Discussion Of Management Of Stage Iv Non
NSCLC is the leading cause of cancer-related deaths worldwide. Brain, bone, liver, and adrenal gland are the most common extrapulmonary sites of distant metastases. 20-50% of NSCLC will present with metastatic disease. Stage IV NSCLC cancer has an overall median survival time of 7-11 months.
In the past, patients with stage IV disease were generally believed to be incurable. Patients with oligometastatic disease represent a distinct subset. After full evaluation, approximately 7% of patients with metastatic disease will have solitary metastasis. There is evidence that in such patients, survival benefit can be achieved with surgical resection.
Accurate clinical staging is of utmost importance before embarking on curative surgery. FDG-PET/CT plays an important role in decision making and should be done if radical treatment is considered. The overall 5-year survival rate is about 28% for patients with satellite nodules and 21% for patients with ipsilateral pulmonary nodules. In patients with brain metastases, surgical resection achieves 5-year survival rates between 11% and 30%, and those with adrenalectomy for adrenal metastases have 5-year survival rates of 26%.
Most of the data on curative management of oligometastatic NSCLC include patient with adrenal metastasis, brain metastasis, and few selected reports of patients with lung cancer with only a malignant pleural effusion and no other metastatic sites who have long-term cures with chemotherapy and surgery.
Chemotherapy Drugs Used To Treat Nsclc
The chemo drugs most often used for NSCLC include:
Combinations of 2 chemo drugs are often used to treat early-stage lung cancer. If a combination is used, it often includes cisplatin or carboplatin plus one other drug. Sometimes other combinations that do not include these drugs, such as gemcitabine with vinorelbine or paclitaxel, may be used.
Advanced lung cancer though may be treated with a single chemo drug especially for people who might not tolerate combination chemotherapy well, such as those in poor overall health or who are elderly.
For some people with advanced lung cancer, a targeted therapy drug or an immunotherapy drug may be given along with chemotherapy. For more on this, see Treatment Choices for Non-Small Cell Lung Cancer, by Stage.
Chemotherapy For Lung Cancer Treatment: What You Should Know
The use of drugs to treat lung cancer is called chemotherapy or chemo for short. Chemotherapy for lung cancer treatment uses a drug that employs cell-killing medications to attack cancer cells. These drugs are usually given intravenously either by injection or infusion. Some chemo drugs are available in pill form. Chemo is the primary treatment for small cell lung cancer . For non-small cell lung cancer , your doctor may recommend chemotherapy either before or after surgery.
Understand the basics of chemotherapy for lung cancer in this intro video from Hope with Answers. In this video, patient advocate Montessa Lee discusses chemotherapy for lung cancer with lung cancer researcher, Dr. Vincent Lam.
Learn more detailed information about chemotherapy for lung cancer in this intermediate video from Hope with Answers. In this video, lung cancer patient and advocate Montessa Lee discusses chemotherapy for lung cancer with Dr. Vincent Lam from Johns Hopkins Medical Center. Discover in-depth information about chemotherapy for lung cancer. Patient advocate Montessa Lee asks Dr. Vincent Lam to discuss new treatment options that help with the side effects of chemotherapy.
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Treatment Option Overview For Nsclc
In This Section
In non-small cell lung cancer , results of standard treatment are poorexcept for the most localized cancers. All newly diagnosed patients with NSCLCare potential candidates for studies evaluating new forms of treatment.
Treatment decisions are based on some of the following factors:
- Knowledge of histologic type.
- Status and location of lymph nodes by station.
- Lymphovascular invasion.
Surgery is potentially the most curative therapeutic option for this disease. Postoperative chemotherapy may provide an additional benefit to patients with resected NSCLC. Radiation therapy combined with chemotherapy can produce a cure in a small number of patients and can provide palliation in most patients. Prophylactic cranial irradiation may reduce the incidence of brain metastases, but there is no evidence of a survival benefit and the effect of prophylactic cranial irradiation on quality of life is not known. In patients with advanced-stage disease, chemotherapy or epidermal growth factor receptor kinase inhibitors offer modestimprovements in median survival, although overall survival is poor.
The treatment options for each stage of NSCLC are presented in Table 5.
|NSCLC = non-small cell lung cancer TKIs = tyrosine kinase inhibitors TNM = tumor, node, metastasis.
Other Limited Stage Cancers
For most people with limited stage SCLC, surgery is not an option because the tumor is too large, its in a place that cant be removed easily, or it has spread to nearby lymph nodes or other lobes in the same lung. If you are in good health, the standard treatment is chemo plus radiation to the chest given at the same time . The chemo drugs used are usually etoposide plus either cisplatin or carboplatin.
