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Treatment of Lung Cancer

Posted Aug 24 2008 1:49pm
ANNOUNCER: Lung cancer is one of the most common cancers in the U.S. There are two main types-small cell accounts for about 15-20% of all lung cancer and usually spreads rapidly. Non-small cell is far more common. It accounts for the majority of lung cancers diagnosed and develops more slowly. For each type of this disease, there are several treatment options to be considered.

DAVID JOHNSON MD: For small cell lung cancer, the treatment of choice always includes chemotherapy. Small cell lung cancer is virtually always widely spread as soon as it's diagnosed. And therefore some form of treatment that courses through the bloodstream and goes to all the various parts of the body is necessary to treat small cell lung cancer. Occasionally radiation therapy is also used but always in conjunction with chemotherapy when treating small cell lung cancer.

For non-small cell lung cancer, treatment can consist of surgery, radiation therapy, chemotherapy or some combination of all of the above. For those individuals whose cancer has already spread beyond the chest, typically chemotherapy is used primarily. And occasionally radiation treatment might be used, principally to treat an area that is quite symptomatic. For example a lesion in the bone, where the tumor has spread and caused an injury to the bone.

ANNOUNCER: When chemotherapy is used, there are many drugs available.

NASSER ALTORKI, MD: Usually you will get more than one drug, usually two drugs. One drug by itself is probably not sufficient; three drugs combined together probably will add more side effects and little benefit. So most people will use two drugs of chemotherapy together in treating lung cancer. And you know there are a number of them out there. There's Taxol and carboplatin and cisplatin and a variety of agents.

DAVID JOHNSON, MD: We now know that combination therapy that is adding a second drug to cis or carboplatin, is the most effective way of treating advanced non-small cell lung cancer. In the United States, the most common drugs used to treat this disease are carboplatin and a drug known as paclitaxel or Taxol or possibly a drug known as Gemzar or gemcitabine. But other drugs, like docetaxel or taxotere can be used in the treatment of this disease as well.

In small cell lung cancer, cisplatin and a drug know as etoposide or VePesid are the most common drugs used. Other drugs like Cytoxan, adriamycin and vincristine can be used.

These drugs are typically administered intravenously. These are done today as an outpatient. It used to be that we had to hospitalize individuals, but with the new supportive care medications that can combat the side effects of chemotherapy, like nausea, vomiting, and the like, we're able to do this quite successfully in the outpatient setting. So most patients come in for a few hours, receive their therapies and go home that same day.

ANNOUNCER: Another treatment option for many lung cancer patients is surgery.

DAVID JOHNSON, MD: Surgery is used when the disease is confined to the chest and the surgeon can remove all the visible disease without rendering the patient a pulmonary cripple. That is causing him or her to be breathless after their surgery. About 20% maybe as high as 25% of patients can be treated with an operation.

I think in this day and age, what we're seeing is more and more of a combined modality approach, with multiple physicians involved in the care of individuals with lung cancer. For example, there are a few patients we see who are possibly candidates for an operation, but for whom some cancer cells might be left behind. In situations like that, we do believe that perhaps giving chemotherapy prior to the operation, with or without radiation treatment, may allow the surgeon to successfully re-sect all the visible cancer, and perhaps may kill the cancer that has moved to some other part of the body. ANNOUNCER: As doctors continue to learn more about lung cancer, there is reason to hope that earlier diagnosis and future treatments will be more successful at combating this disease.

DAVID JOHNSON, MD: We're improving our ability to diagnose this disease, earlier and earlier. I think that's important. I think the message has finally gotten out that cigarette smoking is not a good thing. We don't have nearly as many Americans smoking today as we did 25 years ago, and that's good news.

NASSER ALTORKI, MD: Cancer is found early before it had produced symptoms, preferably at a small size, preferably when it's still operable. All these together substantially increase the likelihood of cure if surgery is performed. For those who have advanced disease, the good news is not quite here, but maybe will materialize in the next few years. I think there will be a substantial explosion of new agents that will come to the field that are more specific in the way they treat lung cancer.

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