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Risk and Complications

What are the risks and complications of lung cancer and its treatment?

Surgery

This treatment option depends on the size and location of the tumor. During an operation all or part of the tumor as well as a portion of healthy tissue is removed. Surgery is done under a general anesthetic and you will require a stay in hospital for a few days following the surgery.

Surgery is most commonly used for non-small cell cancer or for small cell lung cancer if it is found at an early stage. There are a number of types of surgery that can be done (e.g., wedge resection, segmental resection, lobectomy, segmentectomy, pneumonectomy) depending on the nature of your tumor. Sometimes lymph nodes in the chest will be removed as well. There are some surgical risks including bleeding and infection.

It will take some time to recover after the surgery. Side effects can include pain or discomfort and the collection of air or fluid in the chest. You can also expect there will be some shortness of breath right after the surgery. These side effects are temporary and can be managed. You will likely need to perform coughing and breathing exercises several times a day.

Radiation therapy

Radiation therapy may be given before surgery to shrink tumors (induction or neoadjuvant therapy) or after surgery to help destroy cancer cells that may remain in the body (adjuvant therapy).

This treatment makes use of both external and internal radiation treatment approaches. The therapy consists of high energy beams from sources such are x-rays and protons to kill cancer cells. It can be used after surgery to kill any remaining cells or can be used for lung cancers that cannot be removed by surgery. For individuals with advanced cancer, radiation therapy can be sued to relieve pain and other symptoms.

External beam radiation treatment uses a large machine to direct an external beam of radiation directly at the tumor. As a patient, you lie on a table without moving. Treatment times are short and there is no pain in receiving the treatment. Internal beam radiation or brachytherapy is provided by placing the radioactive material (i.e., seeds, needles, or catheters) directly into or near the tumor.

The radiation damages the cells in its path – normal as well as tumor cells – and the side effects are a result of the normal cells being damaged. The specific side effects result based on the part of the body being radiated. Fatigue and shortness of breath are the most common ones lung cancer patients experience.

Treatments are given at a cancer centre that has the radiation equipment. They are provided on a daily basis (for the duration of the treatment course). Most patients live at home during the treatment and travel to the clinic each day. Those who live too far away from the cancer centre for daily commuting may have to seek accommodation near the cancer centre for the duration of their treatment regime.

For people with lung cancers that are very small, one option may be stereotactic body radiotherapy. This form of radiation aims many beams of radiation from different angles at the lung cancer. Stereotactic body radiotherapy treatment is typically completed in one or a few treatments. In certain cases, it may be used in place of surgery for small tumors.

Chemotherapy

Chemotherapy may be given before surgery to shrink tumors (induction or neoadjuvant therapy) or after surgery to help destroy cancer cells that may remain in the body (adjuvant therapy).

This treatment may be given as an injection or an oral therapy, depending on the actual drug that is required. The chemotherapy drugs interfere with the ability of the cancer cells to grow and spread, but they damage the healthy cells as well. The healthy cells recover over time, but patients experience a range of side effects. You may experience side effects such as nausea, vomiting, loss of appetite, fatigue, lung problems, hair loss, and increased risk of infection.

Chemotherapy by injection is usually given at the cancer centre. There are a variety of protocols for various drugs and patients go to the cancer centre at various time intervals depending on the drug they are receiving.

More recently, there has been an increase in the number of drugs that can be given orally. This means individuals are able to take the medication on their own at home. This saves on the time and energy for patients to visit the cancer centre, but means the individual may be required to monitor and manage his or her own symptoms. It is important to talk with the health care team about when you should call the cancer centre if you are experiencing changes in your side effects.

Targeted therapy

For individuals with non-small cell lung cancer, targeted therapy approaches are based on genomic test results that identify specific mutations and proteins that are contributing to the cancer cells’ growth. Once a patient’s tissue is tested, and there is a full picture or genomic profile of your unique tumor, there may be a specific drug therapy that can be taken to slow or stop the lung cancer cell growth. The therapy may be FDA approved or be available through clinical trial. The best time to talk with your physician about completing a comprehensive tumor testing is before a biopsy.


What can I do to manage the side effects of treatment?

Cancer treatments have side effects such as fatigue, loss of hair or nausea. However, treatments affect each person somewhat differently. It is hard to predict exactly what your experience with side effects will be. The important thing to remember is that side effects can be managed effectively. Talk with your health care team about what you are experiencing and seek their advice about managing the side effects. Below are tips for managing a few of the most common ones individuals experience. Some you can manage yourself while others will need the assistance of the health care team members.

