Page last updated: May 2024
The information on this webpage was adapted from Understanding Lung Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in May 2024.
Expert content reviewers:
This information was developed based on Australian and international clinical practice guidelines, and with the help of a range of health professionals and people affected by lung cancer:
- A/Prof Brett Hughes, Senior Staff Specialist Medical Oncologist, Royal Brisbane and Women’s Hospital, The Prince Charles Hospital and The University of Queensland, QLD
- Dr Brendan Dougherty, Respiratory and Sleep Medicine Specialist, Flinders Medical Centre, SA
- Kim Greco, Nurse Consultant – Lung Cancer, Flinders Medical Centre, SA
- Dr Susan Harden, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC
- A/Prof Rohit Joshi, Medical Oncologist, GenesisCare and Lyell McEwin Hospital, Director, Cancer Research SA
- Kathlene Robson, 13 11 20 Consultant, Cancer Council ACT
- Peter Spolc, Consumer
- Nicole Taylor, Lung Cancer and Mesothelioma Cancer Specialist Nurse, Canberra Hospital, ACT
- Rosemary Taylor, Consumer
- A/Prof Gavin M Wright, Director of Surgical Oncology, St Vincent’s Hospital and Research and Education Lead – Lung Cancer, Victorian Comprehensive Cancer Centre, VIC.
Treatment for lung cancer will depend on the type of lung cancer you have, the stage of the cancer, how well you can breathe (your lung function) and your general health.
Your specialist will consider treatment options and discuss them with other health professionals at what is known as a multidisciplinary team (MDT) meeting. If you are a smoker, your doctor will advise you to stop smoking before you start treatment.
Treatment options by type and stage
Non-small cell lung cancer (NSCLC):
- Early (stage 1 or 2) – usually treated with surgery to remove the cancer and nearby lymph nodes. If surgery is not an option or you choose not to have surgery, you may have radiation therapy. Sometimes, chemotherapy may be given after surgery to reduce the risk of the cancer returning.
- Locally advanced (stage 3) – can be treated with surgery and chemotherapy, or with radiation therapy and chemotherapy. Immunotherapy drugs may also be used. Treatment will depend on where the cancer is in the lung and the number and location of lymph nodes with cancer. In some cases, targeted therapy may be used to slow the spread of the cancer.
- Advanced (stage 4) – depending on the symptoms, palliative drug treatment (targeted therapy, immunotherapy or chemotherapy), palliative radiation therapy or both may be used.
Small cell lung cancer (SCLC):
- Early or locally advanced (stages 1 to 3) – usually treated with chemotherapy and radiation therapy. Surgery is not used.
- Advanced (stage 4) – mainly treated with palliative chemotherapy, with or without immunotherapy. Palliative radiation therapy may also be given.
Understanding the aim of treatment
For early or locally advanced non-small cell lung cancer or limited-stage small cell lung cancer, treatment may be given with the aim of making all signs and symptoms of the cancer go away. This is called curative treatment.
Because lung cancer causes vague symptoms in the early stages, many people are diagnosed when the cancer is advanced. This means the cancer has spread outside the lung to other parts of the body.
The goal of treatment is to maintain quality of life by controlling the cancer, slowing down its spread and managing any symptoms, which is called palliative treatment.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for lung cancer can help you make sense of what should happen.
It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Surgery for lung cancer
People with early non-small cell lung cancer will generally be offered surgery to remove the tumour. How much of the lung is removed depends on the location of the cancer, its size, your general wellbeing and fitness, as well as your lung function.
Surgery is not suitable for most people with late-stage lung cancer. If there is fluid in the pleural cavity (called pleural effusion) that keeps coming back, you may have minor surgery (pleurodesis) to control this.
Preparing for treatment
Quit smoking
If you smoke, your health care team will usually advise you to stop smoking before you start treatment for lung cancer.
Quitting smoking can improve how treatments work and reduce the impact of side effects such as breathlessness. Research shows that quitting smoking before surgery also reduces the chance of complications.
To work out a plan for quitting, talk to your doctor or call Quitline on 13 78 48 (13 QUIT).
Eat well and exercise
Your health care team may also suggest that you exercise and eat healthy foods before starting lung cancer treatment.
You may be referred to allied health professionals such as a dietitian or exercise physiologist to support you to make changes.
Preparing for treatment in this way is called “prehabilitation”. It can help you to cope with cancer treatment, recover more quickly and improve your quality of life.
