symptoms, with an emphasis on quality of life, is as important to our doctors as it is to you, and it’s part of every patient’s care.

Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation oncologist A physician who has special training in using radiation to treat cancer. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Thoracic Having to do with the chest.
Innovative lung cancer therapies

SCCA patients have access to advanced therapies being explored in over a dozen clinical studies for lung cancer conducted here and at our founding organizations Fred Hutchinson Cancer Research Center and UW Medicine.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease.
Lung cancer treatment tailored to you

We view treatment as a collaborative effort. Your SCCA doctor will explain all your options and recommend a treatment plan based on the type and stage of your cancer and several other factors, including your health, your lifestyle and the probability of curing your disease, extending your life or relieving your symptoms.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Team-based approach

Your personal team includes more than your lung cancer doctors. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like an infectious disease doctor, palliative care professional, social worker, physical therapist or dietitian.

Learn More About Supportive Care Services

Ongoing care and support

During and after treatment, your team continues to provide follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life as a lung cancer survivor.

Learn More About the SCCA Survivorship Clinic

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at SCCA. 

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Chemotherapy

Depending on the type and stage of your cancer, your medical oncologist may recommend chemotherapy:

  • Before surgery to shrink your tumor so it’s easier to remove
  • After surgery to kill any remaining cancer cells and improve your chances of a cure 
  • Along with other treatments, if surgery isn’t an option for you

Lung cancer chemotherapy is generally given every three to four weeks in cycles, either in pill form or through an intravenous (IV) line in the hand or arm or a port in the chest.

Your SCCA team will talk with you about the specific medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout SCCA.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.
Chemotherapy

Depending on the type and stage of your cancer, your medical oncologist may recommend chemotherapy.

Immunotherapy

One of the major changes in lung cancer treatment recently is the introduction of immunotherapies. These medicines harness your immune system to fight your cancer. They may be used alone or with chemotherapy or, in clinical trials, with other treatments.

Most lung cancer immunotherapy relies on medicines called checkpoint inhibitors. SCCA doctors and researchers are exploring additional types of immunotherapy for lung cancer.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies.
Immunotherapy

One of the major changes in lung cancer treatment recently is the introduction of immunotherapies. These medicines harness your immune system to fight your cancer. They may be used alone or with chemotherapy or, in clinical trials, with other treatments.

Proton therapy

Proton therapy offers:

  • Less radiation to your heart, lung, and esophagus
  • Potentially fewer side effects in some patients from radiation treatment, including lower rates of pneumonitis and esophagitis (less inflammation of the lungs and esophagus) compared to conventional radiation 
  • Similar efficacy at killing cancer cells as other forms of radiation

Advantages of proton therapy over X-ray radiation 

Too much radiation to the healthy tissue surrounding the tumor can increase the risk of side effects. This is a major concern when it comes to radiation treatment for lung cancer because the cancer may be close to your heart, healthy lung, and other critical organs. The unique properties of protons allow proton radiation to better conform to your cancer, reducing excess radiation to the healthy tissues and organs around it.

A large clinical trial in lung cancer treatment recently showed that a patient’s survival after lung cancer treatment is closely related to the amount of radiation the patient’s heart received, and the amount of esophagus toxicity (swallowing difficulty) patients developed during radiation treatment (trial RTOG 0617). Proton therapy can decrease the radiation dose to the heart and the esophagus, as well as normal lung.

In the figure below, a proton therapy radiation plan is shown on the right, and a plan with conventional radiation is shown on the left. With proton radiation, there is less radiation to the normal lung, heart, and rest of the body, compared with conventional radiation.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Proton therapy lung

Types of lung and thoracic cancers

Below is a list of lung and thoracic cancers that can benefit from proton therapy. Our radiation oncologists use other forms of radiation to treat cancers, so they will provide you with an expert recommendation for your consideration. 

  • Non-small cell lung cancer
  • Select small cell lung cancer 
  • Malignant mesothelioma
  • Mediastinal tumors
    • Thymoma
    • Sarcoma
  • Select recurrent lung and metastatic cancer

Are you a candidate for proton therapy?

You should consider proton therapy if you:

  • Have lung cancer that has not spread outside your chest, especially along with one of the following:
    • Have limited or poor pulmonary function
    • Have a heart condition
    • Had prior radiation therapy
Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation oncologist A physician who has special training in using radiation to treat cancer. Thoracic Having to do with the chest.
Proton therapy

Proton therapy is a form of radiation therapy that, for some lung cancer patients, allows for greater sparing of their organs from the effects of radiation exposure.

Radiation treatment

Many people with lung cancer have radiation therapy alone or along with other treatments. It is painless and noninvasive, and each treatment lasts only minutes. 

Radiation therapy may be used:

  • To cure lung cancer, either alone or with surgery, chemotherapy or immunotherapy 
  • To relieve symptoms of advanced lung cancer, such as pain or trouble breathing

Different types of radiation treatments are used for different situations. A few examples of the types used for lung cancer are:

  • Intensity-modulated image-guided radiotherapy (IMRT/IGRT)
  • Radiosurgery
  • Proton therapy

IMRT/IGRT

In this form of radiation treatment, doctors use computed tomography (CT) to scan your tumor and create beams of radiation that closely conform to the tumor’s shape. The beams vary in shape and intensity to deliver a higher dose of radiation to the tumor and lower doses to nearby healthy tissue. 