Concurrent chemoradiation can help people with limited stage SCLC live longer and give them a better chance at a cure than giving one treatment . The downside is that this combination has more side effects than either chemo or radiation alone.
People who arent healthy enough for chemoradiation are usually treated with chemo by itself. This may be followed by radiation to the chest.
If no measures are taken to prevent it, about half of people with SCLC will have cancer spread to their brain. If your cancer has responded well to initial treatment, you may be given radiation therapy to the head to try to prevent this. The radiation is usually given in lower doses than what is used if the cancer had already spread to brain, but some patients may still have side effects.
In most people with limited stage SCLC, tumors treated with chemo will shrink significantly. In many, the tumor will shrink to the point where it can no longer be seen on imaging tests. Unfortunately, for most people, the cancer will return at some point.
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Ajcc Stage Groupings And Tnm Definitions
The AJCC has designated staging by TNM classification to define NSCLC.
|aReprinted with permission from AJCC: Lung. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 43156.
|Regional lymph nodes cannot be assessed.
|No regional lymph node metastasis.
|Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension.
|Metastasis in ipsilateral mediastinal and/or subcarinal lymph node.
|Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node.
|aReprinted with permission from AJCC: Lung. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 43156.
|Single extrathoracic metastases in a single organ .
|Multiple extrathoracic metastases in a single organ or in multiple organs.
Chemotherapy For Small Cell Lung Cancer
Chemotherapy is usually the first treatment for small cell lung cancer . You may have it:
- at the same time as radiotherapy , if the cancer has not spread to other parts of the body
- before radiotherapy to try to shrink the cancer
- on its own to control advanced cancer, help you live longer and improve symptoms.
Chemotherapy may also be given after surgery to try to get rid of any remaining cancer cells. But surgery is not usually possible for SCLC.
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Differential Diagnosis And Diagnostic Evaluation Recommended
The common differential diagnoses for weight loss and lung mass with lymphadenopathy in a male smoker in our country are chronic obstructive lung disease, chronic bronchitis, tuberculosis, pneumonia, and lung cancer. Clinical history and thorough examination should be made with careful palpation of the neck for lymphadenopathy and chest auscultation. A chest radiograph is the basis of imaging and is complemented by a contrast-enhanced CT scan of the chest, which should include the liver and the adrenal glands. Tissue diagnosis is mandatory if the clinicoradiological suspicion of malignancy is high and a biopsy should be performed either by bronchoscopy or with CT guidance. If confirmed to be malignant, further staging workup would be required if the chest CT scan shows non-metastatic disease. A metastatic workup would include a positron emission tomography -CT scan and a magnetic resonance imaging scan of the brain.
Our patient presented to us with a CT scan showing a left upper lobe mass with ipsilateral mediastinal lymphadenopathy and a small pleural effusion. His vitals were normal, physical examination was unremarkable, and ECOG performance status was 1. Fiber optic bronchoscopy showed no endobronchial growth. Diagnostic thoracentesis was performed. Pleural fluid cytology was positive for metastatic squamous cell carcinoma.
Treatment Of Occult Nsclc
In occult lung cancer, a diagnostic evaluation often includes chest x-ray andselective bronchoscopy with close follow-up ,when needed, to define the site and nature of the primary tumor tumorsdiscovered in this fashion are generally early stage and curable by surgery.
After discovery of the primary tumor, treatment involves establishingthe stage of the tumor. Therapy is identical to that recommended for other non-small cell lung cancer patients with similar-stage disease.
Is Stage 4 Lung Cancer The Same As Stage 4 Mesothelioma
No. Mesothelioma is a very rare cancer that affects the linings of major body organs. Mesothelioma is sometimes mistaken for lung cancer since it often develops in the lung lining.
That said, stage 4 mesothelioma is not the same illness as stage 4 lung cancer. Doctors must take a different approach when treating stage 4 mesothelioma than would be used if the patient had stage 4 lung cancer.
Since both mesothelioma and lung cancer can be caused by asbestos exposure and since the cancers have similar symptoms its important to talk to your doctor and get correctly diagnosed before starting treatments.
American Cancer Society. . Chemotherapy for small cell lung cancer: Lung cancer chemo. Retrieved September 15, 2022, from https://www.cancer.org/cancer/lung-cancer/treating-small-cell/chemotherapy.html
American Cancer Society. . Immunotherapy for small cell lung cancer: SCLC immunotherapy. Retrieved September 15, 2022, from https://www.cancer.org/cancer/lung-cancer/treating-small-cell/immunotherapy.html
American Cancer Society. . Non-small cell lung cancer chemotherapy: Chemo side effects. Retrieved September 15, 2022, from https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/chemotherapy.html
American Cancer Society. . Non-small cell lung cancer palliative procedures. Retrieved September 15, 2022, from https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/palliative.html
Stage 4 Lung Cancer Symptoms
While there are typically little to no symptoms in the early stages of lung cancer, patients often experience uncomfortable symptoms in stage 4.
