How Is Lung Cancer Treatment Decided?
Lung cancer treatment is not one-size-fits-all. Before recommending a plan, your oncologist will consider the lung cancer’s type (non-small cell or small cell), the stage, your overall health and lung function, and the results of biomarker testing. Biomarker testing checks your tumour for specific mutations - such as EGFR, ALK, ROS1, or KRAS - that determine whether targeted therapy or immunotherapy is suitable. These results are essential before treatment begins for all NSCLC patients.
Surgery
Early-stage non-small cell lung cancer’s (NSCLC, Stages I and II) primary treatment is surgery. When the tumour is localised and lung function is adequate, it offers the best chance of cure.
Types of Lung Cancer Surgery
- Lobectomy -The removal of an entire lobe of the lung; the most common procedure
- Segmentectomy (wedge resection) - removal of a smaller section; used for smaller tumours or patients who cannot tolerate a full lobectomy
- Pneumonectomy: The removal of an entire lung; reserved for large or centrally located tumours
- Sleeve resection - used for central airway tumours, preserving more lung tissue
Most surgeries are now performed using minimally invasive Video-Assisted Thoracic Surgery (VATS) or robotic-assisted techniques, resulting in less pain, shorter stays, and faster recovery than open surgery. Patients with Stage IV disease, poor lung function, or tumours near major blood vessels are not surgical candidates.
Chemotherapy
Chemotherapy uses drugs delivered intravenously or orally to destroy cancer cells throughout the body. It is a core treatment for both NSCLC and SCLC.
How Chemotherapy Is Used
- Neoadjuvant (before surgery) - shrinks the tumour before removal
- Adjuvant (after surgery) - eliminates remaining cancer cells and reduces recurrence risk
- Concurrent (alongside radiation) - enhances radiotherapy in locally advanced disease
- Primary treatment - the main approach for advanced NSCLC or SCLC
Platinum-based regimens (cisplatin or carboplatin) form the backbone of most protocols. Pemetrexed is standard for non-squamous NSCLC; etoposide plus platinum is used for SCLC. Side effects like fatigue, nausea, and hair loss are manageable with modern supportive medications, and many patients maintain daily activities throughout treatment.
Radiation Therapy
Radiation therapy uses carefully focused high-energy rays to damage and destroy cancer cells. Modern techniques target the tumour precisely while protecting surrounding healthy lung tissue.
Types of Radiation Used in Lung Cancer
- External Beam Radiation Therapy (EBRT) - the most common form, delivered from outside the body
- Stereotactic Body Radiation Therapy (SBRT) - high-dose, focused radiation delivered in 3 to 5 sessions; used for early-stage tumours in patients unsuitable for surgery
- Intensity-Modulated Radiation Therapy (IMRT) - shapes beams to the tumour contour, minimising dose to healthy tissue
Radiation is used as a standalone treatment for early-stage NSCLC in non-surgical patients, combined with chemotherapy for locally advanced Stage III NSCLC or SCLC, and as palliative care in Stage IV disease for symptoms like bone pain or airway obstruction. Radiation is not felt during delivery. Side effects include fatigue and oesophageal irritation. Radiation pneumonitis can develop weeks after treatment and requires prompt monitoring.
Targeted Therapy
Targeted therapies block specific genetic mutations that drive cancer growth. They are only suitable for patients whose tumours carry actionable mutations - confirmed through biomarker testing. Common targets include EGFR (10-15% of NSCLC cases), ALK rearrangements (~5%), ROS1, KRAS G12C, and MET exon 14. Approved drugs include osimertinib (EGFR), alectinib (ALK), and sotorasib or adagrasib (KRAS G12C). These oral medications produce better outcomes than chemotherapy alone for patients with the relevant mutations.
Immunotherapy
Immunotherapy helps the body’s immune system recognise and attack cancer cells more effectively. Pembrolizumab is often used as a first-line treatment for advanced NSCLC with high PD-L1 expression and may also be combined with chemotherapy in some cases. For patients with resectable NSCLC, nivolumab together with chemotherapy may be given before surgery to help shrink the tumour. For SCLC, atezolizumab and durvalumab are used with chemotherapy in extensive-stage disease. The key side effect to monitor in lung cancer patients is immune-related pneumonitis, which requires close surveillance throughout treatment.
Conclusion
Lung cancer treatment has improved significantly over the years, with several effective options now available depending on the type and stage of the disease. From surgery and chemotherapy to newer approaches like targeted therapy and immunotherapy, treatment plans are becoming more personalized to each patient.The right treatment strategy and regular medical follow-up, many patients can achieve better outcomes and maintain a good quality of life.
