Cómo se trata el cáncer de pulmón

Hay muchas opciones de tratamiento para las personas con cáncer de pulmón, pero esto no siempre ha sido cierto. Los tratamientos en sí mismos, así como las tasas de supervivencia asociadas con ellos, también han mejorado dramáticamente en los últimos años. Para las personas con cáncer de pulmón en etapa temprana, la cirugía puede ofrecer la posibilidad de una cura. Incluso si tiene cáncer de pulmón en etapa avanzada, hay una variedad de opciones para el tratamiento. Los avances recientes que permiten a los médicos personalizar los tratamientos para el cáncer de pulmón, así como una mejor comprensión de cómo funciona el sistema inmunológico para combatir el cáncer, han aumentado significativamente los métodos para tratar esta enfermedad.

Cirugías y procedimientos dirigidos por especialistas

Dado que hay muchos tratamientos diferentes disponibles para el cáncer de pulmón, puede ser útil dividir estas terapias en dos enfoques principales:

  • Tratamientos locales: los tratamientos locales tratan el cáncer en su origen, en otras palabras, a nivel local. Estos incluyen cirugía y radioterapia, tratamientos que eliminan el tumor pero no pueden alcanzar las células que han viajado más allá del sitio original del tumor. Con los cánceres de pulmón en etapa temprana, los tratamientos locales pueden ser suficientes para intentar curar el cáncer.
  • Tratamientos sistémicos: los tratamientos sistémicos destruyen las células cancerosas en cualquier lugar del cuerpo. Estos tratamientos incluyen quimioterapia, terapias dirigidas e inmunoterapia. Cuando un cáncer de pulmón se ha diseminado a los ganglios linfáticos oa otras regiones del cuerpo, las terapias sistémicas suelen ser la mejor opción de tratamiento.

Un término confuso que puede encontrar es la terapia adyuvante . Algunas veces se usan tratamientos sistémicos incluso si el cáncer no parece haberse diseminado. Por ejemplo, se puede administrar quimioterapia o un medicamento de terapia dirigida aunque la cirugía también se realizó. Los tratamientos adyuvantes son aquellos que se realizan para tratar cualquier célula que se haya diseminado más allá del sitio inicial del cáncer, pero que aún no se puede detectar con las pruebas de imagen que tenemos actualmente.

Cirugía

Cuando el cáncer de pulmón se detecta en las primeras etapas, antes de que se disemine más allá de los pulmones, la cirugía puede ser curativa. Para los cánceres de pulmón de células no pequeñas en etapa temprana (específicamente cánceres de pulmón de células no pequeñas en estadio I a estadio IIIA), a menudo se considera la cirugía. En raras ocasiones, la cirugía puede considerarse para el cáncer de pulmón de células pequeñas en etapa temprana (etapa limitada).

Existen cinco procedimientos quirúrgicos primarios que pueden realizarse para tratar el cáncer de pulmón:

  • Neumonectomía: una neumonectomía se refiere a la extirpación de todo un pulmón.
  • Lobectomía: en una lobectomía , se extrae uno de los lóbulos del pulmón. (El pulmón derecho tiene tres lóbulos, y el pulmón izquierdo tiene dos lóbulos).
  • Resección en cuña: en una resección en cuña , el tumor se extirpa junto con un área en forma de cuña de tejido pulmonar que rodea el tumor.
  • Resección de la manga: en una resección de la manga, se extrae un lóbulo del pulmón, junto con parte del bronquio (las vías aéreas que conducen al pulmón).
  • Segmentectomía: en una segmentectomía, se extrae un segmento de un lóbulo. La cantidad de tejido que se extrae con este procedimiento es más que una resección en cuña, pero menos que una lobectomía.

Los efectos secundarios comunes de la cirugía incluyen infecciones, sangrado y dificultad para respirar, dependiendo de la función pulmonar antes de la cirugía y la cantidad de tejido pulmonar extirpado.

Terapia de radiación

La radioterapia para el cáncer de pulmón utiliza rayos X de alta energía que se aplican desde fuera del cuerpo para matar las células cancerosas. Hay algunas formas en que se usa la radiación para el cáncer de pulmón:

  • Como tratamiento adyuvante para tratar cualquier célula cancerosa que permanezca después de la cirugía.
  • Para ayudar a disminuir el tamaño de un tumor para que la cirugía sea posible
  • Como tratamiento paliativo para disminuir el dolor u obstrucción de las vías respiratorias en personas con cánceres que no se pueden curar
  • As a curative treatment: A specific type of radiation therapy known as stereotactic body radiotherapy (SBRT) uses high-dose radiation given to a small area in the lungs. This may be used as an alternative to surgery when surgery is not possible.

Common side effects of radiation therapy can include redness and irritation of the skin, fatigue, and inflammation of the lungs (radiation pneumonitis).

Chemotherapy

Chemotherapy for lung cancer uses medications designed to kill rapidly dividing cells such as cancer cells. Chemotherapy drugs may be used as a primary treatment for advanced lung cancer, after surgery (adjuvant chemotherapy), or before surgery to reduce the size of a tumor (neoadjuvant therapy.)

