Treatment for advanced lung cancer
Advanced lung cancer
Advanced (or metastatic) lung cancer means the cancer has
spread from where it started in the lung. A cancer may be advanced when
it is first diagnosed. Or the cancer may come back some time after you
are first treated (recurrent cancer).
Lung cancer can spread locally into nearby structures – for example, it may grow into an airway, the chest wall or the lining of the lung (the pleura). You can find more information about the stages of lung cancer in this section.
Specialists regard a lung cancer as advanced if you have fluid collecting around the lung and the fluid contains cancer cells. This situation is called a pleural effusion. There is information about treating pleural effusion on the treatment for advanced lung cancer page.
A cancer that has spread to another part of the body is called a secondary cancer or metastasis. Some of the lung cancer cells have travelled through the lymphatic system or bloodstream and lodged in another part of the body. The cells have then started to grow there. See the what is cancer page for information about how this happens.
Lung cancer can spread locally into nearby structures – for example, it may grow into an airway, the chest wall or the lining of the lung (the pleura). You can find more information about the stages of lung cancer in this section.
Specialists regard a lung cancer as advanced if you have fluid collecting around the lung and the fluid contains cancer cells. This situation is called a pleural effusion. There is information about treating pleural effusion on the treatment for advanced lung cancer page.
A cancer that has spread to another part of the body is called a secondary cancer or metastasis. Some of the lung cancer cells have travelled through the lymphatic system or bloodstream and lodged in another part of the body. The cells have then started to grow there. See the what is cancer page for information about how this happens.
Not all lung cancers will spread. But if the cancer does
spread there are certain parts of the body that it is more likely to go
to. The most common areas for lung cancer to spread to are
Remember that you may sometimes get aches and pains that are not related to the cancer. But do check with your doctor about any symptom that worries you. Your doctor will be able to help.
- The lymph nodes within the chest, or in the abdomen, neck, or armpit
- The liver
- The bones
- The brain
- The adrenal glands
Lymph nodes
Lymph nodes containing cancer are usually bigger than normal. If you find any lumps in your neck or armpit, do tell your doctor. Lymph nodes do also get bigger if you have an infection. So you can't be sure of the cause of a lump until your doctor has examined you and done some tests.Liver
Cancer spread to the liver may cause pain in your right side, just under your ribs. Or you may feel sick, particularly after eating rich food. A later symptom is often jaundice, where the whites of your eyes and your skin may look a bit yellow. Your doctor can use a blood test to check how well your liver is working. You may also have an abdominal ultrasound.Bones
If you have cancer cells in the bone, this is most likely to show up as pain. The cancer cells weaken the bone and sometimes a fracture is the first sign. It is most likely to be diagnosed on an X-ray or after a bone scan. Treatment can help to control the pain and may strengthen the bone.Brain
Cancer spread to the brain may make you drowsy and confused. Or you may have severe headaches, often with sickness. Cancer in the brain is most often treated with radiotherapy, together with steroid tablets, to control symptoms. It is most likely to be diagnosed with a brain scan, either a CT scan or an MRI scan.Adrenal glands
Cancer that has spread to the adrenal glands does not usually cause symptoms. The adrenal glands are hormone producing glands on top of the kidneys. But your level of adrenal hormones may get very low if both adrenal glands contain cancer cells. Low levels of these hormones may cause faintness, dizziness, weakness, tiredness and weight loss. Some people may also have stomach aches. Adrenal gland secondaries usually show up on a CT scan or ultrasound scan.Remember that you may sometimes get aches and pains that are not related to the cancer. But do check with your doctor about any symptom that worries you. Your doctor will be able to help.
Our lung cancer organisations page has details of people who can give information about advanced lung cancer and its treatment. Some organisations can put you in touch with a cancer support group. Our lung cancer reading list has information about books and leaflets on lung cancer treatments.
You can ask your doctor or specialist nurse to write down the names of your treatments so that you can look them up. We have detailed information about cancer drugs in our cancer drugs section.
How your treatment is planned
You may have chemotherapy or radiotherapy to treat advanced lung cancer.
