As an oncologist, I know how important it is to help my patients have hope. Being diagnosed with lung cancer can be very scary. Sometimes when someone hears the word “cancer” they think it’s over. But this is not true. There are so many treatment options. We are in totally different times than we knew when it came to treating cancer, especially non-small cell lung cancer (NSCLC).
So how can I help patients have hope? I tell them to treat it like a chronic disease. People die of high blood pressure, diabetes, and heart disease, but most people don’t immediately perceive these conditions as a death sentence. These are chronic conditions that can be managed. In most cases, non-small cell lung cancer can also be a chronic disease that can be managed. Seeing it this way helps you see things differently.
Treatment depends on many factors, including the genetic makeup of the tumor and the stage of your cancer. Your stage is determined by the type of cancer you have, as well as the characteristics of your tumor and how far your cancer has spread. Early stage NSCLC is stage 1 and stage 2. This means that the cancer has not spread outside of the lung or to another part of the lung. When the cancer spreads, it is considered stage 3 and stage 4. When we treat NSCLC stages 1 and 2, we are treating with the intention of curing the disease. For stages 3 and 4, we treat to try to control the disease.
For early stage lung cancer, the first thing we will usually do is to surgically remove the cancer, along with some lymph nodes and a small part of the tissue around the cancer called the margins. Some cancers may not be properly staged before surgery because surgery gives us so much more information. After surgery, we reevaluate based on the pathologist’s report. We will look at the size of the tumor and assess if the margins are free of cancer. We also look at the number of lymph nodes that were removed and make sure the remaining lymph nodes are cancer-free. Sometimes we initially classify someone’s cancer as stage 1, but after surgery we find that the lymph nodes are involved and so we classify it as stage 2 or stage 3, which means the patient needs additional treatment.
If we find that the surgery has completely removed the cancer and we determine that a person is at low risk of their cancer returning, we consider the cancer cured and provide them with survivorship support and a follow-up schedule. . If they are at higher risk of recurrence, we might prescribe targeted therapy or immunotherapy as maintenance therapy. Targeted and immunotherapy treatments are new options that can prevent certain parts of your body from playing a role in cancer growth. They can be used at any phase of treatment, depending on what we think is best for each patient.
Monitoring is really important. If your cancer comes back and we catch it early, we can treat it quickly and have a better chance of making you cancer free again. And of course, it’s not just about seeing your lung cancer doctors for follow-up. It’s also important to see your GP regularly and get screened for other cancers and health issues as well.
Not everyone with early-stage lung cancer is a good candidate for surgery, especially if they smoke cigarettes, which can lead to poor lung function. In these cases, radiation therapy may be an option. Today, radiation is very targeted; it’s not like in the past, when the whole lung was affected. Today, people do very well with radiation therapy, and studies indicate that if someone cannot have surgery, radiation therapy is almost as effective.
Treat advanced lung cancer
If you are diagnosed with advanced stage cancer, surgery may not be a good option for you. In these cases, we will try chemotherapy, radiotherapy, targeted therapy, immunotherapy, other techniques or a combination of these methods. It’s also helpful to know that the field of lung cancer research is constantly improving, so new treatments may be available today that weren’t possible even a year ago. If your cancer comes back, we will do another test of its genetic makeup, as genetic mutations can change over time. If your tumor turns out to have a different genetic mutation than your original cancer, we may be able to treat it with a targeted therapy that stops that mutation from helping the cancer grow. With stage 4 NSCLC, we focus on slowing cancer growth and improving your quality of life. For example, targeted radiation can reduce any masses in your airways that make it difficult to breathe.
The side effects of these treatments can vary, and it’s really important to be open and honest with your doctor about how you feel. Often we can take steps to manage side effects so that you feel better during treatment, so there is no reason to keep the difficulties to yourself. Tracking symptoms in a diary can be helpful, as can bringing a loved one with you to appointments. They might notice patterns or remember problems that you forget to mention to the doctor.
I always tell people up front that it’s not an easy process, but having a positive mindset is really important. However, it can be difficult to stay positive during such a difficult time. That’s why I encourage everyone to get the support they need. Our health care team includes behavioral health services delivered by licensed mental health and allied professionals who can provide counseling and coping techniques specifically for people undergoing cancer treatment, as well as their caregivers. You don’t have to be alone on a cancer journey. You can count on professionals, as well as your loved ones, to support you.
Local or online support groups can also be extremely helpful. Our cancer center connects patients with others who have had the same treatment, which many people find very beneficial. I may know everything there is to know about treating lung cancer, but I don’t put myself in my patients’ shoes. I see people like them every day, but I still don’t know exactly what they are going through. Connecting with someone else who gets it can help immensely.
Emotional support isn’t the only thing people need – we can also provide advice on diet and exercise. Your healthcare team also includes dietitians, physiotherapists, and naturopaths who can teach you about supplements and other ways to feel better during and after treatment. This process can be daunting, but you are not alone. You have a strong team behind you and effective treatment options to help your body fight back.