Diagnosis & Treatment
Lung Cancer
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Lung cancer treatment abroad

Lung cancer treatment abroad

Lung cancer treatment abroad has gained great popularity; many patients seek first-class services and unique procedures at an affordable price.

Lung neoplasms can be benign or malignant (cancer).

About 90% of lung tumors are malignant.

They can develop in all parts of the lung, but most often the tumors are located in the upper part.

This area is better ventilated during breathing. It is much more exposed to harmful substances.

Many factors contribute to the development of lung cancer.

Tobacco smoke, radon and airborne pollutants transform normal bronchial mucosal cells into cancer cells.

Diet, infections, occupational diseases and hereditary factors also play a role. Although there is no clear evidence of the latter, some families suffer from this disease more often than others.

Lung cancer often occurs after 40.

The risk increases with age. Most patients with lung cancer are about 65 years old.

This is the most common cause of death for men and the third leading cause of cancer death among women in the developed world.

In the European Union, 1,100 new cases are diagnosed every day. About 1,000 Europeans die of lung cancer every day. This corresponds to 353,000 deaths per year.

A study in the United States showed that regular low-dose computed tomography in heavy smokers can reduce lung cancer mortality by 20%. The problem is false-positive results in 40% of examined patients who do not actually have cancer. This leads to stress, additional costs, and unnecessary diagnostic procedures (biopsies) that usually do not confirm cancer.

The treatment of lung cancer in the world has improved significantly over the past ten years.

In the early stage of the disease, minimally invasive procedures are often sufficient to completely cure. Thoracic surgeons from the USA, Germany, Japan, Israel and other countries are constantly expanding the possibilities of surgical treatment for patients with inoperable tumors.

In some cases, chemotherapy, immunotherapy and targeted therapy are successfully used before surgery to improve treatment outcomes.

Which country has the best lung cancer treatment?

Undoubtedly, the training of medical personnel, the technical level of hospitals, financing and infrastructure across the world vary significantly.

However, it is not correct to choose the best countries in the world for the treatment of lung cancer. Medical tourists should look for the best hospitals, clinics and specialized institutes that sometimes can be located in distant parts of the world.

The best lung cancer centers can be found in the following countries:

• Australia
• Canada
• Finland
• France
• Germany
• Israel
• South Korea
• Sweden
• Switzerland
• Turkey
• United States.

The cost of diagnosing and treating lung cancer is also significantly different.

For example, clinics in Turkey and Israel offer relatively affordable services, while treatment in leading US cancer centers is extremely expensive.

Germany is rightly considered the best destination in Europe for medical tourists facing cancer.

Approximate prices for lung cancer treatment in Europe:

• Lung Biopsy - $ 2000-4000
• Thoracic surgeon consultation - $ 500-1000
• Comprehensive diagnostics - $ 2000 and more
• Computed tomography - about $ 1000
• Tumor Removal - $ 8,000 or more
• CyberKnife - up to $ 15,000
• Robotic Surgery - $ 12,000-30000.

The exact expenses of patients depend not only on the hospital, but also on the stage of the disease and the characteristics of the specific clinical case.

Often, treatment and patient care costs tens of thousands of dollars annually. The patient must find money in advance, because treatment interruption can greatly affect the outcome.

If funds are limited, sometimes it is better to initially look for an inexpensive clinic than to risk interrupting an expensive therapy due to lack of money.

Which country has the best lung cancer treatment?

It is important to consider the distance and cost of living in the country. It is possible that the treatment and follow-up will require frequent flights and a long stay at the hotel with relatives.

What are the first signs of lung cancer?

Early detection of lung cancer is extremely difficult.

When patients develop noticeable symptoms, such as chest pain, shortness of breath, and hemoptysis, the cancer has usually spread to the surrounding tissues.

For this reason, heavy smokers and some professional groups should be tested regularly. The later cancer is diagnosed, the worse the prognosis.

There are no specific early symptoms of lung cancer. In addition, there is currently no established method for rapid and sensitive screening in a healthy population.

But there are alarming symptoms to pay attention to. A prolonged cough is a possible symptom of lung cancer. If a smoker’s chronic cough changes, consult a doctor as soon as possible.

