Radiation therapy is a routinely used cancer treatment that utilizes X-rays or high-energy beams to damage cancerous cells and destroy their ability to grow or divide by obliterating their genetic material. This can be delivered to the patient using machines or small instruments placed directly inside the patient's body. Radiation therapy plays an important role in lung cancer treatment in all stages. In early stage disease, radiation may be used alone or given concurrently with chemotherapy to cure patients. In later stages of the disease, radiotherapy may be used for palliation to reduce symptoms caused by the cancer and improve quality of life. New research shows that radiation, in select patients, may also extend life even in patients with stage IV disease.
What is stage four lung cancer?
Stage four lung cancer is considered late stage and it refers to the spreading of cancer in the body which can also be known as Metastatic lung cancer or advanced lung cancer.
Read MoreStage 4A Lung Cancer
This stage is characterized by one of the following features:- Cancer exists in both lungs
- Presence of fluid with cancer cells enclosed either in the lungs or the heart
- Cancer has spread to lymph nodes and one other organ
Stage 4B Lung Cancer
This follows stage 4A and is characterized by cancer spreading to multiple other organs instead of just one.
Stage four Lung cancer symptoms
The most common symptoms of lung cancer include the following:
- Persistent cough that only gets worse
- Persistent infections
- Coughing up blood
- Shortness of breath
- Fatigue and tiredness
- Unprecedented wheezing
- Hoarseness (a condition referring to a strained or raspy voice)
- Chest pains which become worse with activity
- Weight loss
With the advance of the disease to later stages where cancer metastasizes, other symptoms may appear depending on the organ that cancer spreads to, for example:
- If cancer spreads to the liver, jaundice can occur and is manifested in yellow skin and eyes.
- If cancer spreads to the brain, there can be s nervous system changes manifested by headaches, dizziness, imbalance, seizures, weakness, and numbness).
- If cancer spread to the bone, it's manifested in extreme bone pain
- Swelling of lymph nodes.
What are the treatment options available for stage four lung cancer?
Generally, besides the stage of lung cancer, there are other factors to consider when it comes to choosing the best treatment plan and these are:
- Type of lung cancer (whether diagnosed as having Small Cell Lung Cancer or Non-Small Cell Lung Cancer)
- Location of cancer
- Other underlying medical conditions
- Associated gene mutations causing the disease
- Patient overall health and personal preference
For Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC), the goal of treatment is to control the disease and relieve the symptoms. Treatment options include:
- Chemotherapy if the patient is stable and well (maybe administered alone or in combination with radiation therapy or immunotherapy)
- Radiotherapy
- Targeted therapy (when a specific protein or mutation has been identified to cause cancer, it can then be targeted and inhibited)
- Immunotherapy (ex. Checkpoint inhibitors )
- Surgery (removing affected lymph nodes and tumors if applicable)
Doctors are cautious about applying chemotherapy only to patients who are well and stable. By carefully monitoring a patient’s condition, doctors can ensure that chemotherapy is only used when the potential benefits outweigh the risks. In some cases, chemotherapy may even be postponed until a patient’s condition improves. By taking these precautions, doctors can help ensure that chemotherapy is used safely and effectively.
What are the side effects of chemotherapy for NSCLC and SCLC?
The side effects of chemotherapy for lung cancer patients include the following:
- Loss of hair
- Nausea
- Vomiting
- Sores in the mouth
- Constipation or diarrhea
Other serious side effects happen when chemotherapy affects the cells that form the blood in the bone marrow. They include:
- Fatigue or tiredness (due to low red blood cells)
- Elevated risk of infections (due to low white blood cells)
- Bruising and bleeding easily (due to low platelet count)
What is the success rate of stage four lung cancer radiation therapy?
As previously stated by Dr. Billy Loo, a Professor of Radiation Oncology and Bioengineer who directs the Thoracic Radiation Oncology Program at Stanford that radiation therapy can be used to treat stage four lung cancer as part of palliative treatment to shrink tumors and alleviate some of the cancer symptoms such as trouble swallowing, coughing, and pain. Furthermore, he shared other thoughts by saying it can also help "special cases where the spread…to other parts of the body may be very limited. Some of these patients can be treated more intensively with the attempt to try to eliminate all of the cancer to cure it."
This was supported by several studies, including one study in 2014, which was done on 201 patients with advanced-stage non-small-cell lung cancer who were also taking chemotherapyto find out that radiation therapy has significantly increased their survival. Recently, newer studies have also demonstrated improvements in overall survival in select patients with a limited number of metastasis who are treated with a highly focused and powerful type of radiation called Stereotactic Body Radiotherapy or SBRT. It is important to ask your treatment teams about these options.
Radiotherapy techniques for lung cancer
The radiation treatment techniques used on lung cancer patients vary and the choice of which of these to undergo is a decision taken by your healthcare provider as seen fit for your case. There are two main classes of radiation therapy- external beam radiation therapy (EBRT) and brachytherapy. There are multiple ways of delivering external beam radiotherapy and it's very important to be aware of your options.
Types of External beam radiotherapy :
- Intensity-modulated radiation therapy (IMRT) (which depends on applying radiation in the shape of the tumor) is a very sophisticated way to deliver radiation that maximizes the dose to the tumor while protecting normal tissues nearby.
- Stereotactic body radiation (SBRT) or Stereotactic ablative radiotherapy (SABR) (depends on applying high doses of radiation with great accuracy to the lungs and their surrounding area)
- Stereotactic radiosurgery (SRS) (targets tumors that have spread to the brain and spinal cord with high radiation)
Brachytherapy (internal or implant radiation therapyinserted directly in the tumor or near it)
Common side effects of radiation therapy
Granted, radiotherapy for stage 4 lung cancer has many wins in the scientific literature. However, it doesn't go without its challenges, as many of its patients go through some side effects and these include:
- Skin reactions (blistering, peeling, or itching)
- Fatigue
- Cough
- Sore throat
However, these can differ from one patient to another since they are applied locally and directly affect the selected organ.
Factors that influence stage 4 lung cancer survival
Several factors can affect the outlook of having lung cancer, these are:
- Age a study done in 2013 strongly recommended the inclusion of patients' age in clinical practice when deciding on the best treatment plan.
- Sex Through the statistical analysis, it was proven that women were more likely to get lung cancer than men.
- Overall health and response treatment Commonly, if you've been diagnosed with lung cancer while you have no other underlying medical conditions, the response to treatment and your disease outlook will be much better.
- Smoking Being the most established risk factor for lung cancer, there has been scientific evidence to support that patients with stage 4 lung cancer who quit smoking can increase their survival time by 6 months.
- The type of cancer and its location Presumably, some lung cancers are more aggressive and fatal than others, especially if the tumor is lodged in a compromised place next to important vascular structures such as the aorta, heart, and great vessels.
- Genetic mutations Lung cancer patients who have identified genetic mutations can have the best outlook when these mutations are diagnosed and treated via targeted therapies. An example of this is targeting EGFR, which is a very common genetic mutation that causes Non-Small Cell Lung Cancer (NSCLC).
The Bottom Line
A diagnosis of advanced-stage lung cancer can be overwhelming, but it doesn't necessarily mean that there's nothing else to do but give up. On the contrary, Radiotherapy has proved its pivotal role in relieving symptoms, extending survival rates, and even curing cancer that has spread to other organs to control metastasis.
Thus, it's imminent to discuss treatment options and reach an agreement with your healthcare provider on the best plan of action to take. Additionally, having stage 4 lung cancer can take its toll on a person both physically and mentally, so it's important to stay positive and seek assistance from your loved ones or from cancer support groups to help you get through this tough time.
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