Staging allows the physician to fully understand the extent of the patient’s cancer to help make treatment decisions and determine expected outcomes. Doctors use specific terms to describe the stages of cancer, but a straightforward way of describing staging might be as follows:

All relevant information about the patient, including his or her health status, the kind of tumor and how far it has spread are brought together to design the most appropriate therapy for that individual’s cancer.

Lung cancer is a very challenging cancer to treat. The most critical factor in determining the survival rate is the stage at the time of diagnosis. Those that are diagnosed at a localised stage are curable. Unfortunately, most people are diagnosedwhen the disease has spread outside the chest (advanced or distant) or involves the nodes in the chest (regional). Also, the lungs are very sensitive organs and may not handle some forms of treatment easily. This helps explain why lung cancer has one of the poorest survival rates of all cancers. Two-year survival rate of those diagnosed with lung cancer is 25 percent. At five years, survival rate drops to 15 percent.

It is important to discuss the goals of lung cancer treatment with your doctor. Some treatments may be used to control the cancer. Others are used to improve quality of life and/or reduce symptoms. These treatments may be used alone or in combination.

Chemotherapy is the use of drugs that are designed to kill rapidly growing cells, such as cancer cells. Chemotherapy may be injected directly into a vein (by IV, or intravenously) or given through a catheter, which is a thin tube placed into a large vein and kept there until it is no longer needed. Some chemotherapy drugs are taken by pill.

Targeted agents are a newer class of drugs that are designed to act against specific weaknesses in cancer cells or surounding supportive tissues, such as blood vessels. These drugs can also be taken by pill or by IV. They are most effective in cancers with specific changes in their genes.

In early stages of non-small cell cancer, chemotherapy may be used in conjunction with surgery to improve survival rates. In more advanced stages of non-small cell cancer and in all stages of small cell cancer, chemotherapy and targeted therapies may be used to relieve symptoms and extend life.

These therapies affect both normal cells and cancer cells. Your doctors will try to prevent side effects as much as possible while treating the cancer appropriately. Side effects depend largely on the specific type of drug and the amount given. They can be 

different for each person and may be only temporary. Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores & fatigue. Your health care providers can suggest ways to make any side effects more manageable and to help relieve symptoms that may occur during and after procedures

Radiation therapy is a form of high energy X-ray that kills cancer cells. It can be used as a primary treatment, or in combination with chemotherapy (with or without surgery). It often can play an important role in advanced cancer patients by providing relief from pain, blockage of the airways, shortness of breath or coughing.

Radiation therapy is a “focused” treatment, meaning it is designed to maximize its effect on the cancer cells while minimizing any injury to normal cells. Radiation to treat lung cancer most often comes from a machine (external radiation). Occasionally, the radiation may be delivered internally using tubes that place a radioactive seed directly into or near the tumor (internal radiation or brachytherapy).

Side effects of radiation therapy depend mainly on the part of the body that is treated and the treatment dose. Common side effects of radiation therapy to the chest is a dry, sore throat; difficulty swallowing; fatigue; skin changes at the site of treatment; and loss of appetite.

An area of particular innovation in radiation therapy is a high-technology approach, sometimes termed “radiosurgery.” In very select patients who have small tumors but for whom surgery is unsafe, radiosurgery using very high doses of precisely focused radiation aimed only at the small tumor in the lung, is an effective alternative.

Surgery

Surgery is still considered the 'gold standard' for treating early-stage lung cancer.

Removing the tumor and surrounding lung tissue gives the best chance for cure for patients whose disease is localized. Surgery should be performed by specialized thoracic surgeons with particular expertise in treatment of lung cancer and other chest malignancies. Your surgeon will determine whether a tumor is resectable (removable). Not all tumors are resectable due to their location near – or if they have invaded – vital structures.

In some patients with multiple medical problems or poor lung function, surgery may not be the best option. This is carefully determined by our multidisciplinary team including pulmonologists, medical oncologists and radiation oncologists who work collaboratively daily.

Types of surgery

How much lung tissue will be removed and what type of surgical approach will be used depends on where the tumor is located in the lung, its size, patient’s body type/weight and any previous chest surgeries. All patients are considered first for minimally invasive surgery, although some complex cases may still require a traditional, open approach. Trained thoracic surgeons perform video-assisted thoracic surgery (VATS) and VATS lobectomy routinely as well as robotic surgery. Surgical resection of lung cancer is generally performed as:

• Limited resection: An operation to remove only a small portion of the lung is called a segmental or wedge resection
  
• Lobectomy: Removal of large section of the lunge, (there are three lobes of the lung on the right and two on the left), is called a lobectomy. This is the most common surgery performed for lung cancer
  
• Pneumonectomy: The removal of an entire lung is called a pneumonectomy.​

Lung cancer screening refers to testing a healthy individual at high risk for developing lung cancer who has no symptoms of lung cancer in hopes of finding lung cancer at a stage that it can be cured. Low-dose chest CT based screening has been found to reduce the number of people who die from lung cancer with acceptable risks when performed in a high quality setting. 

At Cleveland Clinic, we have a comprehensive lung cancer screening program for those individuals at high risk of developing lung cancer (aged 55 to 77, 30+ pack-years of smoking, smoked within the past 15 years).