Symptoms of stage 4 lung cancer include:
- Swelling in lymph nodes
Further, there are several symptoms that occur because the cancer has spread to other body parts.
For example, stage 4 lung cancer patients may suffer from headaches, dizziness, or numb limbs due to brain metastasis. They may also develop jaundice if the tumors reach the liver and prevent it from functioning normally.
Fluid may also build up in the lining of the lungs or heart in cases of stage 4 lung cancer. These are known as pleural effusions and pericardial effusions, respectively. Both can cause chest pain and breathing problems.
If you or a loved one is having any of the symptoms listed above and lung cancer is suspected, see a doctor as soon as possible. Stage 4 lung cancer is life-threatening, but prompt treatment can ease symptoms and possibly help you live longer.
Call to learn how you can afford medical care for stage 4 lung cancer.
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Stage 4 Small Cell Lung Cancer
The second most-common type of lung cancer after NSCLC is small cell lung cancer . SCLC is not typically grouped into numbered stages. Instead, its identified as limited stage or extensive stage.
- With limited-stage SCLC, the cancer is present in one lung and may have spread to lymph nodes near that lung, but its contained to one side of the chest. If the lung has multiple tumors, the cancer may not be in the limited stage.
- Extensive-stage SCLC is similar to stage 4 NSCLC in that it is metastatic. SCLC is considered extensive if it has spread throughout the original lung, into the other lung or faraway lymph nodes, or to any other areas of the body.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place . Most often, when there is recurrence, it is stage IV disease.
When there is a recurrence, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
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Types Of Chest Wall Tumors
Tumors found in the chest wall are also categorized by whether they are primary tumors or metastatic tumors . All metastatic tumors are malignant. In children, most chest wall tumors are primary, while they are more often metastatic in adults. Primary tumors start in the bones or muscles located in the chest wall.
Sarcomas â tumors that start in bone or muscle tissue, or more rarely in other types of tissue â are the most common type of primary tumor found in the chest wall.
Symptoms Of Stage 4 Lung Cancer
If lung cancer has spread to other areas of the body, multiple symptoms may be present, including:
- Jaundice, or yellowing of the skin and eyes
- A sensation of pain in the bones
- Swollen lymph nodes around the neck or collarbone
- Nervous system problems such as balance issues, seizures, dizziness, muscle weakness or numbness in the arms or legs
These symptoms may be combined with the symptoms of earlier stage lung cancers, which can include persistent coughing, chest pain, shortness of breath, voice hoarseness and coughing up blood. Symptoms may also vary according to where in the body the lung cancer has spread. For example, an individual with brain metastasis is more likely to experience headaches and neurological problems, while liver metastasis often results in jaundice.
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Surgical Outcomes Of Stage Iv Non
Chenxi Zhang#, Lei Wang#, Weimiao Li#, Zhao Huang, Wenhao Liu, Peilong Bao, Yuanyang Lai, Yong Han, Xiaofei Li, Jinbo Zhao
Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University , , China
Contributions: Conception and design: C Zhang, L Wang, W Li, X Li, J Zhao Administrative support: X Li, J Zhao Provision of study materials or patients: P Bao, Y Lai, Y Han Collection and assembly of data: C Zhang, L Wang, W Li, Z Huang, W Liu Data analysis and interpretation: C Zhang, L Wang, W Li, X Li, J Zhao Manuscript writing: All authors Final approval of manuscript: All authors.
#These authors contribute equally to this work.
Background: Increasing evidence has shown the effectiveness of surgery for stage IV non-small cell lung cancer . Present study aims to summarize the experience of our institution in dealing with advanced NSCLC in the context of multimodality therapy including lung surgery.
Methods: Patients underwent surgical resection for stage IV NSCLC diagnosed before or during surgery from January 2014 to June 2017 at Tangdu Hospital were included in this study.
Surgery may be a considerable choice for stage IV NSCLC in the context of multimodality therapy.
Keywords: Non-small cell lung cancer surgery multimodality therapy targeted therapy overall survival
Submitted Apr 26, 2019. Accepted for publication Sep 03, 2019.
How Is Chemotherapy Given
Chemo drugs for lung cancer are typically given into a vein , either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctors office, chemotherapy clinic, or in a hospital setting.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. They are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
Many different kinds of CVCs are available. The 2 most common types are the port and the PICC line.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 3 or 4 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
Adjuvant and neoadjuvant chemo is often given for 3 to 4 months, depending on the drugs used. The length of treatment for advanced lung cancer is based on how well it is working and what side effects you have.
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