Lung Cancer Treatment in Delhi, India

Based on biological behaviour and for the purpose of treatment decisions, lung cancer is classified as:

 
• Non-small-cell Carcinoma - includes squamous cell carcinoma, adenocarcinoma, large cell carcinoma, bronchioloalveolar cell carcinoma, etc.
• Small-cell Carcinoma - also called oat cell carcinoma because of the shape of the cell. Unfortunately, it spreads early and causes few early symptoms.

Lung cancer is caused by a variety of risk factors, including:

• Smoking (causes up to 90% of lung cancers).
• Contact with asbestos, steel, nickel, chrome and coal gas processing.
• Exposure to radiation. Miners of Uranium, Fluorspar and Hematite may be exposed to radiation by breathing air contaminated with Radon gas.

Some other risk factors that cause lung cancer include:

• Secondhand smoke
• Air pollution
• Family history
• Certain genetic mutations
• Chronic lung diseases, such as asthma and COPD

Not everyone who is exposed to risk factors for lung cancer would develop the disease. Lung cancer specialists, however, suggest that individuals must be aware of the risks and to minimise their exposure.

The symptoms of lung cancer are vague and overlap with infective conditions and other benign diseases. In some cases, the symptoms are diagnosed during routine health check-ups (X-ray Screening picks up a lung lesion). The most common symptoms of lung cancer are:

• A cough that won’t go away or a change in a chronic cough.
• Shortness of breath
• Bloodstained sputum
• Chest pain
• Unexplained weight loss
• Wheezing (due to a blockage in the windpipe)
• Repeated bouts of pneumonia
• Bronchitis may also be sign of lung cancer
• Hoarseness of voice

There may also be symptoms that seem unrelated to the lungs. These may be caused by the spread of lung cancer to other parts of the body. We encourage people to get investigated if any symptom persists for more than 4 weeks.

Your lung cancer doctor will first ask you about your past and current health, smoking and work history and do a physical examination. You may have to undergo the following tests:

• Chest X-ray
• Computerised Tomography Scan (CT Scan)
• Positron Emission Tomography (PET Scan)
• Sputum Cytology
• Bronchoscopy
• Fine-Needle Aspiration
• Biopsy
• Magnetic Resonance Imaging (MRI) of the brain
• Endo-Bronchial Ultrasound (EBUS) – Trans-Bronchial Needle Aspiration (TBNA)
• Mediastinoscopy
• Bone Scans
• Ventilation/Perfusion Lung Scans
• Thoracentesis
• Blood Tests
• Breathing Tests (Pulmonary Function Test - PFT)

The tests mentioned above show whether an individual has cancer, where the primary cancer is, and whether the cancer cells have spread to other parts of the body. This helps the lung cancer doctor ‘stage’ the disease. Staging is necessary for a lung oncologist to decide the treatment strategy for you.

Tumour Board

At Max Institute of Cancer Care (MICC), we are committed to recuperating our patients as soon as possible and providing one of the most advanced and comprehensive lung cancer treatments in India. We believe that each patient and his/her disease is unique. Hence, our team of lung cancer experts prepare a 'personalised treatment plan' based on the discussions in Tumour Board meetings. There is a constant cross-chat between the various specialities at the DMG Tumour Board meetings of lung cancer.

The main aim behind the DMGs at MICC is to make the best skills available to the patients. The team consists of experts from Thoracic surgical oncology, radiation oncology, medical oncology, pathology, imaging and related disciplines who come together in the Tumour Board meetings to discuss various cases and form a customised/joint decision on the treatment plan.

Max Institute of Cancer Care (MICC) offers state-of-the-art services for early diagnosis, staging, treatment and hospital-based care of the Disease management group (DMG) of lung cancer. Site-specific oncology allows the clinicians involved in patients' care to focus only on certain cancers at which they become world experts. The meetings are held every week to discuss all the patients diagnosed with DMG-specific cancer and arrive at the best treatment plan for the patient. The Surgical, Radiation, Medical and specialists of the lung cancer DMG, along with the Pathologists, Molecular Oncologists and Radiologists, attend these weekly meetings and add their valuable expert opinion.