Learn more about IMRT/IGRT and other forms of external-beam radiation therapy (EBRT).

Radiosurgery

Radiosurgery is an advanced form of highly focused, high-dose radiation therapy that can kill tumors in fewer treatments than conventional radiation treatment — typically one to five sessions rather than daily sessions for several weeks. It has a greater than 95 percent chance of killing small lung tumors.

There are many names for this type of treatment, including:

  • Stereotactic body radiation therapy (SBRT)
  • Stereotactic ablative body radiotherapy (SABR) 
  • CyberKnife, a brand name

Proton therapy 

Proton therapy is an advanced therapy and an important alternative to conventional radiation for many types of cancer (and some noncancerous tumors).
 
Lung cancer is frequently located close to critical structures. The advantage of using protons to treat this cancer is that doctors can target high doses of radiation at the cancer with the goal of minimizing radiation to healthy tissues. This may reduce side effects. SCCA Proton Therapy Center is the only facility in a seven-state region to offer this treatment.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Radiation treatment

Many people with lung cancer have radiation therapy alone or along with other treatments. It is painless and noninvasive, and each treatment lasts only minutes. 

Surgery

SCCA patients have surgery at University of Washington Medical Center (UWMC) with thoracic surgeons who are among the best in the country. Surgeons at UWMC do more lung operations than anywhere else in the Pacific Northwest. They also help diagnose and stage lung cancer and relieve symptoms of advanced disease.

Our surgeons have some of the most extensive experience in the world taking on the most complex cases, including patients who might be told elsewhere that they cannot have surgery or surgery is too risky.

  • For early-stage non-small cell lung cancer, surgery to remove the cancer may be an option. When it is an option, it provides the best chance for a cure. 
  • For small cell lung cancer, doctors rarely use surgery because by the time the disease is found it has often spread too far for surgery to be effective.

Any surgery your team recommends will depend on the type and stage of your disease, your general health and your lung function. Your surgeon will probably remove lymph nodes too to check them for signs of cancer. 

Common surgical procedures for lung cancer

These surgeries are typically used to treat lung cancer.

  • Lobectomy — removing a whole lobe (section) of the lung. This is the most common lung cancer surgery.
  • Wedge resection or segmentectomy — removing part of a lobe of the lung. This is the second most common lung cancer surgery. It may be used for several reasons, including if you have compromised lung function, are too sick to undergo lobectomy or strongly prefer to preserve lung function.
  • Pneumonectomy — removing the entire lung on the side of your body with the tumor. You may need this surgery due to the size or location of your cancer, although most experts look for ways to spare the lung using advanced surgical procedures.

Video-assisted thoracic surgery

Minimally invasive surgery called video-assisted thoracic surgery (VATS) may be an option if you have early-stage lung cancer. 

Classically, surgeons make a 6- to 10-inch incision, cutting larger portions of muscles and spreading ribs to reach the tumor.

With VATS, surgeons make three to four small incisions about an inch long, cut less muscle and entirely avoid spreading ribs. They operate by inserting a camera through one incision and surgical instruments through the others.

People who have VATS may have less pain and a quicker recovery of function and quality life after leaving the hospital.

Advanced surgical and endoscopic procedures

Sometimes lung cancer is difficult to remove surgically because it involves the main air passages, major blood vessels, the rib cage or other important structures in the chest.

Procedures performed at UWMC for complex or advanced lung cancers include:

  • Sleeve resection — used for cancer in the large airways (trachea or bronchi). The cancerous section of the airway is removed, and the remaining sections are sewn together.
  • Carinal pneumonectomy — to remove the lung and the lower part of the trachea, where it branches toward that lung. The remaining trachea and lung airway are sewn together.
  • Vascular reconstruction — to rebuild the pulmonary artery when the tumor involves this blood vessel as well as the airways. The goal is to remove the cancer entirely and save the lung, potentially avoiding a pneumonectomy.
  • Chest-wall resection and reconstruction — to remove a tumor in the chest wall and reconstruct the chest.
  • Stenting – to place a tube inside the airway to help open it, allowing patients to breathe easier.
  • Tumor debulking – to remove a tumor piece by piece from inside the airway, allowing patients to breathe easier.

 

Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Thoracic Having to do with the chest.
Surgery

SCCA patients have surgery at University of Washington Medical Center (UWMC) with thoracic surgeons who are among the best in the country. Surgeons at UWMC do more lung operations than anywhere else in the Pacific Northwest. They also help diagnose and stage lung cancer and relieve symptoms of advanced disease.

Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. These medicines are used most often in people with advanced and recurrent lung cancer and are effective in patients with specific changes in their tumor genes

The current standard of care is to test for changes in the genes EGFR, ALK, ROS1 and BRAF, which we can do using UW-OncoPlex, a diagnostic tool developed by researchers at UW Medicine. Treatments are being developed to target other genetic changes as well.

For lung cancer, targeted therapies called small molecules are used to block specific growth-factor receptors involved in cancer cell proliferation (growth and division of cancer cells). Examples include erlotinib (Tarceva), gefitinib (Iressa), crizotinib (Xalkori), alectinib (Alecensa) and others.

At SCCA, patients have access to newer targeted therapies in clinical studies that aren’t available otherwise. This is a very active area of research.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. These medicines are used most often in people with advanced and recurrent lung cancer and are effective in patients with specific changes in their tumor genes.