Non-Small Cell Lung Cancer Treatment Options at Penn

Different treatments are available for those with non-small cell lung cancer. Some treatments are called standard. This means they are the currently used treatments. Some treatments are being tested in clinical trials. A treatment clinical trial is a study meant to help improve current treatments or obtain information on new treatments.

When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. You may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment, while others are available during or after treatment.

Treatment options vary depending on your situation including the stage of the cancer and other factors that may be present.

Talk with your team about the approach that is best for you.

Diagnosing Non-Small Cell Lung Cancer

Tests that examine the lungs are used to detect (find), diagnose, and stage non-small cell lung cancer.

Tests and procedures to detect, diagnose, and stage non-small cell lung cancer are often done at the same time. The following tests and procedures may be used:

• Physical exam and history is an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of health habits, including smoking, and past jobs, illnesses, and treatments will also be taken.
• Chest x-ray takes an image of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body.
• Sputum cytology is procedure in which a pathologist views a sample of sputum (mucus coughed up from the lungs) under a microscope, to check for cancer cells.
• Fine-needle aspiration (FNA) biopsy of the lung is the removal of tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest. Penn interventional pulmonologists are using a new minimally invasive technology, called endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), as a less invasive way to stage lung cancer.
• Bronchoscopyis procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Thoracoscopy is a surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.
• Thoracentesis is the removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.

Standard treatments for patients with non-small cell lung cancer offered at Penn

Surgery

• Wedge resection is surgery to remove a tumor and some of the normal tissue around it. When a slightly larger amount of tissue is taken, it is called a segmental resection.
• Lobectomyis surgery to remove a whole lobe (section) of the lung.
• Pneumonectomyis surgery to remove one whole lung.
• Sleeve resection is surgery to remove part of the bronchus.

Penn thoracic oncologists have developed new surgical procedures to treat previously inoperable lung cancer.

Our surgeons are expert in evaluating the risks and benefits of minimally invasive procedures versus open procedures, so that you can make the decision that’s best for you.

We offer lung conserving procedures to help in retaining the highest quality of life possible.

Radiation therapy

• External radiation (or external beam radiation) comes from a machine outside the body. The machine directs high-energy rays at the cancer and some normal surrounding tissue. It is the most often used radiation treatment. The machine used to deliver the high-energy rays is called a linear accelerator.

• Three-dimensional (3-D) conformal radiation treatment is a type of external

beam radiation. It uses computers to allow doctors to more precisely target a tumor with radiation beams (using width, height, and depth).

• Intensity-modulated radiation treatment (IMRT). IMRT is a type of 3-D conformal radiation treatment that uses radiation beams (usually x-rays) of various intensities to give different doses of radiation, at the same time, to small areas of tissue. This allows the delivery of higher doses of radiation to the tumor and lower doses to nearby healthy tissue.

• Internal radiation treatment, or brachytherapy, is given by placing an implant into or near the tumor. The implant is a small container that holds the radioactive source or material. Internal radiation treatment allows your doctor to give a higher total dose of radiation to a smaller area and in a shorter time than with external radiation treatment.

• Photodynamic therapy (PDT) combines a drug called a photosensitizer or photosensitizing agent with a specific type of light to kill cancer cells. Photosensitizers are drugs that when exposed to a specific wavelength of light, produce a form of oxygen that kills nearby cells. PDT can also work by shrinking or destroy tumors by damaging blood vessels in the tumor. This prevents the cancer from receiving nutrients. Also, PDT may activate the immune system to attack the tumor cells.

• Stereotactic radiosurgery is a a type of external radiation therapy that uses special equipment to position the patient and precisely give a single large dose of radiation to a tumor. It is used to treat brain tumors and other brain disorders that cannot be treated by regular surgery. It is also being studied in the treatment of other types of cancer. Also called radiation surgery, radiosurgery, and stereotaxic radiosurgery.

• Proton Therapy is the most precise form of radiation treatment for cancer possible, while minimizing damage to healthy tissue and surrounding organs.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells. Find out when this is avail at Penn.

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining of internal organs.

Watchful Waiting (Expectant Management)

Watchful waiting is or expectant management is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. This may be done in certain rare cases of non-small cell lung cancer.

New types of treatment are being tested in clinical trials.

Chemoprevention

Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk cancer will recur (come back).

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

New combinations

New combinations of treatments are being studied in clinical trials.

New types of treatment are being tested in Clinical Trials at Penn.

Survivor Stories

Tanya Zekovitch

By the age of seven, Tanya Zekovitch already understood what it was like to be a cancer patient after being treated for Ewing's Sarcoma, a rare form of bone cancer. So when she was diagnosed with Acute Myeloid Leukemia in the summer of 2000, when she was still only in her early 20's, she felt lucky to find that Penn's Abramson Cancer Center offered patient support specialits and counselors to help patients cope with their diagnosis, not only to navigate the medical system, but also to address their emotional needs. Having benefited from counseling services when she was treated as a child, Tanya found Mindy Weismer, a Patient Service Coordinator, and they quickly developed a close relationship.

Spotlight

Stand Up to Cancer

Peter O'Dwyer, MD, professor of Hematology-Oncology and program director of Development Therapeutics in the Abramson Cancer Center, was interviewed on NBC10's 10! Show about Penn's work as part of the Stand Up to Cancer Dream Team... Read more