All the patients seen between these meetings are, however, discussed in the common tumour Boards held once a week. Our holistic cancer care includes the following:

• Adherence to the latest international cancer treatment protocols.
• Superior cancer treatment technology: Max Institute of Cancer Care is the first facility in Northern India to acquire Novalis Tx for IMRT/IGRT, Radiosurgery, and SRS/5RT. Other technologies at our disposal include the Da Vinci XI Surgical Robotic System and Linear Accelerator (LINAC).
• Complete cancer care: Right from cancer screening, early detection, multidisciplinary treatment to rehabilitation.
• Dedicated daycare chemotherapy centres outside the hospital or in separate areas with chemo chairs and recliners, patient beds, a library, TV sets, and iPads are provided to take patients’ minds off from the treatment.
• A wider range of medical resources to draw from, with our multi-super speciality backups.

Max Institute of Cancer Care is equipped with cutting-edge technology with which our team of oncology experts offer holistic care to patients. The main treatments for lung cancer are surgery, radiotherapy and chemotherapy or chemo-immunotherapy. The choice of treatment will depend on the type of lung cancer you have, the stage of the disease, whether your lungs are working properly, your general health and what you want.

Lung Cancer Surgery

If your cancer has not spread beyond the affected lung and the same side of mediastinum, your general health is reasonably good, and your breathing capacity is sufficient, the treatment that gives the best chance of cure is surgery.

• Lobectomy: It is the most commonly performed operation for lung cancer; this involves removing the affected part of the lung.
• Pneumonectomy: A surgery where the whole lung on the affected side is removed.
• Sleeve Resection: It is a complex procedure with the purpose of preserving as much normal functional lung as possible. Only a part of the airway affected by cancer, along with lung tissue, is removed. The remaining lung is then reattached to the remaining part of the airway.
• Segmental Lung Resection: Depending on the extent of the cancer, the surgeon may decide to remove part of the lobe or segment of the lung. It is usually performed either with the intention to obtain tissue for diagnosis or in frail patients for removing cancerous tissues who would otherwise not tolerate a lobectomy.
• Chest Wall Resection: In certain cases, if the lung cancer affects the ribs or muscles of the chest in continuity with the main tumour, it may need to be removed. The defect, created in the chest, is then filled by using flesh and muscles along with prosthetic material like mesh and bone cement or Titanium implants.
• Diagnostic Thoracoscopy: This allows the doctor to see inside the chest and to take tissue samples for biopsy, if necessary.
• Mediastinoscopy: When the nodes in the mediastinum look suspicious but have not been correctly identified as a harbouring disease by EBUS, it may be necessary to perform surgical excision of these nodes to better characterise the nature of abnormality affecting them.

Chemotherapy

Chemotherapy is the treatment of lung cancer with anti-cancer drugs. The aim is to destroy cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from multiplying. Chemotherapy is the treatment of choice for patients with small cell carcinoma. In non-small cell carcinoma, you may also have chemotherapy after surgery to remove the cancer to increase the chances of cure. This is called adjuvant chemotherapy. It is also given prior to surgery to shrink the tumour and downstage the disease.

Radiation Therapy

Radiation therapy involves using high-energy beams to kill cancer cells and shrink tumours. Newer techniques of Intensity intensity-modulated radiotherapy (IMRT) and Image-Guided Radiotherapy (IGRT) ensure maximum dose to the tumour, safeguarding the normal uninvolved organs from adverse effects. There is also Gated Radiation Therapy, where the lung tumour is targeted in a particular phase of the breathing cycle.

Targeted Therapy/Immunotherapy

Some people, usually non-smokers, are suitable for a newer class of drugs that are designed to act against specific weaknesses in cancer cells or surrounding 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.

1. What are the different treatment options available for lung cancer?

Treatment options for lung cancer may include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy.