Shortness of breath

Shortness of breath is a common symptom of lung cancer. Having difficulty breathing can be a lonely, frightening and overwhelming experience, but it can be managed. As there are different reasons why you may be short of breath, it is important to discuss this symptom with your health-care team. They may need to investigate it further and determine what is causing it.

In the meantime, here are some general strategies that may be helpful to you:

  • Move slowly and pace activities/plan ahead (try not to overexert yourself)
  • Allow time to rest before and after activities
  • Learn and practice breathing exercises such as pursed lip breathing
  • Learn and practice relaxation techniques such as visualization, self-hypnosis and slow, deep breathing
  • Be aware of your breathing patterns; notice when you become short of breath and do not hold your breath when you are engaged in activity
  • Tell family and friends what they can do to help you (e.g. turning on a fan, staying with you, coaching you to breathe slowly, etc.) including issues of potential treatments such as thoracentesis or inhalers.
  • Check out if there are local rehabilitation programs or Chronic Lung Programs that could help with breathing retraining

Coughing up blood

Lung cancer can cause bleeding in the airway and cause you to cough up blood (called hemoptysis). Sometimes bleeding can become severe. Treatments are available to control bleeding. Contact your health care team about this issue and what ought to be done.

Pain

Everyone who has cancer pain will feel it differently. Only you know how much pain you are feelng and how it affects you. Getting relief from pain is important because it can interfere with etting a good sleep, eating well, enjoying your time with family and friends, and doing your work or hobbies.

You do not have to accept pain as a normal part of living with cancer. Tell your health care team about what you are feeling.

Pain will feel different when it comes from different parts of your body.

  • Bone pain can be felt as a deep throbbing pain that can be sharp at times. It may get worse as you move around.
  • Neuropathic pain is from damage to your nerves. This pain can be burning, shooting or feel l like ‘pins and needles’. It can hurt when things touch your skin (i.e., clothing, water, wind)
  • Visceral pain is from the organs inside your body. It can be dull, deep or squeezing pain. Sometimes it is hard to tell where it is coming from.
  • If you are taking medication regularly for pain, you may experience breakthrough pain between doses. It can happen suddenly.

Discuss your pain experience with your doctor and the health care team. There are different medications for different types of pain. Sometimes it takes some adjusting to find the right dose and time to take your medications. Your doctor may prescribe more than one type of pain medication. It is important to work together to find the right plan for your situation.

Fluid in the chest (pleural effusion)

Lung cancer can cause fluid to accumulate in the space that surrounds the affected lung in the chest cavity (pleural space). This accumulation of fluid can result in shortness of breath and pain. Treatment are available to drain this fluid from your chest and reduce the risk that the pleural effusion will occur again. Contact your health care team about this issue.

Fatigue

Fatigue is one of the most common side effects of cancer treatment. The fatigue with cancer treatment is different than usual fatigue. The difference, for cancer patients, is that this constant exhaustion is not relieved by rest.

Not all patients experience fatigue, but many notice their fatigue becomes worse over the course of their treatment. Sometimes it can feel particularly severe immediately following the end of treatment. Energy levels then tend to improve over the course of several months.

Experiencing fatigue may mean that you will have low energy for many of your usual activities including housework, social engagements, working, leisure or sports activities, or sexual relations. For a time, you may have to make choices about what you do each day. You may need to pick what is most important to you and do not try to do everything.

You may find the following strategies helpful in managing your fatigue:

  • Save your energy/balance your daily activities
  • Pace yourself/spread your activities out over the day
  • Eat well/a balanced diet
  • Distract yourself (for example, music, reading, movie, talk with others)
  • Relax/practice stress management
  • Get a good night’s sleep (talk with your physician if symptoms are preventing you from sleeping)
  • Get help for some of the routine things that you do
  • Exercise (according to what you are able to do)
  • Do not be afraid to ask for help

Cancer that spreads to other parts of the body (metastasis)

Lung cancer can spread (metastasizes) to other parts of the body. Common sites of metastases are the brain and the bones. When cancer starts to grow in other parts of the body, there can be symptoms that develop: pain, nausea, headaches and other signs that an organ is affected. Once lung cancer has spread to other organs, it is generally not curable. However, treatments are available to decrease signs and symptoms and to help you live longer. Referral to a palliative care program will be helpful in managing the symptoms and supporting you and your family.