Inoperable Lung Cancer: For Patients

Inoperable lung cancer, also called unresectable lung cancer, means lung cancer that cannot be treated with surgery. Surgery aims to remove the entire tumor. For many patients with lung cancer, surgical removal of the tumor is not possible or not be the best treatment option for them. Although it may be discouraging to hear that your lung cancer is inoperable, there are many ways to treat lung cancer outside of surgery. Non-surgical treatments for lung cancer include radiation, chemotherapy, targeted therapy, immunotherapy, and laser therapy as well as new lung cancer treatments accessible through clinical trials.

When is lung cancer inoperable?

Lung cancer is inoperable when it is not possible to remove all of the lung cancer with surgery. This may be because it has spread outside of the lungs, the location and size of the tumor make surgery risky, or the patient is not healthy enough for surgery. Surgery may be too difficult to perform if the tumor is situated too close to other organs or blood vessels that could be damaged during surgery or very deep in the lung tissue.

It is possible that doctors will determine that a patient’s lungs are not healthy enough to function after surgery and this can be a reason for lung cancer to be inoperable. Patients considering surgery will have a lung function test such as spirometry to measure the force of their breath before the surgical procedure.

Certain health conditions, such as chronic pulmonary disease (COPD), can make lung cancer surgery too risky for some patients. Patients will have their heart checked before surgery because lung surgery can cause complications such as heart attack or other heart problems. Someone in poor health can be expected to have more complications from surgery and anesthesia. Patients must be healthy enough to overcome complications such as blood loss, clotting, infections, and pneumonia.

Inoperable small-cell lung cancer (SCLC)

Whether surgery is the best option is different for each patient and depends partly on the type of lung cancer present and the stage. 10-15% of lung cancers are small-cell lung cancer (SCLC), a fast-growing cancer linked to cigarette smoking. The stages of SCLC are categorized as limited or extensive. Limited SCLC is only in one part of the chest. Extensive SCLC has spread to other parts of the body such as the other lungs, brain, bones, or bone marrow.

SCLC is usually diagnosed after cancer has spread outside the lungs and it is rarely treated with surgery. Surgery may be considered for SCLC if it is diagnosed at a very early stage. Since SCLC cells grow very quickly, treatments that target fast-growing cells, such as chemotherapy and radiation therapy are generally good options.

Inoperable non-small-cell cancer (NSCLC)

Approximately 8 in 10 lung cancer cases are non-small-cell cancer (NSCLC), which includes adenocarcinoma, squamous cell carcinoma, and large-cell (undifferentiated) carcinoma subtypes. Surgery is one of the main treatment options for NSCLC. Unfortunately, symptoms such as cough, chest pain, and shortness of breath often begin after lung cancer has spread. This is why lung cancer may be inoperable at the time of diagnosis.

Doctors will use tests to determine the stage of lung cancer, which is based on the location, whether it has spread, and how other parts of the body are affected. Surgery is an option to remove the tumor in Stage 0 and Stage 1 cancer because at these stages NSCLC has not spread to lymph nodes. In Stage 2 NSCLC the tumor is larger and may have spread to lymph nodes.

Surgery is sometimes an option for Stage 2 NSCLC. Stage 3 tumors in NSCLC may be very difficult to remove depending on how large the tumor is and which lymph nodes are involved. Some Stage 3 NSCLC cannot be treated with surgery. Stage 4 NSCLC is inoperable lung cancer, which has spread to more than one area of the lung, the fluid around the lungs, heart, or other parts of the body.

Treatment options for inoperable lung cancer

Receiving a diagnosis of inoperable lung cancer is scary but it is important to remember that inoperable cancer does not mean untreatable cancer. There are many treatment options for patients with inoperable lung cancer that can shrink tumors, improve symptoms, and slow the progression of disease. Your doctor will help you choose the best treatment for your lung cancer, taking into account your overall health.

In addition to radiation therapy, chemotherapy, targeted therapy, immunotherapy, and laser therapy available as approved treatments, new lung cancer treatments are being tested in clinical trials. By joining a clinical trial, a patient can gain access to treatments that are not yet available to everyone. Your doctor can help you decide if a clinical trial option is right for you.

Radiation Therapy

Radiation therapy is the use of high-energy X-rays or other radiation to kill cancer cells or hinder their growth. For patients with SCLC and some patients with NSCLC, external radiation therapy is used. This means that the radiation comes from a machine outside the body. Internal radiation therapy is when the source of radiation is a radioactive seed, wire, or needle implanted near the cancer. This form of radiation therapy is sometimes used for NSCLC. Radiation therapy may be used alongside other treatments for lung cancer.

Chemotherapy

Chemotherapy is the use of drugs that kill cancer cells or prevent cell division. Chemotherapy may be administered as pills or injections. Fast-growing cells, including cancer cells, are targeted by chemotherapy. Chemotherapy may be used in combination with other treatments for lung cancer.

Targeted Therapy

Targeted therapy is a treatment often used for NSCLC that is directed at cancer cells with specific mutations that the drugs recognize and home in on. Targeted therapy has less collateral damage to healthy cells compared with radiation or chemotherapy. Targeted therapy can allow some patients to live with their lung cancer and keep it under control, similar to living with a chronic disease.

Immunotherapy

Immunotherapy, also known as biological therapy, is a treatment that boosts the immune system’s ability to fight cancer. Immunotherapy drugs may alter the way the immune system responds to cancer or cause the immune system to target cancer cells more effectively. Not all lung cancer patients respond well to immunotherapy, but it is very effective in about 30% of lung cancers.

Laser therapy

Lasers can be used to shrink or destroy tumors. In photodynamic therapy (PDT) a special drug is delivered into the bloodstream and gets absorbed into the cancer cells. Then a laser is used to activate the medication and cause a chemical reaction that kills cancer cells.

Summary

Patients diagnosed with inoperable lung cancer are not recommended to have surgery as a treatment. It may not be possible to remove their tumor with surgery or the risks of surgery may be too high. Patients with inoperable lung cancer have many nonsurgical treatment options that can slow cancer growth, shrink tumors, ease symptoms, and extend their lives. Cancer researchers continue to seek new and better treatments for lung cancer. In addition to approved treatments, patients should discuss clinical trial lung cancer treatment options with their doctor.

myTomorrows is dedicated to helping patients with lung cancer find and access lung cancer clinical trials and other potential treatment options.