2. How is the stage of lung cancer determined?

The stage of lung cancer is determined by various factors, including the size and location of the tumour, its spread to nearby lymph nodes or other organs, and whether it has metastasised to distant sites. Imaging tests, such as CT and PET scans, along with biopsies, help in staging the cancer.

3. What is the role of surgery in the treatment of lung cancer?

Surgery plays a critical role in treating lung cancer, especially in the early stages. It involves the removal of the tumour and nearby lymph nodes. Depending on the location and size of the tumour, different surgical procedures like lobectomy, pneumonectomy, or segmentectomy may be performed.

4. Can radiation therapy be used to treat lung cancer?

Yes, radiation therapy can be used to treat lung cancer. It involves the use of high-energy beams to destroy cancer cells or shrink tumours. It can be used as the primary treatment, along with surgery or chemotherapy, or as palliative treatment to relieve symptoms in advanced stages.

5. What are the benefits and risks of chemotherapy in lung cancer treatment?

Chemotherapy uses drugs to kill cancer cells in the body. It may be used before surgery to shrink tumours, in advanced stages to control the disease, or after surgery to kill remaining cancer cells. The benefits include destroying cancer cells, but it also carries risks like side effects such as nausea, hair loss, and lowered blood cell counts.

6. Is targeted therapy an effective treatment option for lung cancer?

Yes, targeted therapy is an effective treatment option for certain types of lung cancer, particularly those with specific genetic mutations. Targeted therapy drugs block specific abnormalities in cancer cells, inhibiting their growth and spread. It can often provide more precise and less toxic treatment compared to traditional chemotherapy.

7. Can immunotherapy be used in the treatment of lung cancer?

Yes, immunotherapy can be used in the treatment of lung cancer. It helps stimulate the body's immune system to recognise and destroy cancer cells.

8. What is the role of palliative care in lung cancer treatment?

Palliative care aims to provide relief from the pain, symptoms, and stress associated with lung cancer, regardless of the stage of the disease. It focuses on improving the quality of life for patients and their families.

9. How is the treatment plan for lung cancer determined?

The treatment plan for lung cancer is determined based on several factors, including the stage of the cancer, the type of lung cancer, the patient's overall health, and the patient's preferences. A multidisciplinary team of doctors collaborate to develop an individualised treatment plan.

10. Can lung cancer be treated with a combination of therapies?

Yes, lung cancer can often be treated with a combination of therapies. This approach, known as multimodal or combination therapy, may include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy, depending on the specific characteristics of the cancer, the patient's condition and the sequence of treatment modality.

11. Are there any clinical trials available for lung cancer treatment?

Yes, there are ongoing clinical trials for lung cancer treatment. Clinical trials evaluate new treatments, therapies, and interventions to determine their safety and effectiveness. Participating in clinical trials may provide access to innovative treatments and contribute to the advancement of lung cancer care.

12. Can lung cancer be treated with minimally invasive procedures?

Yes, minimally invasive procedures, such as video-assisted thoracic surgery (VATS) and robotic-assisted surgery, can be used to treat lung cancer. These procedures involve smaller incisions and specialised instruments, resulting in reduced trauma, faster recovery, and shorter hospital stays compared to traditional open surgery.

13. What is the prognosis for lung cancer patients?

The prognosis for lung cancer patients varies depending on several factors, including the stage of cancer, type of lung cancer, health of the patient, and effectiveness of the chosen treatment. Early detection and treatment may improve prognosis, but lung cancer can be challenging to treat, especially in advanced stages. The survival scenario is changing as newer treatment modalities are available.

14. Does the type of lung cancer affect the treatment approach?

Yes, the type of lung cancer, whether non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC), can significantly affect the treatment approach. NSCLC and SCLC have different characteristics and may require different treatment strategies, including surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.

15. Can lung cancer be treated without surgery?

Yes, lung cancer can be treated without surgery, especially in certain cases where surgery is not feasible due to the location or stage of the tumour. Treatment options include chemotherapy, radiation therapy, immunotherapy, targeted therapy, or a combination of these approaches.