Types of lung surgery
Removing lymph nodes
During surgery, nearby lymph nodes will also be removed to see whether the cancer has spread.
Knowing if the cancer has spread to the lymph nodes also helps the doctors decide whether you need further treatment with chemotherapy or radiation therapy.
How the surgery is done
There are two ways to perform surgery for lung cancer, and both require a general anaesthetic. Each type of surgery has advantages in particular situations – talk to your surgeon about the best option for you.
- VATS – a keyhole approach known as video-assisted thoracoscopic surgery (VATS). The surgeon makes a few small cuts (incisions) in the chest wall. A tiny video camera and operating instruments are passed through the cuts, and the surgeon performs the operation from outside the chest. A keyhole approach usually means a shorter hospital stay, faster recovery and fewer side effects.
- Thoracotomy – if a long cut is made between the ribs in the side of the chest, the operation is called a thoracotomy or open surgery. You will need to stay in hospital for 3–7 days.
After surgery you will have several tubes in place, which will be removed as you recover. Some degree of pain or discomfort is common after surgery, but this can be controlled.
You will probably go home after 3–7 days, but it may take 6–12 weeks to resume your usual routine and activities.
Gentle exercises as part of a pulmonary rehabilitation program will help improve breathlessness and reduce the risk of developing a chest infection.
What to expect after surgery
- Exercises for breathlessness – A pulmonary rehabilitation program can help improve breathlessness and reduce the risk of chest infection. A physiotherapist will show you how to do exercises.
- Pain – You may have some pain but this can be controlled. Managing the pain will allow you to do breathing exercises and help you to recover. Pain will improve when tubes are removed from the chest.
- Recovery time – You will probably go home after 3–7 days. It may take 4–8 weeks after VATS or 6–12 weeks after thoracotomy to get back to your usual activities. Walking can improve fitness, help clear your lungs and speed up recovery.
- Tubes and drips – You will have several tubes in place, which will be removed as you recover. A drip in a vein in your arm (intravenous drip) will give you fluid and medicines. There may be tubes in your chest to drain fluid and help your lungs expand; and a tube in your bladder to check how much urine you pass.
Radiation therapy
Also known as radiotherapy, radiation therapy is the use of targeted radiation to kill or damage cancer cells so they cannot grow, multiply or spread.
Radiation therapy may be offered on its own or in combination with surgery or chemotherapy, and may be recommended:
- to treat an early lung cancer if you are unable or choose not to have surgery
- to treat locally advanced NSCLC or limited-stage SCLC
- after surgery if tests show cancer in the mediastinal lymph nodes, to reduce the risk of the cancer coming back in the mediastinum
- as palliative treatment to improve quality of life by relieving pain or other symptoms.
For lung cancer, the radiation is usually in the form of x-ray beams that come from a machine outside the body. This is called external beam radiation therapy (EBRT) and it can be delivered in different ways:
Standard external beam radiation therapy (EBRT)
This is usually given Monday to Friday over several weeks. For NSCLC, treatment aimed at making the signs and symptoms of cancer go away (curative course) may involve 20–30 radiation therapy sessions over 4–6 weeks.
Palliative radiation therapy may involve up to about 10 treatments. For SCLC, treatment may be given twice a day for 3 weeks (about 30 treatments).
Stereotactic body radiation therapy (SBRT)
This is also called stereotactic ablative body radiation (SABR). It is a way of giving a very precise high dose of radiation therapy to small, early-stage NSCLC.
How SBRT is done
Stereotactic body radiation therapy (SBRT) precisely targets beams of high-dose radiation from different angles onto the tumour.
SBRT may be used when you are not well enough to have surgery, or surgery is not possible due to the location or size of the cancer.
SBRT is often given as 3–4 treatment sessions over a couple of weeks. It is suitable only for tumours that are not close to major airways or major blood vessels.
Side effects of radiation therapy can include difficulty swallowing and heartburn, fatigue, skin changes, shortness of breath and coughing.
Planning radiation therapy
Before treatment starts, you will have a planning session at the radiation therapy centre to design a treatment plan for you.
During this appointment, you will have a CT scan to pinpoint the area to be treated, and marks will be put on your skin so the radiation therapist treats the same area each time.
Often, you will have a 4-dimensional CT scan to monitor how the lung cancer moves as you breathe in and out. You may also be given some breathing exercises to help your breathing stay as regular as possible during the treatment sessions.
