Non Small Cell Lung Cancer

Introduction

Chemotherapy uses cytotoxic drugs to target cancer cells by killing them or preventing their growth and division (Macmillan, 2015). This means that chemotherapy is used ideally to stop the growth of cancer cells, but if this is not possible to slow the growth of and shrink cancer cells. This information could suggest that chemotherapy is only suitable for early stages of Non-small cell lung cancer (from here on referred to as NSCLC), however, chemotherapy is also used as a palliative treatment. If cancer reaches an advanced stage, chemotherapy can be used to shrink a painful tumor, which would improve the patient’s quality of life (American Cancer Society,2016). In these situations, it is difficult to determine the effectiveness of chemotherapy as the goal of the treatment is now different. The way the treatment is delivered changes depending on the stage NSCLC is at in the patient.

Evaluation

Chemotherapy is a systematic treatment, meaning it affects the whole body (What is chemotherapy? (c2016). The implication of this is that during the treatment process will not only destroy and stop the growth of cancer cells, but it will also affect the bodies normal, healthy body and nerve cells, and this consequence is unavoidable. Doctors and patients, therefore, need to make the decision whether chemotherapy is a worthwhile treatment option as with particularly weak or unhealthy patients, the damage to their cells will only worsen their condition and in these cases, the disadvantages may outweigh the advantages to NSCLC patients.

However, this is only the case if the chemotherapy is taken orally or via injection. Regional chemotherapy results in a more focused treatment that only affects cancer cells in the area, whereas systematic chemotherapy that enters the bloodstream and effects healthy and cancer cells. Therefore, the effects should be less severe and are consequently, less harmful to the patient. By stage iv, the most advanced stage of NSCLC the cancer cells have spread to other parts of the body, such as the brain, and away from a tumor and therefore cannot be located easily on the scans. Since chemotherapy is mostly used in isolation for NSCLC patients in stage iii or iv, as by stage iii survival is extremely unlikely with 6% possibility, and once cancer reaches stage iv, the majority of patients don’t survive for more than 2 years after diagnosis (Cancer Research UK, 2017).

In these cases, chemotherapy is used to increase the patient’s quality of life. Systematic chemotherapy is an effective treatment in this case as it can travel through the bloodstream and affect cancer cells that are too small or not in close proximity to a tumor and eliminate cancer cells that scans cannot pick up on.

Chemotherapy is often prescribed for Stage iv NSCLC (citation) because although by this stage NSCLC cannot be cured, the goal is to increase the patient’s quality of life. It is normally referred to as combination chemotherapy as a combination of drugs is used. Cisplatin and carboplatin are the most common to be used in combination with a second drug, however, the use of these drugs introduce a lot of side effects. Cisplatin and carboplatin increase the risk of the patient getting an infection (Cancer Research UK, 2017).

As a result of the weakened immune system, your bone marrow no longer makes white blood cells and means your body becomes vulnerable to pathogens, including those that wouldn’t normally be harmful to a human body. Infections could be particularly harmful to NSCLC patients as they would affect cancer patients a lot more drastically than they would affect the average healthy person. Because of a decreased neutrophil white blood cell count that cancer patients already suffer from (Cancerorg, 2015), the addition of cisplatin or carboplatin increasing the risk of infection would mean that as a result of this treatment patients would be incredibly vulnerable to infections and could cause a lot of complication for the operating doctors and nurses in the future treatment of this patient.

The drugs used in chemotherapy also have a level of toxicity which means that the level of dosage is especially important as too low will make the entire treatment process obsolete as the treatment will be ineffective however too high would have toxic side effects such as nausea and diarrhea (John P.Cunha, 2017). Cisplatin can also cause temporary infertility in men, and if all sperm cells are killed by the chemotherapy treatment it can become permanent, if after 4 years the patient is not producing sperm, it is unlikely to return (American cancer society, 2016).

Surgery

There are four main types of surgery for NSCLC including Lobectomy, Pneumonectomy, Sleeve resection and Segmentectomy (American cancer society, 2016). Pneumonectomy is the removal of an entire lung. A lobectomy can be thought of as the most effective type of surgery and involves removing an entire lobe of the lung.

American Cancer Society has decided the most effective treatment for NSCLC to be surgery, “if surgery can be done” (American cancer society,2016). This is of interest as although surgery may be a very effective treatment, its only in certain situations and is not possible in all instances. Surgery is a rarely selected treatment choice once NSCLC reaches the advanced stages as it is most effective if a tumor is in a small area and by stage iii or iv cancer has spread to other parts of the lungs and the body.

In cases where surgery has been used and the cancer cells have spread to other places of the body or metastasized, what would happen is that cancer would re-emerge. This makes surgery ineffective on its own around stage iii and iv due to the fact the cancer is not being cured. From the same article, American Cancer Society has mentioned that surgery can be used to remove cancer “often along with other treatments” (American cancer society,2016). This is noteworthy because surgery is often used in combination with chemotherapy, and this is called adjuvant therapy and can have very good outcomes (Cancernet, 2017).

The surgery can kill the bulk of the cancer cells and the chemotherapy is used to target cancer cells that have reached other parts of the body. This makes the treatment much more effective and reduces the chance of cancer reemerging. The pitfalls of adjuvant therapy would be the same as the pitfalls of the second treatment chosen.

In cases where chemotherapy is used to complement surgery, alongside the disadvantages of surgery, patients will also suffer from the chemotherapy side effects and negatives that come with the treatment. Another issue surrounding adjuvant therapy is that if adjuvant therapy is used unnecessarily administered the patient will suffer from the side effects but not reap any benefits, however, if doctors are reluctant to treat patients this way, cancer has a chance of reemerging.

This is the reason, surgery and chemotherapy are not recommended for patients with stage iA NSCLC, but for patients with stage iB, (Cancernet, 2017) as by this stage cancer has become more advanced and therefore needs the chemotherapy to decrease the chance that cancer will reemerge. The time taken to recover from lung surgery is dependent on how much of the lung removed and the patients’ health before the treatment.