16. What are the side effects of different lung cancer treatments?

The side effects of lung cancer treatments can vary depending on the treatment modality. Surgery may involve pain, infection, or complications related to anaesthesia. Radiation therapy can cause fatigue, skin changes, and temporary lung inflammation. Chemotherapy may result in hair loss, nausea, and lowered blood cell counts. Targeted therapy and immunotherapy may have their own side effects, which can vary among individuals.

17. How does smoking cessation affect lung cancer treatment?

Smoking cessation is crucial for lung cancer patients, as continued smoking can interfere with the effectiveness of treatments and overall prognosis. Quitting smoking reduces further damage to the lungs, improves treatment outcomes, and improves overall health and well-being.

18. Can lung cancer treatment affect fertility?

Some lung cancer treatments, such as certain chemotherapy drugs or radiation therapy to the pelvic area, can affect fertility. It is essential for patients concerned about fertility to discuss this with their healthcare team before starting treatment. Options like fertility preservation or assisted reproductive techniques may be available.

19. Is there a role for nutrition and exercise in lung cancer treatment?

Nutrition and exercise play a role in supporting overall health and well-being during lung cancer treatment. A balanced diet and regular physical activity can help manage treatment side effects, maintain strength, support the immune system, and improve overall quality of life.

20. Can lung cancer treatment be personalised based on genetic testing?

Yes, lung cancer treatment can be personalised based on genetic testing. Genetic testing helps identify specific genetic mutations or alterations in cancer cells, allowing doctors to choose targeted therapies that are most likely to be effective for individual patients.

21. What supportive care options are available during lung cancer treatment?

Several supportive care options are available during lung cancer treatment to manage symptoms, side-effects and improve quality of life. These may include pain management, nutritional support, psychosocial support, integrative therapies, and palliative care services.

22. Can lung cancer treatment affect the heart or other organs?

Yes, certain lung cancer treatments, such as radiation therapy or certain chemotherapy drugs, can affect the heart or other organs. Close monitoring and appropriate management strategies are implemented to minimise potential risks and ensure the well-being of patients.

23. Can lung cancer treatment cause hair loss?

Hair loss is a common side effect of some lung cancer treatments, such as chemotherapy. However, not all lung cancer treatments cause hair loss. The potential for hair loss can vary depending on the drugs used in chemotherapy regimens.

24. Are there specific treatment considerations for elderly patients with lung cancer?

Yes, there are specific treatment considerations for elderly patients with lung cancer. Age-related factors, such as overall health, comorbidities, and tolerance to treatments, are taken into account when developing a treatment plan. Individualised approaches may prioritise less aggressive treatments or supportive care options.

25. Can lung cancer treatment cause lung damage or breathing difficulties?

In some cases, lung cancer treatments, particularly radiation therapy or certain surgeries, can cause temporary or permanent lung damage or lead to breathing difficulties. However, these risks are carefully evaluated and balanced against the potential benefits of treatment. Close monitoring and appropriate interventions are implemented to mitigate complications.

26. Is there a difference in treatment approach for non-small cell lung cancer and small cell lung cancer?

Yes, there is a difference in treatment approaches. NSCLC is typically treated with surgery, radiation therapy, targeted therapy, and immunotherapy. SCLC is often treated with chemotherapy combined with radiation therapy or immunotherapy.

27. Can lung cancer treatment impact the immune system?

Yes, certain lung cancer treatments, such as chemotherapy or immunotherapy, can impact the immune system. Chemotherapy may temporarily lower the number of immune cells, while immunotherapy is designed to activate the immune system to target cancer cells. The impact on the immune system is carefully monitored during treatment.

28. Are there any long-term effects of lung cancer treatment?

Some lung cancer treatments may have long-term effects, depending on the specific treatments received. These effects can vary and may include lung damage, heart problems, secondary cancers, or hormonal imbalances. Regular follow-up care and surveillance help monitor and manage any potential long-term effects.

