Lung Cancer Treatment Guidelines for Patients Version III/October 2006 Introduction

With this report, patients have access to information on the way lung cancer is treated at the nation’s leading cancer centers. Originally developed for cancer specialists by the National Comprehensive Cancer Network (NCCN), these treatment guidelines have now been translated for the public by the American Cancer Society (ACS).

Since 1995, doctors have looked to the NCCN for guidance on the highest quality, most effective advice on treating cancer. For more than 90 years, the public has relied on the American Cancer Society for information about cancer. The Society’s books and brochures provide comprehensive, current, and understandable information to hundreds of thousands of patients, their families, and friends. This collaboration between the NCCN and ACS provides an authoritative and understandable source of cancer treatment information for the public.

These patient guidelines will help you better understand your cancer treatment options. We urge you to discuss them with your doctor. Here are some questions you might want to ask:

• What is the exact type of lung cancer I have?
• Has my cancer spread?
• What is the stage of my cancer and what does that mean in my case?
• What treatment choices do I have?
• What do you suggest for treatment and why?
• What should I do to get ready for treatment, minimize side effects of treatment, and hasten my recovery?
• What is the goal of this treatment?
• What risks or side effects are there to the treatment you suggest?
• Will I be able to return to my normal activities?
• What are the chances of my cancer recurring (coming back) with the treatment options we have discussed?
• What rehabilitation and support services are available to me and my family?
• Do I need follow-up appointments to check for recurrence?
• Is this the right time to discuss my living will or advance directives?

In addition to these questions, be sure to write down some of your own. For instance, you might want more information so that you can plan your work schedule. Or, you may want to ask about clinical trials for which you may qualify.

Making Decisions About Lung Cancer Treatment

Although lung cancer is a very serious disease, it is one that a team of healthcare professionals can treat. This team may include a surgeon, radiation oncologist, medical oncologist, lung specialist, oncology nurse, and social worker.

But not all people with lung cancer should have the same treatment. Doctors must take into account each patient’s specific medical situation. These guidelines are intended to help you understand the treatment options available to people with lung cancer so that you and your doctors can work together to identify which treatment best meets your medical and personal needs.

In this study you’ll find flow charts that doctors call “decision trees.” Each one shows how you and your doctor can arrive at the choices you need to make about your treatment, depending on the type, location, and extent of the lung cancer.

Here you will also find background information on lung cancer with explanations of cancer stage, work-up, and treatment – all categories used in the flow charts. We’ve also provided a glossary. Words in blue italics are defined in the glossary; you can access their definitions in a small pop-up window by clicking the word.

About the Lungs

Most cancers are named after the part of the body where the cancer first starts. Lung cancer begins in the lungs. In addition, other cancers can spread to the lungs, but these cancers are named according to where they first developed. For example, breast cancer can spread (metastasize) to the lungs, but it is called metastatic breast cancer, not lung cancer. These guidelines only address cancers that start in the lungs. The lungs are 2 sponge-like organs in the chest. They bring air in and out of the body, taking in oxygen and getting rid of carbon dioxide gas, a waste product.

The right lung has 3 sections, called lobes. The left lung has 2 lobes. It is smaller because the heart takes up more room on that side of the body. The lining around the lungs, called the pleura, helps to protect the lungs and allows them to move when you breathe. The trachea (windpipe) brings air down into the lungs. It divides into tubes called bronchi, which divide into smaller branches called bronchioles. At the end of these small branches are tiny air sacs known as alveoli. Most lung cancers start in the lining of the bronchi, but they can also begin in other areas such as the trachea, bronchioles, or alveoli.

Lymphatic vessels are similar to veins but carry lymph instead of blood. Lymph is a clear fluid that contains tissue waste products and immune system cells. Lymphatic vessels of the lungs lead to nearby lymph nodes inside the chest. These nodes are located around the bronchi and in the mediastinum (the area between the 2 lungs.) Cancer cells may enter lymph vessels and spread out along these vessels to reach lymph nodes. Lymph nodes are small, bean-shaped collections of immune system cells that are important in fighting infections. When lung cancer cells reach the lymph nodes, they can continue to grow. If cancer cells have multiplied in the lymph nodes, they are more likely to have spread to other organs of the body as well. One of the most important decision points about lung cancer treatment is based on whether or not the cancer has spread to the nearby lymph nodes in the mediastinum. The names, location, and importance of lymph nodes near the lungs are explained in the section on staging of lung cancer (see Lung Cancer Staging) and are shown in the diagram above.

The entire report is also available as a PDF file:

NCCN Lung Guidelines.pdf 884 k

You will need Adobe Acrobat to read this file.  Click here to download a current version.

TYPES OF LUNG CANCER

The mutual goal of the National Comprehensive Cancer Network® (NCCN®) and the American Cancer Society (ACS) partnership is to provide patients and the general public with state-of-the-art cancer treatment information in understandable language. This information, based on the NCCN's Clinical Practice Guidelines, is intended to assist you in the dialogue with your physician. These guidelines do not replace the expertise and clinical judgment of your physician. Each patient's situation must be evaluated individually. It is important to discuss the guidelines and all information regarding treatment options with your physician. To ensure that you have the most up-to-date version of the guidelines, consult the web sites of the ACS (www.cancer.org) or NCCN (www.nccn.org). You may also call the NCCN at 1-888-909-NCCN or the ACS at 1-800-ACS-2345 for the most recent information.

NCCN Clinical Practice Guidelines were developed by a diverse panel of experts. The guidelines are a statement of consensus of its authors regarding the scientific evidence and their views of currently accepted approaches to treatment. The NCCN guidelines are updated as new significant data become available. The Patient Information version will be updated accordingly and will be available on-line through the NCCN and the American Cancer Society web sites. To ensure you have the most recent version, you may contact the American Cancer Society or the NCCN.

©2007, by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reprinted in any form for commercial purposes without the expressed written permission of the NCCN or the American Cancer Society. Single copies of each page may be reproduced for personal and non-commercial uses by the reader.