Symptoms of lung cancer:

• A cough that has recently begun, or an unexplained worsening of a chronic cough.
• Blood cough or bloody sputum.
• Bronchitis or a cold that does not respond to antibiotic treatment or often recurs.
• Difficulty breathing.
• Paralysis or severe pain in the chest, shoulders, or arms.
• Swelling of the face or neck.
• Unexplained weight loss.
• Weakness, fatigue and loss of appetite.

Life expectancy: Is lung cancer curable?

One of the most common types of cancer in the world is lung cancer.

Life expectancy and chances for recovery depend mainly on the type of tumor and the stage of the disease. Basically, the prognosis is poor, and recovery is no longer possible. However, with proper treatment, the life expectancy of many patients can be significantly increased.

A complete cure for lung cancer is possible only in a few cases, because the disease is often found only in the later stages.

According to Western statistics, for every 25 new cases of the disease, 20 deaths are recorded annually. For example, in Germany, 5-year survival for lung cancer is 15% for men and 20% for women, and a 10-year survival rate is 10% and 15%, respectively.

What does lung cancer survival depend on?

The life expectancy of a patient with lung cancer depends mainly on two factors.

On the one hand, the stage of the disease at the time of diagnosis is crucial. In the early stages of lung cancer, the chances of a full recovery and life expectancy are higher than in the later stages.

On the other hand, the type of tumor also affects the survival of patients. Lung cancer is divided into two main groups: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). They develop in different ways, so the chances of recovery are different.

Small cell lung cancer: survival

Small cell lung cancer is less common than NSCLC, but this type of tumor is very aggressive. Without treatment, patients usually die within two to four months after diagnosis.

The cells of this tumor divide very quickly, so small cell lung cancer is prone to rapid growth and metastasis. It forms secondary tumors early (metastases) in other parts of the body. Consequently, the life expectancy and recovery chances for this type of disease are usually lower.

It is all the more important to diagnose and treat small cell lung cancer as early as possible. In very early stages, a tumor can be surgically removed. Unfortunately, this applies to very few patients.

In most patients, small cell lung cancer is diagnosed in the later stages, when surgery is no longer meaningful or impossible. The main method of treatment is chemotherapy (often in combination with radiation therapy) and some modern options, such as immunotherapy.

Is chemotherapy effective for SCLC?

Small cell lung cancer usually responds well to chemotherapy. Cytotoxic drugs used in chemotherapy are particularly effective against rapidly dividing cells, including cells of SCLC.

Survival rate and life expectancy increase slightly for some patients. In most cases, tumor growth temporarily slows down. After some time, the cancer cells become resistant to chemotherapy, and the tumor begins to grow again.

Non-small cell lung cancer: survival

Non-small cell lung cancer is the most common type of lung tumors. Doctors distinguish several types of NSCLC. The recovery chances and life expectancy for these subtypes are comparable.

Non-small cell lung cancer grows much slower compared with SCLC. Secondary tumors in other parts of the body are formed only in the later stage. Therefore, survival and chances of recovery for non-small cell lung cancer are usually higher.

In approximately 25-30% of patients, surgery is the treatment of choice. If the disease is diagnosed at a late stage, radiation therapy is prescribed, possibly in combination with chemotherapy. Sometimes an inoperable tumor can be reduced for subsequent surgical removal.

Life expectancy and recovery chances decrease as the tumor spreads.

If the neoplasm is less than three centimeters in diameter, the lymph nodes are not involved and there are no metastases, then the five-year survival rate is about 65%. In metastatic non-small cell lung cancer, up to 99% of patients die within five years after diagnosis.

There are other factors that affect the life expectancy of patients with lung cancer. These include, for example, the patient’s general condition, tobacco use and concomitant diseases such as heart disease, hypertension, and diabetes.

Can lung cancer be cured?

In principle, lung cancer is curable, but only when all cancer cells can be completely removed or destroyed. This is usually possible with surgery, sometimes with chemotherapy and / or radiation. With chemotherapy or radiotherapy alone, it is rarely possible to completely cure lung cancer.

