Inoperable lung cancer — also known as unresectable lunger cancer — refers to a type of lung cancer that can not be removed completely through surgery. However, having inoperable cancer doesn’t mean that your situation is hopeless or that cancer can’t be treated. Doctors can use several other types of treatments to help manage lung cancer, including radiation therapy, chemotherapy, targeted drug therapy, and immunotherapy. These treatments can make unresectable cancers resectable.

When Is Lung Cancer Inoperable?

Doctors most often use surgery to treat less advanced cases of lung cancer. However, there are certain situations in which surgery is not the best treatment option. People who are in worse overall health or who have advanced-stage cancer may have inoperable or unresectable lung cancer.

Overall Health

A person’s overall health is a big factor regarding whether surgery is a good option. Any major surgery comes with potential complications that may be too risky for some people. Complications are medical problems that develop as the result of a disease or its treatment. Complications of lung cancer surgery can include:

• Bleeding problems
• Blood clots
• Infections
• Side effects from anesthesia

Some of these complications may be serious or even fatal. Even in cases where there are no complications, recovery may take months. People who have other health problems or are in worse general health may have a harder time healing after surgery.

Advanced-Stage Lung Cancer

When diagnosing lung cancer, doctors also assign a stage. The lung cancer stage describes how far the cancer has spread. The higher the lung cancer stage is, the more cancer there is in the body and the harder it is to treat with surgery. More than half of people with non-small cell lung (NSCLC) cancer are not diagnosed until after they develop advanced-stage disease, in which cancer has spread to other parts of the body. NSCLC is staged with a number from 0 to 4 — stage 4 is the most advanced. Small cell lung cancer (SCLC) is most commonly staged as either limited-stage (early stage) or extensive stage (advanced).

Doctors often treat stage 0, 1, or 2 NSCLC with surgery, if the person is healthy enough. This is sometimes also combined with radiation therapy or with chemotherapy. Surgery is a less common treatment in people with stage 3 or stage 4 disease. Higher-stage lung cancers have spread to multiple areas within the lung, other tissues or lymph nodes in the chest, or other parts of the body. It may not be possible to surgically remove certain tumors that are growing into or involving important organs. Additionally, if cancer cells are growing in multiple locations throughout the body, removing all or most of them may not be helpful.

Surgery may also not be an option for those who have more extensive cancer within the lung. Lung cancer surgery typically involves the removal of all or part of the lung, depending on how large the lung tumor is or how much it has spread within the lung. In some cases, removing all of the cancerous parts of the lung would mean that a person doesn’t have enough healthy tissue left to function. These cases are considered unresectable.

Treatments for Inoperable Lung Cancer

People with inoperable lung cancer have other treatment options. When coming up with a treatment plan, doctors may consider factors such as the type of lung cancer, lung cancer stage, gene changes within cancer cells, and other health problems.

Radiation Therapy

Inoperable NSCLC and SCLC are sometimes treated with radiation treatments. The most common type of radiation therapy is external beam radiation therapy, in which a machine outside of the body delivers high-energy beams or particles to the tumor. Doctors may use external beam radiation therapy to treat tumors in the lungs or single tumors that exist in more distant locations. This type of treatment is not effective for treating widespread cancer, so people with stage 4 lung cancer don’t usually receive radiation therapy as their main treatment.

Another type of radiotherapy called brachytherapy may also be recommended during the early stages of lung cancer. During brachytherapy, doctors place radioactive material directly inside of the body, next to the tumor. Brachytherapy is most effective for treating lung cancer cells that are in or next to the main airways. There are also focused methods of radiation, but they may require special equipment to compensate for breathing movements of the lung.

Systemic Therapy

Systemic therapy includes medication that travels through the bloodstream to reach all parts of the body. Systemic therapy can kill cancer cells even in situations where a tumor can’t be surgically removed. Doctors may give people with lung cancer a single drug or combinations of several different types of medication. These treatments may help people live longer and have a better quality of life. Systemic therapy for NSCLC includes:

• Chemotherapy — Drugs that kill cancer cells or prevent them from making copies of themselves
• Targeted therapy — Medications that recognize genes or proteins found on cancer cells, killing them while leaving healthy cells alone
• Immunotherapy — Drugs that help the body’s immune system better fight cancer

SCLC is also treated with chemotherapy and targeted therapy. The U.S. Food and Drug Administration recently approved sotorasib (Lumakras) as targeted therapy for SCLC.

Bronchoscopic Treatment Options

Some other nonsurgical treatments for cancer use a technique called bronchoscopy. During bronchoscopy, doctors pass a long, thin tube into a person's windpipe. Cameras or devices for treatment are sometimes attached to this tube. Bronchoscopy allows doctors to see and treat cancer cells growing in or near the airways. The goal of these therapies is to open an obstructed air passage. Bronchoscopic procedures may be used to treat people with inoperable early-stage lung cancer. Some people receiving these types of treatments achieve complete remission, meaning all signs of their cancer is gone:

• Photodynamic therapy uses light treatments to damage cancer cells.
• Laser therapy kills cancer cells using beams of light.
• Argon plasma coagulation, electrosurgery, and radiofrequency ablation are all treatments that deliver damaging heat energy to cancer cells.
• Cryotherapy freezes and kills cancer cells.

Palliative Care

Lung cancer treatment often involves palliative care. Palliative treatments reduce symptoms and help people feel more comfortable. Inoperable lung cancer that has spread more widely often requires palliative care.

Some of the same treatments used to achieve remission in early-stage inoperable lung cancer may also be used as palliative treatments for later-stage inoperable disease. For example, radiation or even surgery can be used as palliative treatments by reducing the size of tumors that cause symptoms. Bronchoscopic treatments are also sometimes used to relieve symptoms. For example, they can shrink tumors that are blocking the airways.

Inoperable Lung Cancer Prognosis

A person’s lung cancer stage is the main factor that affects their prognosis (outlook). Lower-stage inoperable tumors can often be kept under control, and the person with the condition may reach complete remission. People with higher-stage lung cancer achieve complete remission less often.

Lung cancer survival rates are often grouped based on how far cancer has spread. Survival rates for people with NSCLC are as follows:

• People with cancer only in the lung are 63 percent as likely to live five years or more after receiving a lung cancer diagnosis, compared with people who don’t have lung cancer.
• People with cancer that has spread to nearby tissues are 35 percent as likely to live five years or more.
• People with cancer that has spread to distant tissues are 7 percent as likely to live five years or more.

Among people with SCLC, the survival rates are as follows:

• People with cancer only in the lung are 27 percent as likely to live five years or more after diagnosis, compared with people who don’t have lung cancer.
• People with cancer that has spread to nearby tissues are 16 percent as likely to live five years or more.
• People with cancer that has spread to distant tissues are 3 percent as likely to live five years or more.

Other factors, like the subtype of lung cancer and gene changes found in the tumor, also play a role in prognosis. These survival rates were estimated based on people who were diagnosed with lung cancer five to 10 years ago. Treatments are constantly improving, and people who are diagnosed today may have better outcomes than people who were diagnosed a decade ago.

Talk With Others Who Understand

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