What are the treatments for lung cancer?

  Once lung cancer is clearly diagnosed, it should be treated promptly. With the advancement of medicine, there are many ways to improve the survival of lung cancer patients. The treatment plan of lung cancer is mainly decided according to the histological classification of lung cancer, clinical stage and the patient’s tolerance to treatment.  I. Non-small cell lung cancer (SCLC): (a) Chemotherapy: the median survival of untreated small cell lung cancer is 6-17 weeks, and the median survival of patients treated with combination chemotherapy is up to 40-70 weeks. Most small cell lung cancer patients relapse within 10-12 months after chemotherapy, and the chemotherapy regimen should be adjusted in time.  (b) Radiotherapy: Most small cell lung cancer is highly sensitive to radiotherapy, and radiotherapy can be given to lung lesions according to specific conditions, and whole brain high-dose radiotherapy should be given to those with clear cranial metastases.  (c) Most small cell lung cancer in limited stage can be given chemotherapy, which has been synchronized with the comprehensive treatment of radiotherapy and chemotherapy. Only a small number of early stage patients have the opportunity of surgery.  II. Non-small cell lung cancer (NSCLC) (a) Limited early stage lesions 1. surgery: for patients with stage Ia, Ib, IIa, IIb NSCLC who can tolerate surgery, surgery is preferred. stage IIIa patients with appropriate age, cardiopulmonary function, and anatomical site can also be considered for surgery, and preoperative chemotherapy is feasible if necessary.  2.Radical radiotherapy: Radical radiotherapy can be considered for stage III patients as well as stage I and II patients who refuse or cannot tolerate surgery.  3.Radical combination therapy: Combined radiotherapy and surgery can be used for supraglottic sulcus tumors that produce Pancoast syndrome. Combined radiotherapy can be used for locally advanced lesions, and neoadjuvant chemotherapy can be used for preoperative IIIa lesions.  (ii) Disseminated lesions: 70% of patients with inoperable NSCLC have a poor prognosis. The core of treatment is standard medical management, proper use of pain medication, and appropriate application of radiotherapy and chemotherapy.  1.Chemotherapy: Chemotherapy should use standard regimens, such as paclitaxel + carbo, paclitaxel + cisplatin, vincristine + cisplatin, gemcitabine + cisplatin and other cisplatin-based chemotherapy regimens.  2.Radiotherapy: If the patient’s primary tumor obstructs the bronchus causing obstructive pneumonia, hemoptysis, upper respiratory tract or superior vena cava obstruction and other symptoms, radiotherapy should be considered. It is also possible to give preventive radiotherapy to asymptomatic patients. Pericardial compression can be treated by pericardiocentesis and radiotherapy, while cranial or spinal cord compression and brachial plexus nerve involvement can be relieved by radiotherapy.  3.Targeted therapy: It takes the specific molecules in tumor tissues or cells as targets, and uses molecular targeting drugs to specifically target the biological functions of the targets and selectively reverse the malignant biological behavior of tumor cells at the molecular level, so as to achieve the purpose of inhibiting tumor growth or even making the tumor subside. The commonly used drugs are gefitinib, erlotinib, avatinib, crizotinib, etc., but these targeted therapeutic drugs will develop resistance at a certain time. The monoclonal antibody cetuximab is used for those who have failed chemotherapy or cannot receive chemotherapy.  4.Treatment of metastatic lesions: cranial metastasis should be given radiotherapy. Thoracic metastasis is very common, mostly manifested as large amount of pleural effusion, which is difficult to control, closed drainage, injection of bleomycin, mitomycin C, talcum powder and other drugs can be given to control malignant pleural fluid. Recurrence of endotracheal tumor can be treated by minimally invasive tracheoscopy.  Immunotherapy: some immunomodulators, such as BCG, short rods, soluble tumor antigen, thymidine, TIL cells, etc. have certain adjuvant therapeutic effects.  IV. Chinese medicine: some Chinese medicines have certain immunomodulatory and tumor-suppressive effects.