The chances of recovery are highest in patients with a small tumor without involvement of the lymph nodes and metastases. In later stages, the disease can be controlled with chemotherapy, radiation, and immunotherapy.

Sometimes it works so well that the signs of cancer go away. However, “healing” in such cases is unlikely. Instead, oncologists talk about remission, because in most patients cancer comes back.

Lung cancer treatment methods abroad

Lung cancer treatment can be aimed at a complete cure (curative therapy) or the slowdown in the growth and spread of a tumor. If cure is not possible, so-called palliative therapy is offered. It aims to relieve symptoms and improve the quality of life.

An integral component of lung cancer treatment is the so-called supportive therapy. This term refers to the prevention and treatment of complications associated with cancer and aggressive therapies.

Whether it is surgery, chemotherapy, radiation therapy, targeted therapy or immunotherapy – the specific treatment method depends primarily on the type of tumor (non-small cell lung cancer or small cell lung cancer), the stage of the disease, the genetic changes of the tumor cells and the general condition of the patient.

Scientific institutions around the world publish recommendations for the treatment of diseases that are regularly reviewed and updated.

Approach in different countries may be different.

What kind of therapy for which patient?

Each clinic has a tumor advice that decides which therapy is appropriate for the patient. This includes several doctors representing different areas of medicine. They discuss and evaluate the results of the survey and recommend a treatment plan.

The physician will then explain to the patient which treatments are optimal in his case.

The choice of therapy depends on whether a cure is possible or the therapy should only ensure a long and mostly asymptomatic life.

The focus in modern oncology is always on the patient’s quality of life. Patients may experience severe physical and social limitations in the final period of life.

Lung cancer surgery

If lung cancer is in a treatable condition, then in the vast majority of cases, doctors use several therapeutic options at once. For example, surgical removal of tumors, chemotherapy and radiation therapy in various combinations.

In non-small cell lung cancer, surgical intervention makes a significant contribution to the recovery of the patient, but in small cell lung cancer, surgical intervention is not always of therapeutic value.

Goals of surgery in lung cancer

1. Curative tumor resection

The essence of surgical treatment is to completely remove the tumor. As a rule, this is only possible if the tumor has not yet spread to neighboring tissues and lymph nodes.

In patients with metastatic lung cancer (for example, secondary tumors in the brain or adrenal glands), surgery is rarely useful.

2. Palliative surgery

In some cases, surgery can be used when a full recovery is no longer possible. In these cases, the surgeon can alleviate the symptoms caused by the tumor and improve the quality of life of patient.

The tactics of palliative surgical treatment depend on the specific clinical case.

Limitations of surgical treatment of lung cancer

The main goal of the operation is the complete (radical) removal of the tumor.

At the same time, it is necessary to calculate the loss of lung tissue so that the organ function remains sufficient / tolerable for the patient after surgery.

For some patients, surgical treatment, unfortunately, is not possible if the reserve of pulmonary function is insufficient.

However, a large number of patients can take advantage of a special program.

In particular, German doctors offer such patients smoking cessation, inhalation, physiotherapy exercises, respiratory therapy and drug therapy to improve pulmonary function.

In the presence of latent heart disease (coronary artery disease), a short-term treatment by a cardiologist may be required to reduce risks during surgery.

Anatomical basics of lung cancer surgery

The lung is a complex organ consisting of four main elements: bronchi and alveoli, pulmonary artery system, pulmonary venous system and lymphatic system. All these elements form a “tree”.

Essentially, a distinction is made here between “central” tumors and “peripheral” tumors.

If the tumor is located in the center of the aforementioned tree-like structures, surgery may result in a large loss of lung tissue. Therefore, the location of the tumor must be accurately determined using MRI or invasive examinations before surgery.

The lung tissue is divided on the left side into two parts, and on the right side into three parts, the so-called lung lobes.

A radical surgical procedure may require removal of one lobe of the lung or even complete removal of the affected lung.

In isolated cases (a very early stage of the disease, poor general condition of the patient or lung disease), only one segment can be resected.