29. Can lung cancer treatment be effective in the advanced stages of the disease?

Lung cancer treatment can be effective in advanced stages, although the goal of treatment may shift from cure to symptom management and improve quality of life. Targeted therapy, immunotherapy, or chemotherapy may help control the progression of the disease and improve the chances of survival.

Pain management options during lung cancer treatment can include medications, such as opioids or nonsteroidal anti-inflammatory drugs, as well as non-pharmacological approaches like acupuncture, physical therapy, or nerve blocks. The choice of pain management depends on the patient's specific needs and the advice of the healthcare team.

30. Can lung cancer treatment affect a patient's mental health?

Yes, lung cancer treatment can impact a patient's mental health. The diagnosis, treatment-related stress, and potential side effects can cause emotional distress, anxiety, or depression. Psychosocial support, counselling, and participation in support groups can be beneficial in addressing these challenges.

31. Can lung cancer treatment be challenging in patients with pre-existing lung conditions like COPD (chronic obstructive pulmonary disease) or asthma?

Lung cancer treatment can be challenging in patients with pre-existing lung conditions like COPD or asthma. These conditions may impact lung function and overall respiratory health, requiring careful consideration and close monitoring throughout the treatment process. The healthcare team works to develop a treatment plan that takes into account the individual's lung condition and balances the benefits and potential risks of various treatment options.

32. Are there different treatment considerations for lung cancer patients with autoimmune disorders, such as rheumatoid arthritis or lupus?

Lung cancer patients with autoimmune disorders like rheumatoid arthritis or lupus may have unique treatment considerations. The treatment plan must take into account the autoimmune condition, as cancer treatments, like immunotherapy, may affect the immune system and potentially exacerbate autoimmune symptoms. Close collaboration between an oncologist and a rheumatologist is essential to ensure a personalised and safe treatment approach that balances cancer management and autoimmune disease control.

33. Are there specific treatment options available for lung cancer patients with a history of smoking-related lung diseases, such as emphysema or bronchitis?

Lung cancer patients with a history of smoking-related lung diseases, such as emphysema or bronchitis, may require tailored treatment options. The healthcare team will consider the individual's lung function and overall respiratory health when determining the most appropriate treatment approach. Minimally invasive procedures, targeted therapies, or radiation therapy may be considered to minimise additional lung damage. Quitting smoking is crucial in improving treatment outcomes and overall lung health.

34. What are the treatment considerations for lung cancer patients with compromised kidney or liver function?

Lung cancer patients with compromised kidney or liver function require careful treatment considerations. The kidneys or liver processes certain chemotherapy drugs and other medications used in lung cancer treatment, so dosage adjustments may be necessary to minimise the risk of toxicity. The healthcare team will closely monitor kidney and liver function throughout the treatment process and make necessary adaptations to ensure patient safety and optimise treatment outcomes.

35. What are treatment considerations for lung cancer patients with compromised immune systems, such as those undergoing organ transplantation or with HIV/AIDS?

Lung cancer patients with compromised immune systems, such as those undergoing organ transplantation or with HIV/AIDS, require specific treatment considerations. The healthcare team will carefully assess the individual's immune status and coordinate with other specialists involved in their care. Immunotherapy, which boosts the immune system, may not be appropriate in these cases due to potential complications. The treatment plan will be tailored to balance cancer management while minimising the risk of infections and other complications associated with immunosuppression. Close monitoring and collaboration between the oncologist and other specialists are essential for optimal care.

Reviewed by Dr. Bhushan Dinkar Thombare, Consultant - Thoracic Oncosurgery, Thoracic Oncology, Cancer Care / Oncology, Surgical Oncology on 1 Nov 2023.

• Lung Cancer: Symptoms, Causes, Tests, Treatment
• What Are the Stages of Lung Cancer?
• The early symptoms and signs of lung cancer
• What You Did Not Know About Lung Cancer
• Lung Cancer – The Silent Killer
• Suffering from Lung Cancer-It is not your fault!
• Something everyone should know about Cancer?