These treatments can shrink the cancer or stop it growing. This can
help to reduce symptoms and keep you well for longer. Doctors may use biological therapies called erlotinib (Tarceva) or gefitinib (Iressa) for some types of non small cell lung cancer.
The treatment that is best for you depends on
If you have already had radiotherapy to a particular part of your body, you may not be able to have any more to that area. There is a maximum amount of radiation that you can have to any part of the body before it causes too many side effects. Your doctor may then suggest chemotherapy or biological therapy instead.
The treatment that is best for you depends on
- The type of lung cancer you have
- Where the cancer has spread to
- The treatment you have already had
- Any other medical conditions you might have
If you have already had radiotherapy to a particular part of your body, you may not be able to have any more to that area. There is a maximum amount of radiation that you can have to any part of the body before it causes too many side effects. Your doctor may then suggest chemotherapy or biological therapy instead.
Advanced lung cancer often causes symptoms. Even if your
cancer cannot be cured, there is treatment available to control your
symptoms. The treatment you need will depend on what is causing your
symptoms.
Common symptoms include a cough and breathlessness, these can be distressing and frightening. They may be caused by a blocked airway or fluid on the lung. Below you can find information about possible treatments if these are the causes. There are other possible causes and other treatments you may have such as antibiotics if you have an infection. Other treatments that can help to control them include steroids and other drugs such as muscle relaxants and pain killers. You can find out more about coping with breathlessness in the living with lung cancer section.
Other symptoms of advanced lung cancer may include tiredness, weight loss and loss of appetite there is more information about coping and treatment for these in the coping physically section.
Common symptoms include a cough and breathlessness, these can be distressing and frightening. They may be caused by a blocked airway or fluid on the lung. Below you can find information about possible treatments if these are the causes. There are other possible causes and other treatments you may have such as antibiotics if you have an infection. Other treatments that can help to control them include steroids and other drugs such as muscle relaxants and pain killers. You can find out more about coping with breathlessness in the living with lung cancer section.
Other symptoms of advanced lung cancer may include tiredness, weight loss and loss of appetite there is more information about coping and treatment for these in the coping physically section.
If the cancer is blocking, or partly blocking, an airway and
making you breathless your doctor may suggest one of several treatment
options. You may have
If the tumour is squashing your airway and making it difficult for you to breathe comfortably, your doctor may suggest putting in a rigid tube to keep the airway clear. The tube is called a stent. There is detailed information about all these treatments on the page about treating a blockage in an airway.
- Internal radiotherapy (endobronchial radiotherapy)
- Electrocautery
- Laser therapy
- Photodynamic therapy (light treatment)
- Radiofrequency ablation
- Cryotherapy (treatment with a freezing probe)
If the tumour is squashing your airway and making it difficult for you to breathe comfortably, your doctor may suggest putting in a rigid tube to keep the airway clear. The tube is called a stent. There is detailed information about all these treatments on the page about treating a blockage in an airway.
It is quite common for people with lung cancer to develop a
collection of fluid between the sheets of tissue covering the lung (the
pleura). This is called a pleural effusion. It makes you breathless
because it takes up space in your chest that your lung would normally
fill when you breathe in.
The treatment is to drain off the fluid. This is called thoracentesis (thora-sen-tee-sis). Your doctor will ask you to sit comfortably, leaning forward onto a table or back of a chair. First, you have a local anaesthetic injection into one side of your back. When the anaesthetic has had time to work, the doctor makes a small cut in the area and puts in a needle called a cannula. This hollow needle is attached to a tube with a drainage bottle (or bag) at the end. Your doctor may put in the tube using a thoracoscope (a tube with a light and camera at the end) so that they can see inside the chest.
If you have more than a litre of fluid inside your chest, it needs to be drained off slowly. So the doctor will put in a stitch to hold the needle in place. Once it is secure, you can walk around carrying the drainage bottle. You may stay in hospital for a day or two while the fluid drains. When no more fluid drains out, you have a chest X-ray to make sure it's all gone. Then the doctor or nurse takes the drain out. Your nurse will put a dressing over the small wound site and then you can go home. If you had a stitch to hold the drain in, it is pulled tight when the doctor takes the tube out. You then have the stitch removed about a week later.