Currently, leading clinical centers in Europe and the United States are conducting studies aimed at minimizing the loss of lung tissue during lung cancer surgery.

Modern surgical procedures usually avoid the loss of a whole lung due to reconstructive procedures with restoration of the bronchial tree (bronchoplasty) and the vascular bed (angioplasty).

Open and minimally invasive approach

“Open” lung cancer surgery requires a long incision in the chest. This is the most traumatic approach, which in many cases is inevitable due to better access to internal organs.

Keyhole surgery was the result of technological advances in endoscopic surgical procedures. Minimally invasive surgery requires several small incisions through which special miniature instruments and cameras are inserted.

When choosing a specific approach, surgeons always weigh the risk of complications and the possibility of successful removal of the tumor.

The benefits of keyhole surgery are faster recovery, minimized blood loss and the prevention of terrible cosmetic defects.

Special situations in lung cancer surgery

1. Invasion of the pleura and chest wall

Often a growing tumor borders or grows into the surrounding anatomical structures.

Lung cancer surgery

The tumor can occupy the chest wall, affecting the ribs and soft tissues. In this situation, an attempt may be made to remove the part of the lung along with the chest with subsequent reconstruction.

2. Tumor growth in surrounding organs

Previously, tumor growth with continuous infiltration of surrounding organs was usually considered a death sentence for the patient.

Currently, leading specialized surgical clinics successfully treat such patients. Infiltration of large vessels (e.g., superior vena cava), pericardium, atrium and esophagus does not preclude successful surgical removal of the tumor.

In the United States, Germany, South Korea, Israel and other countries, you can find centers of expertise and qualified surgeons that deal with such complex cases.

3. Removal of metastases

In special situations (single metastases in the brain, single metastases in the adrenal glands, single metastases in the bone), surgical removal of secondary tumors makes sense.

These procedures can at least extend the patient's life. However, the decision on such a procedure requires great clinical experience.

Radiation therapy for lung cancer

Radiation therapy is considered the only treatment for non-small cell lung cancer stage I and II, when surgery is not possible. This method is used in some patients with stage III cancer.

Radiation is often combined with chemotherapy in patients with stage III non-small cell lung cancer, as well as in patients with small cell lung cancer. If there are metastases in distant organs, such as the brain or bones, radiation therapy can control these secondary tumors.

High-energy ionizing radiation, externally directed to the tumor, destabilizes and destroys cancer cells. The total dose of radiation is divided into several single doses, which the patient receives about five times a week.

With the so-called hyperfractional radiotherapy, which can be used for lung cancer, patients receive a dose twice a day at intervals of several hours, but subsequently they are irradiated with lower single doses.

In addition to conventional radiation therapy, so-called stereotactic radiation therapy is used.

This method involves one or several sessions, during which the patient receives high doses of radiation. The rays are directed into the tumor tissue from different directions after the computer planning. All rays meet at one point, delivering the maximum dose to the center of the tumor.

With stereotactic radiation therapy, the surrounding healthy tissue is relatively protected from the damaging effects of radiation. For this reason, stereotactic radiation therapy is well suited for small tumors, as well as for tumors in vital structures (for example, brain metastases).

Possible side effects

Side effects of radiation therapy are often hoarseness and difficulty swallowing.

The skin is also very sensitive to radiation. Especially in combination with chemotherapy, mucosal inflammation and fungal infections can occur in the oral cavity.

A late consequence of radiotherapy is pneumonia, inflammation of irradiated lung tissue.

In general, the severity and risk of side effects depends on the type and intensity of therapy used.

Lung cancer chemotherapy

Chemotherapy is based on the use of drugs that inhibit the growth and division of cells (cytostatics). They act primarily against fast-growing cells, so small cell lung cancer is particularly sensitive to chemotherapy.

Currently, several chemotherapeutic drugs are available for the treatment of lung cancer. These medicines are selected according to individual needs.

The choice of chemotherapy depends on the type of cancer, the stage of the disease, the patient’s condition and the presence of concomitant diseases.

Usually cytostatic drugs are combined, and in most cases the main drug is cisplatin or carboplatin.