Combination chemotherapy—using more than one chemotherapy drug at the same time—is most commonly used. Different medications interfere with cell division at different points in the cell cycle, and targeting this process in more than one way increases the likelihood of treating as many lung cancer cells as possible. Some chemotherapy medications used for people with lung cancer include:

  • Platinol (cisplatin)
  • Paraplatin (carboplatin)
  • Gemzar (gemcitabine)
  • Taxotere (docetaxel)
  • Taxol (paclitaxel) and Abraxane (nab-paclitaxel)
  • Alimta (pemetrexed)
  • Navelbine (vinorelbine)

Common side effects of chemotherapy include bone marrow suppression (a reduction in red blood cells, white blood cells, and platelets), hair loss, and fatigue. Nausea and vomiting are dreaded side effects of chemotherapy, but thankfully the management of these adverse effects has improved dramatically in recent years.

Lung Cancer Clinical Trials

The National Cancer Institute recommends that everyone with lung cancer consider a clinical trial, and this is more important than ever. Every treatment we have for lung cancer was once studied as part of a clinical trial before being approved. To emphasize the importance of these trials, it may help to mention that between 2011 and 2015, more new treatments were approved for lung cancer than during the four-decade period prior that.

Talk to your doctor about clinical trials and decide if this is something you’d like to explore. Several of the lung cancer organizations have put together a free lung cancer clinical trial matching service in which health professionals can help match the particular characteristics of your cancer with clinical trials in progress anywhere in the world.

Prescriptions

There are two types of drug therapies that are used to treat lung cancer—targeted therapies and immunotherapy. In addition, your doctor may prescribe a variety of medications to address pain and side effects of surgery or other therapies.

Targeted Therapies

Targeted therapies for lung cancer are drugs that are tailored to attack certain characteristics of cancer cells and, hence, may have fewer side effects than traditional chemotherapy.

It is extremely important that everyone who is diagnosed with non-small cell lung cancer, particularly lung adenocarcinoma, have gene profiling (molecular profiling) of their tumor performed. You may hear your doctor talk about “targetable” gene mutations and genetic changes. What this means is that some lung cancer cells have genetic changes that can be targeted (and treated) with specific medications that address these changes.

Treatments have been approved for those with EGR mutations, ALK rearrangementsROS1 rearrangements, and there are also clinical trials studying medications for other mutations and genetic changes in cancer cells. This area of science is changing very rapidly, and it’s likely that new targets and new medications will continue to be discovered.

While targeted therapies can be very effective, resistance to these treatments usually develops over time. However, second- and third-generation drugs are now available and being studied for when this occurs. Some targeted medications approved for lung cancer include:

  • ALK inhibitors – Xalkori (crizotinib), Zykadia (ceritinib), and Alecensa (alectinib)
  • Angiogenesis inhibitors – Avastin (bevacizumab) and Cyramza (ramucirumab)
  • EFGR inhibitors – Tarceva (erlotinib), Gilotrif (afatinib), Iressa (gefitinib), Tagrisso (osimertinib), and Portrazza (necitumumab)

What Are Targeted Therapies for Lung Cancer?

Immunotherapy

A new type of treatment for lung cancer became available in 2015. Immunotherapy drugs work by essentially harnessing your immune system to help rid your body of cancer cells. Though we tend to hear a lot of hype in the news, immunotherapy is truly a reason to get excited about the future of lung cancer and was named the 2016 clinical cancer advancement of the year by the American Society for Clinical Oncology.

While targeted therapies tend to be more effective in people who have not smoked, immunotherapies may be more effective in people who smoked and who have cancers such as squamous cell lung cancer. Immunotherapy drugs currently approved for lung cancer include:

  • Opdivo (nivolumab)
  • Keytruda (pembrolizumab)

What Is Immunotherapy and How Does It Work?

Over-the-Counter (OTC) Therapies

Your doctor may recommend OTC medications and supplements for pain relief, symptom relief, or for the side effects of treatment. Always discuss anything you are taking with your doctor, as some products may interact with the treatments or produce side effects such as bleeding with surgery.

Home Remedies and Lifestyle

If you are a current smoker, quitting smoking can improve your chances of surviving early-stage lung cancer and can lower your risk of recurrence of cancer after treatment. Smoking can also worsen some symptoms of lung cancer, such as shortness of breath.

Shortness of breath is a common problem when you have lung cancer. Your doctor may give you medications or supplemental oxygen, but you will also need tactics to deal with this problem, including relaxation methods, positions, and focused breathing. You may need to modify your schedule and tasks so you can save your energy or take breaks when tired.

While shortness of breath and side effects from treatment may make it difficult, it is best to stay as physically active as you can tolerate. Try walking or yoga.

Getting involved with online lung cancer support groups and lung cancer communities is priceless. Not only are these ways to get support from others who have “been there” and can understand, but these groups can help you learn about and understand the latest developments in lung cancer. The hashtag to help you locate these communities is #LCSM, which stands for lung cancer in the social media world.

Complementary Alternative Medicine (CAM)

While alternative treatments for lung cancer have not been found beneficial in treating lung cancer specifically, there are several integrative cancer treatments that may help people cope with the symptoms of cancer and cancer treatments. Some of these include acupuncture, massage therapy, hypnosis, and meditation.Integrative Therapies for Cancer

Bone Marrow Transplantation at | 832-533-3765 | [email protected] | Website

I am Dr. Christopher Loynes and I specialize in Bone Marrow Transplantation, Hematologic Neoplasms, and Leukemia. I graduated from the American University of Beirut, Beirut. I work at New York Bone Marrow Transplantation
Hospital and Hematologic Neoplasms. I am also the Faculty of Medicine at the American University of New York.