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How will my Further Treatment be Organised?

Once all necessary tests are completed, your oncologist will discuss the further treatment with you. Your treatment will be based on common international staging criteria, the spread of the cancer into other organs, as well as the characteristics of the cancer cells, e.g. TNM classification. Moreover, your treatment at CIO follows a standard based on national and international clinical guidelines.

The management of your cancer is tailor-made and based on your clinical picture. Every step in your treatment will always be explained by our experts and discussed with you and your relatives, they will give you time to make decisions and will assist you with guidance and practical advice throughout.

For additional information on the treatment of your lung cancer, please select your type of cancer:

Non-Small Cell Lung Cancer (NSCLC)

The non-small cell lung cancer (NSCLC) has, in addition to the TNM system, another classification in four stages, designated by roman numerals I, II, III or IV. Stage I represents the earliest stage, stage IV the most advanced.

Stage I

Stage I ("small tumour"): non-small cell lung cancer: the cancer is limited to one lung lobe. The probability that other organs or lymph nodes are affected, is very small.

Treatment: Therapy of choice in Grade I and II is surgery. If it is possible to remove the tumour completely and without evidence of lymph node involvement, you will be discharged from hospital and receive follow-up care on a regular basis. If the histological examination of the tissue shows that the tumour was not completely removed, an additional radiation therapy will be recommended. If you are unable to undergo surgery or if the tumour is inoperable, we will discuss with you the possibility of a combined chemotherapy and radiation therapy treatment.

Click here for information on the further treatment schedule at CIO in the case of Stage I, non-small cell lung cancer (NSCL)

Stage II

Stage II ("small tumour"): In a non-small cell lung cancer Stage II, the tumour has probably not spread outside the lung lobe, however, nearby lymph nodes may be affected.

Click here for information on the further treatment schedule at CIO in the case of Stage II, non-small cell lung cancer (NSCL)

Stage III

Stage III ("lung cancer in the chest"): The cancer has spread from the lung into the chest cavity and/or the cancer has infested the lymph nodes between the chest cavity and the lung lobes (mediastinum). However, the lung cancer remains with the chest.

Treatment of Stage IIIA: Depending on the clinical findings and your general condition, surgery with follow-up chemotherapy or radiation therapy will be recommend. In certain circumstances, we recommend chemotherapy prior to surgery. This will have the effect of shrinking the tumour.

Treatment of Stage IIIB: Should you be diagnosed with a stage IIIB tumour, we will discuss in detail with you which treatment goals should be achieved. Depending on your general health, either treatment with radiation therapy or operation will be recommended. For this purpose, surgeons, radiation oncologists, medical oncologists and other cancer specialists will, during a Tumor Board meeting, discuss which treatment options are the best for you.

Mostly, a combination of chemotherapy and radiation therapy is suggested.
Chemotherapy before an operation will be less frequently recommended. However, if you receive chemotherapy, a new examination will establish to what extent the tumour has shrunk; this is called ‘re-staging’. If tests show that surgery is possible, post-operative radiation therapy post operatively will be suggested. Thereafter you will be discharged from hospital and treated in a follow-up program.

Click here for information on the further treatment schedule at CIO in the case of Stage III, non-small cell lung cancer (NSCL)

Stage IV

The other lung or other organs are affected in Grade IV. Treatment goal in Grade IV is to reduce the further spread of the disease and to improve quality of life.

Treatment: Despite the advanced disease, we can help you. During your treatment with us, you will also meet an additional expert, the Palliative Care Physician. Using a variety of measures, he/she will help you to retain your quality of life. The palliative care expert will talk with you about your fears and concerns and will organise your pain management. This includes discussing with you how the pharmacological pain management or physical measure is best carried out. In addition, your medical oncologist will suggest further treatment options aimed at reducing the further growth of the cancer. In these discussions all involved clinical specialists, e.g. surgeons and radiation specialists, will be consulted.

Small Cell Lung Cancer (SCLC)

Analogous to the non-small cell lung cancer (NSCLC), the small cell lung cancer will be staged according to the TNM classification of malignant tumours. This system, developed by the U.S. Veterans Administration Lung Cancer Group, divides the disease according to its stage:

If the tumour is only present in one lung lobe, this is called limited disease (LD).
In an advanced stage, where organs outside the lung are affected, the term used is extensive disease (ED).

Stage-Specific Treatment Of the Small Cell Lung Cancer (SCLC)

Treatment choices for the management of small cell lung cancer depend on the spread of the cancer, your gender and the general state of your health. The following treatment modalities are used:

Radiation Therapy

Radiation therapy in the case of small cell bronchial cancer can be given alone or in combination with surgery and/or chemotherapy. Radiation therapy and chemotherapy can be carried out back to back or parallel. Before a decision on a specific treatment concept is made, you will receive thorough advice from your treating cancer expert during a special meeting. On a case by case basis, your cancer doctor will seek the opinions from experienced cancer surgeons and radiation therapists.

Chemotherapy

Chemotherapy is the most widely used treatment modality in all stages of the small cell lung cancer: it can be administered orally using tablets or intravenously by infusion. The small cell lung cancer has a very good response to chemotherapy, and a combination of several drugs will often be used. After a maximum of 6 cycles, a therapy free period is scheduled. Should the tumour reappear, a new course of chemotherapy can be commenced.