Surgery, radiotherapy and chemotherapy may be used separately, or together, to treat people with lung cancer. This section discusses separately the treatments for small cell lung cancer and non-small cell lung cancer. This is because they can be quite different.

Your doctor will plan your treatment by taking into account a number of things, including:

• your general health
• the type of lung cancer (small cell or non-small cell)
• the size and position of the tumour
• whether it has spread beyond the lung (the stage).

If you have any questions about your treatment, don’t be afraid to ask your doctor or the nurse looking after you. It often helps to make a list of questions, and to take a friend or relative with you.

Chemotherapy is the main treatment for people with small cell lung cancer. In many people, chemotherapy for small cell lung cancer will enable them to live for longer, with better control of symptoms. Chemotherapy may be given on its own, or before radiotherapy. Sometimes chemotherapy and radiotherapy are given at the same time; this is known as chemoradiation.

Surgery is not usually used to treat people with small cell cancer, except if the cancer is found very early. This is because the cancer has usually spread to other parts of the body before being diagnosed, even if it cannot be seen on a scan. If an operation is possible, chemotherapy or radiotherapy may be given after surgery to help reduce the risk of the cancer coming back. Giving treatment in this way is known as adjuvant treatment.

The scans and tests you had to diagnose the cancer may be repeated later, to see how well you are responding to treatment.

Sometimes, radiotherapy is given to the head (known as prophylactic cranial radiotherapy) to reduce the risk of the cancer spreading to the brain. This may be done for people with small cell lung cancer, if chemotherapy has worked very well or if they have had surgery to remove the tumour.

Radiotherapy may also be used very effectively to relieve symptoms, such as pain, in people with advanced small cell lung cancer.

People with non-small cell lung cancer are given different types of treatment depending on the stage of their cancer.

Stage 1 non-small cell lung cancer can often be removed with surgery. If people have other medical problems, or are not fit enough to have surgery, radiotherapy may be given to the lung tumour instead. Chemotherapy is sometimes used after surgery (adjuvant chemotherapy), to reduce the risk of the cancer coming back. Chemotherapy is also sometimes given before surgery and/or radiotherapy. This is called neo-adjuvant chemotherapy.

Occasionally radiofrequency ablation (RFA) may be used. This is only likely to be suggested if other treatments are not suitable for you. It is only available at some cancer centres.

Stage 2 It may be possible to remove stage 2 non-small cell lung cancer with surgery. Radiotherapy may be used for people who are not fit enough for, or choose not to have, surgery. Chemotherapy is often given following surgery or radiotherapy, to reduce the risk of the cancer coming back.

Stage 3 non-small cell lung cancer can sometimes be removed with surgery, although this is often not possible because it may have spread too far. Chemotherapy, either on its own or combined with radiotherapy, may sometimes be given before an operation (neo-adjuvant treatment). If surgery is not possible, radiotherapy can be given instead. Sometimes chemotherapy given on its own, or in combination with radiotherapy, will be the only treatment used.

Stage 4 If non-small cell lung cancer has spread to other parts of the body, or is affecting more than one lobe of the lung, radiotherapy may be used to shrink the cancer and reduce symptoms. Sometimes chemotherapy may be given before or after the radiotherapy and may shrink the cancer and improve well-being for some people. The aim is to control symptoms and maintain a good quality of life for as long as possible. Radiotherapy may also be very effective in relieving symptoms such as pain.

If your tests show that you have lung cancer, you will be looked after by a multidisciplinary team. This is a team of staff who specialise in treating lung cancer and in giving information and support. It will normally include:

• surgeons who are experienced in lung surgery
• specialist nurses who give information and support
• oncologists – doctors who have experience in lung cancer treatment using chemotherapy, radiotherapy and other cancer treatments
• radiologists who help to analyse x-rays
• pathologists who advise on the type and extent of the cancer.

Other staff will also be available to help you if necessary, such as:

• physiotherapists
• counsellors and psychologists
• social workers.

Together they will be able to advise you on the best course of action and plan your treatment, taking into account a number of factors. These include your age, general health, the type of lung cancer and the stage.

If two treatments are equally effective for your type and stage of cancer your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved, and the side effects you might get, so that you can decide what is the right treatment for you.

Remember to ask questions about any aspects that you do not understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your doctor, specialist nurse, or with one of our nurses.

Before you have any treatment, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

People often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Many people are frightened at the idea of having cancer treatments, because of the side effects that can occur. Although many of the treatments can cause side effects, these can usually be controlled with medicines.

Treatment can be given for different reasons, and the potential benefits will vary depending upon the individual situation. In people with early-stage lung cancer, surgery can sometimes be done with the aim of curing the cancer. Occasionally, additional treatments are also given to reduce the risk of it coming back.

If the cancer is at a more advanced stage, the treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some people in this situation the treatment will have no effect upon the cancer, and they will get the side effects without any of the benefits.

If you have been offered treatment that aims to cure your cancer, deciding whether to accept the treatment may not be difficult. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead with it.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive care, (also known as palliative care) with medicines to help control any symptoms. Some cancer treatments, such as radiotherapy, can also be used to help treat symptoms.

Usually, a number of cancer specialists work together as a team and they use national treatment guidelines to decide on the most suitable treatment for each person. Even so, you may want to have another medical opinion. Either your specialist, or your GP, can refer you to another specialist for a second opinion, if you feel it will be helpful. The second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will give you useful information.

If you go for a second opinion, it may be a good idea to take a friend or relative with you, and have a list of questions ready, so that you can make sure your concerns are covered.