Some people have a tube in for weeks or months – this is called an indwelling catheter. Sometimes the pleura stick together again after a while and the fluid stops building up. You can then have the tube taken out.
Remember that if your tube is connected to a bag or bottle, don't lift it above where the tube goes into your chest. If you do the fluid could drain back in.
The treatment is to drain off the fluid. This is called thoracentesis (thora-sen-tee-sis). Your doctor will ask you to sit comfortably, leaning forward onto a table or back of a chair. First, you have a local anaesthetic injection into one side of your back. When the anaesthetic has had time to work, the doctor makes a small cut in the area and puts in a needle called a cannula. This hollow needle is attached to a tube with a drainage bottle (or bag) at the end. Your doctor may put in the tube using a thoracoscope (a tube with a light and camera at the end) so that they can see inside the chest.
If you have more than a litre of fluid inside your chest, it needs to be drained off slowly. So the doctor will put in a stitch to hold the needle in place. Once it is secure, you can walk around carrying the drainage bottle. You may stay in hospital for a day or two while the fluid drains. When no more fluid drains out, you have a chest X-ray to make sure it's all gone. Then the doctor or nurse takes the drain out. Your nurse will put a dressing over the small wound site and then you can go home. If you had a stitch to hold the drain in, it is pulled tight when the doctor takes the tube out. You then have the stitch removed about a week later.
Some people have a tube in for weeks or months – this is called an indwelling catheter. Sometimes the pleura stick together again after a while and the fluid stops building up. You can then have the tube taken out.
Remember that if your tube is connected to a bag or bottle, don't lift it above where the tube goes into your chest. If you do the fluid could drain back in.
Unfortunately, the fluid can build up again. You can have it
drained more than once. But it isn't a good idea to keep on doing it, as
you are likely to get an infection there in the end. If the fluid keeps
building up, or your doctor thinks that it will, you may have treatment
to try to stop it. This treatment is called pleurodesis
(ploo-ro-dee-sis). The fluid collects between the 2 pleural membranes
that cover the lung. Pleurodesis aims to stick the pleura together, so
there is no space for the fluid to collect. This won't make your
breathing worse in any way.
The procedure is the same as for draining a pleural effusion. Sometimes you have it done using video assisted thorocoscopy. But after the fluid has drained off, your doctor injects a sterile powder (talc) through the cannula. The powder irritates the pleura and makes them stick together. Once the powder is in, the doctor clamps off the tube for an hour or so. Your doctor may ask you to shift position every 10 minutes or so (side to side and front to back). This helps to move the talc around inside so that it coats the pleura all over.
After the hour is up, your doctor may connect a suction tube, as this helps the pleura to stick. Then the doctor can take the tube out, pull the stitch together and put on a dressing. You have the stitch taken out about a week later.
You may have a bit of chest pain after the procedure. Do ask for painkillers if you need them. There is detailed information about pleurodesis in the lung cancer questions section.
The procedure is the same as for draining a pleural effusion. Sometimes you have it done using video assisted thorocoscopy. But after the fluid has drained off, your doctor injects a sterile powder (talc) through the cannula. The powder irritates the pleura and makes them stick together. Once the powder is in, the doctor clamps off the tube for an hour or so. Your doctor may ask you to shift position every 10 minutes or so (side to side and front to back). This helps to move the talc around inside so that it coats the pleura all over.
After the hour is up, your doctor may connect a suction tube, as this helps the pleura to stick. Then the doctor can take the tube out, pull the stitch together and put on a dressing. You have the stitch taken out about a week later.
You may have a bit of chest pain after the procedure. Do ask for painkillers if you need them. There is detailed information about pleurodesis in the lung cancer questions section.
Small cell lung cancer more often spreads to the brain than
non small cell lung cancer. Cancer spread to the brain may make you
drowsy and confused. Or you may have severe headaches and sickness. It
is most likely to be diagnosed with a brain scan – either a CT scan or MRI scan.
To treat brain secondaries, you are most likely to have radiotherapy to the head, together with steroid tablets to control symptoms. You may have short term side effects for a few weeks, including tiredness, headaches and feeling or being sick. Your doctor can give you medicines to help.