Chemotherapy for non-small cell lung cancer usually includes:

• Cisplatin
• Carboplatin
• Vinorelbine
• Docetaxel
• Gemcitabine
• Paclitaxel
• Pemetrexed
• Etoposide

The main drugs for the treatment of small cell lung cancer:

• Cisplatin
• Carboplatin
• Bendamustin
• Cyclophosphamide
• Vinca alkaloids (eg, Vincristine)
• Doxorubicin
• Etoposide
• Irinotecan
• Paclitaxel
• Topotecan.

Possible side effects

Chemotherapy affects all rapidly dividing cell lines. These include not only malignant (cancer) cells, but also healthy cells of the mucous membrane of the digestive tract and cells of hair follicles.

The most common side effects of chemotherapy include nausea, diarrhea, ulcers and hair loss.

Chemotherapy can significantly reduce the population of white blood cells and red blood cells, which is manifested by anemia, pallor, shortness of breath, impaired wound healing and increased susceptibility to infections.

In addition, cytotoxic drugs can cause specific side effects. By informing patients and also by using effective symptomatic drugs, many side effects can be avoided or at least mitigated.

As a rule, they stop shortly after the end of chemotherapy.

Targeted therapy for lung cancer

New therapeutic approaches, called “targeted therapy,” are designed to target specific elements of cancer cells. They act on the tumor in different ways.

The active substances can be directed against factors that promote tumor growth. The so-called angiogenesis inhibitors stop the growth of the vascular network, disrupting tumor blood supply. Other agents repair defects in the genome or eliminate their consequences.

Targeted therapy for lung cancer

Targeted therapy is currently used only for advanced (metastatic) non-small cell lung cancer, because studies in small cell lung cancer have not yet demonstrated sufficient efficacy. Given the intensive research in this area, it is expected that the possibilities of targeted therapy will expand.

Epidermal growth factor receptor tyrosine kinase inhibitors

The activation of genetic changes in the epidermal growth factor receptor (EGFR) leads to the activation of the tyrosine kinases located in the inner part of the receptor. This contributes to the division of cancer cells and their reproduction.

Tyrosine kinase inhibitors stop this process. Tiny molecules penetrate the cell wall and occupy the EGF receptor, disrupting this signaling pathway for cancer cell division.

Three tyrosine kinase inhibitors have been approved for the treatment of lung cancer:

• Erlotinib
• Gefitinib
• Afatinib.

These targeted drugs are available in pills. Thus, treatment can be carried out at home, which means an improvement in the quality of life for many patients. No hospitalizations and infusions.

Tyrosine kinase inhibitors slow the progression of the disease and alleviate the symptoms.

Possible side effects of  EGFR tyrosine kinase inhibitors

Although tyrosine kinase inhibitors are well tolerated compared with chemotherapy, patients may have serious side effects.

In particular, many patients complain of skin rashes on the face and upper body. This may be a sign that the medicine is working well. Other side effects include diarrhea, weight loss and fatigue.

Drug resistance to EGFR tyrosine kinase inhibitors

Tumors can become resistant to therapy with tyrosine kinase inhibitors.

In most cases, this is caused by the so-called T790M mutation. As a result of the mutation, tyrosine kinase inhibitors of the first generation (gefitinib, erlotinib) and second-generation drugs (afatinib) cease to bind tyrosine kinase and are not able to inhibit growth factor.

The new tyrosine kinase inhibitor osimertinib selectively acts even in the presence of T790M mutation. It is prescribed to patients with proven resistance. Osimertinib is taken in pill form.

Possible side effects of  osimertinib

The most common side effects of osimertinib therapy are diarrhea, rash, nausea, loss of appetite, and constipation. These side effects are significantly less pronounced than in the first and second generation drugs (gefitinib, erlotinib, afatinib).

Anti-EGFR monoclonal antibodies

Although cancer cells express the "normal" EGF receptor on its surface (as is the case with squamous cell carcinoma), the epidermal growth factor stimulates tumor growth.

To control this signaling pathway, a combination of chemotherapy agents cisplatin / gemcitabine + necitumumab (anti-EGFR monoclonal antibody) is sometimes used.