Having radiation therapy
Radiation therapy is delivered using a large machine called a linear accelerator. Each treatment day, a radiation therapist will help you to lie on the treatment table and make sure you are in the correct position before leaving the room.
Before the radiation therapy is given, you will have an x-ray or CT scan to make sure the correct area is being treated.
The radiation treatment itself takes only a few minutes, but a session may last 10–20 minutes because of the time it takes to set up the machine.
Side effects of radiation therapy
Radiation therapy itself is painless, but the radiation may affect some tissues of the body and cause various side effects. These side effects vary depending on the dose of radiation, the number of treatments and the part of the chest treated.
Most are temporary and disappear a few weeks or months after treatment.
- Discomfort when swallowing and heartburn – If the cancer is in the centre of the chest and near the oesophagus, you may have some discomfort when swallowing, and heartburn during the treatment period and up to four weeks after treatment ends. Until these side effects improve, you may need to eat soft foods and avoid hot drinks.
- Fatigue – Feeling tired is common after radiation therapy. Plan your daily activities so you can rest regularly. You may find that gentle physical exercise reduces fatigue.
- Skin changes – The skin on your chest and back may become red or dry, like sunburn. It is important to avoid getting direct sunlight on these areas. Applying a moisturising cream daily can help protect your skin – talk to your medical team about which products they recommend.
- Shortness of breath and cough – Radiation therapy may cause inflammation of the lungs. Called radiation pneumonitis, this may cause shortness of breath and/or a cough. This may happen during treatment, but it is more likely to appear 1–6 months after treatment ends. Radiation pneumonitis is usually temporary and can be treated.
Side effects can change from one treatment session to the next and may build up over time. Tell the radiation oncology team about any side effects you have, as most can be managed.
Clinical trials
The area of cancer treatment is changing rapidly, and it's likely that new gene changes and targeted therapy drugs will continue to be discovered.
Talk to your oncologist about any clinical trials that may be suitable for you, and see Victorian Clinical Trials Link for cancer clinical trials being conducted in Victoria.
Visit VCTL
Drug therapies
Sometimes called systemic therapies, drug therapies can travel throughout the body to treat cancer cells wherever they may be. This can be helpful for cancer that has spread (metastatic cancer).
The main types of drug therapies used to treat lung cancer are chemotherapy, immunotherapy and targeted therapy
Chemotherapy
Chemotherapy is the treatment of cancer with drugs that kill cancer cells or slow their growth. It can be used at different times, including:
- before surgery to try to shrink the cancer and make the operation easier (neoadjuvant chemotherapy)
- before or during radiation therapy to make radiation therapy more effective (chemoradiation)
- after surgery to reduce the risk of the cancer returning (adjuvant chemotherapy)
- when cancer is advanced to reduce symptoms and improve quality of life (palliative chemotherapy).
Sides effects of chemotherapy can include anaemia (low red blood cell count), mouth ulcers, hair loss, nausea or vomiting and a higher risk of infection.
Having chemotherapy
Chemotherapy is usually given through a vein (intravenously). It is commonly given as a period of treatment followed by a break to allow your body to recover. This is called a cycle.
The number of cycles will depend on the type of lung cancer and any side effects you have. You will probably have chemotherapy as an outpatient, which means you will go to the treatment centre for chemotherapy but not stay overnight.
Some types of chemotherapy come in tablet form and can be taken by mouth (orally) at home. Ask your doctor about the treatment plan recommended for you.
Side effects of chemotherapy
Chemotherapy works on cells that are dividing rapidly. Cancer cells divide rapidly, as do some healthy cells such as the cells in your blood, mouth, digestive system and hair follicles. Side effects occur when chemotherapy damages these normal cells.
As the body constantly makes new cells, most side effects are temporary. Some side effects are listed below.
- Anaemia – A low red blood cell count is called anaemia. This can make you feel tired, breathless or dizzy. Your treatment team will monitor your red blood cell levels and suggest treatment if necessary.
- Risk of infections – Chemotherapy drugs can lower the number of white blood cells that fight infections caused by bacteria. If you get an infection caused by a virus, such as a cold, flu or COVID-19, the risk of getting a bacterial infection is further increased. Talk to your doctor about being vaccinated against flu and COVID-19. Good hand and mouth hygiene and social distancing are also important measures to reduce the risk of infection. If you feel unwell or have a temperature above 38°C, call your doctor immediately or go to the hospital emergency department.