If you are too unwell to have radiotherapy you will have steroid treatment on its own. If you are very tired you may need to rest a lot and have help and support from your family or friends.
There is detailed information about dealing with the side effects of brain radiotherapy in the brain tumour section.
To treat brain secondaries, you are most likely to have radiotherapy to the head, together with steroid tablets to control symptoms. You may have short term side effects for a few weeks, including tiredness, headaches and feeling or being sick. Your doctor can give you medicines to help.
If you are too unwell to have radiotherapy you will have steroid treatment on its own. If you are very tired you may need to rest a lot and have help and support from your family or friends.
There is detailed information about dealing with the side effects of brain radiotherapy in the brain tumour section.
Advanced lung cancer can sometimes block a large vein that
carries blood from the brain, head and arms back to the heart. The vein
is called the superior vena cava. When it is blocked it is called
superior vena cava obstruction. If the cancer squashes or blocks this
vein, there is a build up of pressure behind the blockage. Fluid then
seeps out from the bloodstream and collects in the tissues of the face.
People developing SVCO might notice swelling around their eyes, particularly first thing in the morning. SVCO can happen quite quickly or may take several weeks to develop.
Treatments are aimed at reducing the blockage of the vein and relieving symptoms. Steroids, such as prednisolone or dexamethasone can often reduce swelling. Other treatments depend on the type of lung cancer you have. Chemotherapy might be used for small cell lung cancer and radiotherapy for non small cell lung cancer.
Sometimes doctors put a metal tube (stent) inside the vein to keep it open. They might use a stent if SVCO develops rapidly, particularly if the cancer has not yet been fully diagnosed. Or they may use it if chemotherapy or radiotherapy does not help to relieve symptoms.
People developing SVCO might notice swelling around their eyes, particularly first thing in the morning. SVCO can happen quite quickly or may take several weeks to develop.
Treatments are aimed at reducing the blockage of the vein and relieving symptoms. Steroids, such as prednisolone or dexamethasone can often reduce swelling. Other treatments depend on the type of lung cancer you have. Chemotherapy might be used for small cell lung cancer and radiotherapy for non small cell lung cancer.
Sometimes doctors put a metal tube (stent) inside the vein to keep it open. They might use a stent if SVCO develops rapidly, particularly if the cancer has not yet been fully diagnosed. Or they may use it if chemotherapy or radiotherapy does not help to relieve symptoms.
When cancer spreads to the bones it can cause pain and weaken
them. When the bones are weaker they break more easily. To help
strengthen your bones, lower the risk of fractures and control pain you
may have drug treatment. You will have painkillers if you have pain and
you may also have drugs that help to strengthen your bones.
Bisphosphonate drugs slow down the damage to the bones that the cancer causes. This helps to lower the risk of fractures and controls pain. There are different types of bisphosphonates. You have some as a drip into your bloodstream but others can be taken as a tablet. You can find out more about bisphosphonates in the main treatment section.
Another drug that can help to strengthen your bones is a monoclonal antibody called denosumab. It works by helping to stop the breakdown of the bones. You have it as an injection just under your skin (subcutaneously).
There is information about denosumab, including possible side effects, in the cancer drugs section. There is also more information about pain control in the coping physically section.
Bisphosphonate drugs slow down the damage to the bones that the cancer causes. This helps to lower the risk of fractures and controls pain. There are different types of bisphosphonates. You have some as a drip into your bloodstream but others can be taken as a tablet. You can find out more about bisphosphonates in the main treatment section.
Another drug that can help to strengthen your bones is a monoclonal antibody called denosumab. It works by helping to stop the breakdown of the bones. You have it as an injection just under your skin (subcutaneously).
There is information about denosumab, including possible side effects, in the cancer drugs section. There is also more information about pain control in the coping physically section.
Trials of experimental treatments are going on and you may be
able to take part in one. Some trials are for new chemotherapy drugs or
new combinations of drugs.