If this regimen is well tolerated, long-term maintenance therapy with necitumumab is possible.

Side effects of necitumumab are similar to side effects of tyrosine kinase inhibitors, but more pronounced compared with the first and second generation drugs.

ALK and ROS1 tyrosine kinase inhibitors

Tyrosine kinase inhibitors of this class are directed against specific proteins that stimulate cell growth. The binding of active substances to these proteins blocks certain signaling pathways and stops the uncontrolled growth of cancer cells.

For example, the ALK tyrosine kinase inhibitor, crizotinib, is approved for the first and second-line treatment (after chemotherapy) in patients with ALK translocation.

The second generation ALK tyrosine kinase inhibitors are alectinib and ceritinib.

They have an even more specific effect on ALK kinase. Brigatinib and lorlatinib are another effective ALK inhibitors that are currently being studied in clinical studies.

ROS1 translocations are more rare changes in tumor cells. Such patients can be treated with the crizotinib tyrosine kinase inhibitor. A newer promising ROS1 inhibitor is lorlatinib.

Possible side effects of ALK and ROS1 tyrosine kinase inhibitors

ALK and ROS1 kinase inhibitors can also cause side effects.

Each drug has its own specific side effect profile.

Most common are liver dysfunction, diarrhea, nausea, vomiting, abdominal pain, chronic fatigue, but there may also be visual impairment and taste changes.

Angiogenesis inhibitors

Angiogenesis means the formation of blood vessels. The lung tumor needs new vessels to supply itself with oxygen and nutrients. Thus, angiogenesis supports tumor growth and metastasis.

Angiogenesis inhibitors disrupt the nutrition of tumors by blocking VEGF protein (vascular endothelial growth factor). Studies have shown that these agents slow down the tumor growth throughout the body and make lung cancer more sensitive to chemotherapy.

Such angiogenesis inhibitors are bevacizumab, ramucirumab, and nintedanib.

Bevacizumab can be administered to patients with metastatic non-small cell lung cancer (stage IV) in combination with platinum-based chemotherapy for initial treatment.

Ramucirumab (regardless of the type of tumor) and nintedanib (adenocarcinoma only) are used in patients undergoing second-line therapy in combination with docetaxel if cancer has recurred.

Possible side effects of angiogenesis inhibitors

During therapy with bevacizumab, the risk of bleeding increases, so continuous monitoring is necessary. In many patients, blood pressure increases. Other less common side effects include blockage of blood vessels (embolism), increased protein excretion and impaired wound healing.

The usual side effects of ramucirumab in combination with docetaxel are neutropenia with and without fever (febrile neutropenia), persistent fatigue and hypertension.

Side effects similar to those of bevacizumab may occur. Some side effects of nintedanib are similar to those of the EGFR tyrosine kinase inhibitors.

Other targeted agents

Between one and two percent of all non-small cell lung carcinomas have BRAF mutations, about half of which are V600E sequence changes.

The BRAF gene produces B-Raf protein, which is involved in the normal growth and survival of cells as a component of the mitogen-activated protein kinase (MAPK) signaling pathway. Changes in this gene lead to excessive activation of this pathway and uncontrolled cell growth.

So-called BRAF inhibitors can stop this. However, experience has shown that resistance to BRAF inhibitors is rapidly developing in lung tumors. Suppression of the so-called MEK-kinases 1 and 2 in the MAPK pathway simultaneously with inhibition of BRAF effectively prevents the development of resistance.

Almost a third of all patients who do not have KRAS, ALK, ROS or EGFR mutations in a tumor have an RET mutation. In this case, cabozantinib therapy may be helpful.

About 2% of all adenocarcinomas (non-small cell lung cancer) have changes in the HER2 receptor. Such patients often respond well to HER2 inhibitors, such as trastuzumab or afatinib.

In the case of amplification and / or MET mutations, MET tyrosine kinase inhibitors such as capmatinib can be used.

Lung cancer immunotherapy

The goal of immunotherapy is to activate the patient’s own immune system so that it starts to recognize the tumor as “foreign” and attacks it.