- Mouth ulcers – Some chemotherapy drugs cause mouth sores, ulcers and thickened saliva, which make it difficult to swallow. Your treatment team will explain how to take care of your mouth.
- Hair loss – You may lose hair from your head and chest, depending on the chemotherapy drugs you receive. The hair will grow back after treatment is completed, but the colour and texture may change.
- Nausea, vomiting or constipation – You will usually be prescribed anti-nausea medicine with your chemotherapy drugs, but some people still feel sick (nauseous) or vomit. Constipation is also a common side effect of some types of anti-nausea medicines. Let your treatment team know if you have these side effects, as they may be able to give you additional medicines.
Get support
When you call the Cancer Council support line on 13 11 20, you’ll talk to a cancer nurse and get the support you need.
It’s free, confidential, and available for anyone affected by cancer who has a question – those diagnosed as well as their family, friends, and carers.
Contact cancer support
Support groups provide an opportunity for people affected by cancer to meet in an emotionally supportive environment.
Explore support groups
Targeted therapy
Targeted therapy is a type of drug treatment that attacks specific features of cancer cells, known as molecular targets, to stop the cancer growing and spreading.
The molecular targets are usually particular gene changes that are found in or on the surface of cancer cells.
Targeted therapy is currently available for people with NSCLC whose tumours have specific gene changes when the cancer is advanced or has come back after initial surgery or radiation therapy.
These drugs will only work if the cancer contains the particular gene targeted and, even then, they do not work for everyone. Ask your oncologist about molecular testing and whether targeted therapy is an option for you.
Targeted therapy can often be given by mouth as tablets or capsules. This area of cancer treatment is changing rapidly, and it’s likely that new gene changes and targeted therapy drugs will continue to be discovered.
Cancer cells often become resistant to targeted therapy drugs over time. If the first-line treatment stops working, your oncologist may suggest trying another targeted therapy drug or another systemic treatment. This is known as second-line treatment.
Side effects of targeted therapy
Although targeted therapy may cause less harm to healthy cells than chemotherapy, it can still have side effects. These side effects vary depending on the type of targeted therapy drugs used.
Common side effects that may develop include an acne-like rash, fatigue, diarrhoea, nausea or vomiting. Targeted therapies may also cause pneumonitis (inflammation of the lung tissue), which can lead to breathing problems.
It’s important to report any new or worsening side effects to your treatment team. If left untreated, some side effects can become serious and may even be life-threatening
"A lot of the people I’ve met with lung cancer, say they’re guarded about their diagnosis. One carer said she didn’t tell anyone for 3 years that her spouse had lung cancer for fear of being stigmatised. There needs to be a lot more compassion." Lillian
Immunotherapy
Immunotherapy is a type of drug treatment that uses the body’s own immune system to fight cancer. Immunotherapy drugs known as checkpoint inhibitors block proteins, such as PD-L1, that stop immune cells from recognising and destroying the cancer cells.
Once the proteins are blocked, the immune cells can potentially recognise and attack the lung cancer. Several checkpoint inhibitors have been approved for most types of advanced NSCLC.
One has also been approved for extensive-stage SCLC when it is used together with chemotherapy. Several other checkpoint inhibitors are being tested in clinical trials for lung cancer, including using a combination of these drugs.
Immunotherapy may be used alone or with chemotherapy as a palliative treatment, or after chemoradiation. In the future, immunotherapy may be used for early-stage NSCLC, either before or after surgery.
Checkpoint inhibitors do not work for all types of lung cancer, but some people have had good results. Ask your oncologist about molecular testing and whether immunotherapy may be an option for you.
Side effects of immunotherapy
Immunotherapy can cause inflammation throughout the body, which leads to different side effects depending on which part of the body becomes inflamed. Common side effects include fatigue, rash, painful joints and diarrhoea.
Most people have mild side effects that can be treated easily and usually improve. Let your treatment team know if you have new or worsening symptoms.
If left untreated, some side effects can become serious and may even be life-threatening.
Palliative treatment
If the cancer is advanced when it is first diagnosed or comes back after treatment, your doctor will discuss palliative treatment for any symptoms caused by the cancer.
Palliative treatment aims to manage symptoms without trying to cure the disease. It can be used at any stage of advanced lung cancer to improve quality of life and does not mean giving up hope. Rather, it is about living as fully and comfortably as possible.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, spiritual and social needs. The team also supports families and carers.