Doctors are researching biological therapies for advanced lung cancer. Some stop cancers from making new blood vessels. These are called anti angiogenesis drugs. Without its own blood supply a cancer cannot continue to grow. Bevacizumab (also called Avastin) is an anti angiogenic monoclonal antibody (MAB) in trials for advanced non small cell lung cancer. Doctors have also been testing it with chemotherapy or other biological therapies. Many other new drugs are being researched.
You can look at the lung cancer research page for information about other areas of research. If you would like to find a particular trial, or see which trials are open, you can look at the clinical trials database in our cancer research section. Pick 'lung' from the dropdown menu of cancer types. There is information about the clinical trial process, including information about taking part in trials.
Doctors are researching biological therapies for advanced lung cancer. Some stop cancers from making new blood vessels. These are called anti angiogenesis drugs. Without its own blood supply a cancer cannot continue to grow. Bevacizumab (also called Avastin) is an anti angiogenic monoclonal antibody (MAB) in trials for advanced non small cell lung cancer. Doctors have also been testing it with chemotherapy or other biological therapies. Many other new drugs are being researched.
You can look at the lung cancer research page for information about other areas of research. If you would like to find a particular trial, or see which trials are open, you can look at the clinical trials database in our cancer research section. Pick 'lung' from the dropdown menu of cancer types. There is information about the clinical trial process, including information about taking part in trials.
Your doctor will discuss the treatment options with you. There may also be a counsellor or specialist nurse at the hospital you could chat to. You may also want to talk things over with a close relative or friend.
Breathlessness due to a blocked airway
Sometimes people with lung cancer develop a blockage or narrowing of one of the main airways – the left or right bronchus. The narrowing can make it hard to breathe and may be caused by a tumour growing in the windpipe or airway.
Or it may be due to pressure from a tumour outside the airway. There
are several ways of treating breathlessness caused by a blockage. You
may have one or more of the following treatments.
Remember that there are many causes of breathlessness. It is not always caused by a blocked airway or by cancer. Do check with your doctor if your breathing changes. You may have a chest infection and need a course of antibiotics.
Remember that there are many causes of breathlessness. It is not always caused by a blocked airway or by cancer. Do check with your doctor if your breathing changes. You may have a chest infection and need a course of antibiotics.
Radiotherapy is often used to treat a blocked airway. You can
have external beam radiotherapy (given from outside the body), or
internal radiotherapy. Internal radiotherapy for lung cancer is also
called brachytherapy or endobronchial radiotherapy. You have internal
radiotherapy through a tube put down your windpipe (bronchoscope). There is detailed information about external and internal radiotherapy for lung cancer in this section.
A laser is a very powerful and hot beam of light. It can be
used to burn away a tumour. The laser does not get rid of the tumour
completely, but it helps to relieve breathlessness by clearing the
airway. You usually have this treatment under strong sedation or a general anaesthetic.
Your doctor will do a bronchoscopy and pass the laser down the bronchoscope tube. When it is in the right place, the doctor turns the laser beam on to burn away as much of the tumour as possible. Then, they pull the bronchoscope tube out. If you have had a general anaesthetic they will then bring you round.
There are usually no side effects from laser treatment. So, you may be able to go home that evening. Or you may need to stay in hospital overnight. If the blockage in your lung has caused an infection, you may have to stay in hospital for a couple of days to have antibiotics through a drip.
If the tumour grows back, you can have laser treatment again. Your doctor may also suggest radiotherapy to slow down the growth of the cancer.
Your doctor will do a bronchoscopy and pass the laser down the bronchoscope tube. When it is in the right place, the doctor turns the laser beam on to burn away as much of the tumour as possible. Then, they pull the bronchoscope tube out. If you have had a general anaesthetic they will then bring you round.
There are usually no side effects from laser treatment. So, you may be able to go home that evening. Or you may need to stay in hospital overnight. If the blockage in your lung has caused an infection, you may have to stay in hospital for a couple of days to have antibiotics through a drip.
If the tumour grows back, you can have laser treatment again. Your doctor may also suggest radiotherapy to slow down the growth of the cancer.
Electrocautery might be used on its own, or with internal
radiotherapy. You have electrocautery through a tube put down your
windpipe (bronchoscope).