Cancer cells can avoid natural immune defenses, for example, by “hiding” their tumor-specific antigens, thanks to which the immune system recognizes foreign cells.

Lung cancer immunotherapy

In addition, lung cancer acquires mutations that inhibit the activity of immune cells or manipulate the so-called immune checkpoints. The latter regulate the activity of T-lymphocytes.

In lung cancer, the PD-1 immune control point plays a crucial role. The PD1 receptor is usually produced on T-cells of the immune system. Cancer cells can carry a specific ligand, PD-L1.

When PD-L1 binds to its PD-1 receptor on T-cells, these lymphocytes are inactivated. If the tumor cells express PD-L1, they avoid the attack of the immune system, “paralyzing” T-cells.

If PD-1 or PD-L1 is blocked by appropriate drugs, such as pembrolizumab, nivolumab, or atezolizumab, the patient's immune cells become active again and can fight cancer.

Pembrolizumab can be used as monotherapy in patients with stage IV non-small cell lung cancer if tumor cells exhibit PD-L1 expression> 50% and without changes in EGFR and ALK.

With second-line therapy, when metastatic non-small cell lung cancer continues to grow or recur despite the treatment, immunotherapy with nivolumab, pembrolizumab can be initiated (PD-L1 expression> 10%).

Possible side effects of lung cancer immunotherapy

In addition to fatigue, loss of appetite and general weakness, therapy with PD-1 and PD-L1 inhibitors may be associated with autoimmune side effects.

Some patients develop thyroid dysfunction, pneumonia, hepatitis, and renal failure. Skin rash, itching and vitiligo often develop. In addition, colitis can occur, which is manifested by severe abdominal pain and diarrhea.

Treatment of bone metastases

Malignant lung tumors tend to form secondary tumors in the bones.

This can cause pain and increase the risk of fractures.

Single metastases can be removed surgically or by stereotactic radiotherapy. In addition, bisphosphonate therapy reduces the risk of complications and alleviates pain.

Another group of drugs used to treat bone metastases is the so-called targeted drugs. In Europe and the USA, denosumab (Xgeva) is approved for this purpose.

Denosumab binds in the body to the RANKL protein, which activates cells that destroy bone tissue. When denosumab blocks RANKL, bone loss is reduced.

Palliative care for lung cancer patients

Medical care for cancer patients includes not only antitumor therapy, but also measures aimed at alleviating symptoms and prolonging life.

Regardless of the stage of the disease, patients should not suffer much from cancer complications and side effects of aggressive therapy.

Palliative care may include:

• Anemia treatment.
• Prevention and treatment of nausea and vomiting.
• Prevention of weakness and fatigue.
• Leukopenia treatment and infection prevention.
• Strengthening bone tissue and preventing fractures.
• Relief of chronic pain.
• Treatment of insomnia, etc.

When a full recovery is no longer possible, doctors focus on relieving symptoms and maintaining the quality of life of patients and their relatives.

This includes not only the prevention and treatment of pain and other physical ailments, but also professional assistance in psychosocial stressful situations that may be associated with cancer.

Among the physical symptoms, respiratory distress and pain are most common in patients with lung cancer. In many cases, they can be alleviated with medication and non-drug methods.

Lung cancer video: risks and symptoms

How to increase lung cancer survival?

Anyone with symptoms of lung cancer should see a doctor immediately. The sooner a diagnosis is made and treatment is started, the higher the life expectancy and the chances of recovery.

This means that you should consult a doctor for non-specific and presumably harmless symptoms, such as prolonged cough, mild fever and fatigue.

First of all, heavy smokers should pay attention to such complaints and clarify them from a medical point of view at an early stage.

In addition, lung cancer patients should follow a balanced and healthy diet. It improves overall health and supports the healing process. The same applies to regular exercise and sport. Anyone who is physically active also improves their quality of life.

For smokers, experts have a particularly important tip: stop smoking!

Some patients think: “In any case it is too late: I already have lung cancer!”.

In fact, patient survival and chances of recovery can be significantly improved by quitting smoking.

Lung cancer treatment is very demanding on the cardiorespiratory fitness of patients.

Smoking is not the best way to improve your heart and lung condition.

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