After putting the bronchoscopy tube down, your doctor uses a probe
heated by an electric current to destroy the tumour tissue blocking your
airway. Electrocautery can help the doctor put down the tube needed for
internal radiotherapy if your airway is quite blocked.
Cryotherapy treatment uses extreme cold to destroy a tumour.
It can shrink a tumour blocking an airway and so can relieve
breathlessness. It is sometimes called cryosurgery.
You have a general anaesthetic. While you are asleep, you have a bronchoscopy. The doctor puts a probe down the bronchoscope. The probe freezes parts of the tumour and kills it. The doctor moves the probe around until it has killed off enough of the tumour to relieve your blockage. The doctor will take out as much of the tumour tissue as possible. You can have cryotherapy repeated if the tumour grows back.
We have information about cryotherapy for lung cancer in this section.
You have a general anaesthetic. While you are asleep, you have a bronchoscopy. The doctor puts a probe down the bronchoscope. The probe freezes parts of the tumour and kills it. The doctor moves the probe around until it has killed off enough of the tumour to relieve your blockage. The doctor will take out as much of the tumour tissue as possible. You can have cryotherapy repeated if the tumour grows back.
We have information about cryotherapy for lung cancer in this section.
Radiofrequency treatment (RFA) can reduce the size of a tumour
blocking an airway. You can have it along with other types of lung
cancer treatment and it can be done more than once. You have RFA under
local or general anaesthetic. Your doctor puts a small probe (like a
needle) through the skin of your chest and directly into the tumour.
You usually have the treatment under CT scan guidance so that the doctor can make sure the probe is in exactly the right place. Radiofrequency energy then passes through the electrode, producing heat which destroys the tumour tissue. You may need to stay in hospital overnight afterwards.
You may have some discomfort or pain at the area of the treatment. Your doctor or nurse will prescribe painkillers for you to take for a few days. You may also have a slight temperature and feel a bit weak and tired. You may need to take it easy for the first few days and avoid any strenuous activity. The most common complication is air getting into the chest cavity (a pneumothorax). This is not serious though and usually goes away on its own with no treatment.
We have a page about radiofrequency ablation for lung cancer in this section.
You usually have the treatment under CT scan guidance so that the doctor can make sure the probe is in exactly the right place. Radiofrequency energy then passes through the electrode, producing heat which destroys the tumour tissue. You may need to stay in hospital overnight afterwards.
You may have some discomfort or pain at the area of the treatment. Your doctor or nurse will prescribe painkillers for you to take for a few days. You may also have a slight temperature and feel a bit weak and tired. You may need to take it easy for the first few days and avoid any strenuous activity. The most common complication is air getting into the chest cavity (a pneumothorax). This is not serious though and usually goes away on its own with no treatment.
We have a page about radiofrequency ablation for lung cancer in this section.
PDT treatment can reduce the size of a tumour blocking the
airway. This makes it easier for you to breathe. You first have an
injection of a drug that makes you sensitive to very bright light. The
drug collects in the tumour cells. Then, a few days later, you go into
hospital. While you are asleep, you have a bronchoscopy.
The doctor puts a tube down the bronchoscope that shines a very bright
light at the tumour. The light triggers the drug to destroy the cancer
cells.
The drug makes you sensitive to light for up to 6 weeks. You can have this treatment repeated if you need to.
We have detailed information about photodynamic therapy and the possible side effects in this section.
The drug makes you sensitive to light for up to 6 weeks. You can have this treatment repeated if you need to.
We have detailed information about photodynamic therapy and the possible side effects in this section.
Some stents are rigid, plastic tubes. The type of stent used most often to keep an airway open is a wire mesh tube that expands outwards in the airway (an expandable stent).
You have this treatment under a general anaesthetic. While you are asleep, the doctor does a bronchoscopy. When the bronchoscope tube is in the right place, the doctor pushes the folded up stent down the tube. As it comes out of the end of the tube, the stent opens up and pushes the walls of the airway open. Your doctor then takes out the bronchoscopy tube and wakes you up from the anaesthetic.
When you come round you will probably not feel the stent. But you will be able to breathe more easily. The stent can stay in your airway permanently.
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