Palliative Procedures for Non-Small Cell Lung Cancer

Palliative care (or supportive care) is meant to relieve symptoms and improve a person’s quality of life.

Options for palliative support

People with lung cancer often benefit from procedures to help with problems caused by the cancer. For example, people with advanced lung cancer can have shortness of breath. This can be caused by a number of things, including fluid around the lung or an airway that is blocked by a tumor. Although treating the cancer with chemotherapy or other drugs may help with this over time, other treatments may be needed as well.

Treating fluid buildup in the area around the lung

Sometimes fluid can build up in the chest outside of the lungs. This is called a pleural effusion. It can press on the lungs and cause trouble breathing.

Thoracentesis

Thoracentesis is a procedure done to drain the fluid. The doctor will numb an area in the lower back, and then place a hollow needle into the space between the ribs to drain the fluid around the lung. An ultrasound may be used to guide the needle into the fluid.

Pleurodesis

Pleurodesis is a procedure done to remove the fluid and keep it from coming back. The 2 main types are:

Chemical pleurodesis: A small cut is made in the skin of the chest wall, and a hollow tube (called a chest tube) is placed into the chest to remove the fluid. Then a substance is put into the chest through the tube that causes the linings of the lung (visceral pleura) and chest wall (parietal pleura) to stick together, sealing the space and limiting further fluid buildup. A number of substances can be used for this, such as talc, the antibiotic doxycycline, or a chemotherapy drug like bleomycin.

Surgical pleurodesis: Talc is blown into the space around the lungs during an operation. This is done using thoracoscopy through a small incision.

Catheter placement

One end of a catheter (a thin, flexible tube) is placed in the chest through a small cut in the skin, and the other end is left outside the body. Once in place, the catheter outside the body can be attached to a special bottle to allow the fluid to drain out on a regular basis.

Treating fluid buildup around the heart

Lung cancer can sometimes spread to the area around the heart. This can lead to fluid buildup inside the sac around the heart (called a pericardial effusion). The fluid can press on the heart and affect how well it works.

Pericardiocentesis

A pericardiocentesis is a procedure that drains the fluid with a needle placed into the space around the heart. This is usually done using an ultrasound of the heart (echocardiogram) to guide the needle.

Creating a pericardial window

During surgery, a piece of the sac around the heart (the pericardium) is removed to allow the fluid to drain into the chest or belly. This opening is called a pericardial window and helps to keep the fluid from building up again.

Treating an airway blocked by a tumor

Cancer can sometimes grow into an airway in the lung, blocking it and causing problems like pneumonia or shortness of breath. Sometimes, this is treated with radiation therapy, but other techniques can also be used.

Photodynamic therapy (PDT)

This type of treatment can be used to treat very early-stage lung cancers that are only in the outer layers of the lung airways, when other treatments aren’t appropriate. It can also be used to help open up airways blocked by tumors to help people breathe better.

For this technique, a light-activated drug called porfimer sodium (Photofrin) is injected into a vein. This drug collects more in cancer cells than in normal cells. After a couple of days (to give the drug time to build up in the cancer cells), a bronchoscope is passed down the throat and into the lung. This can be done with either local anesthesia (numbing the throat) and sedation, or with general anesthesia (where you are in a deep sleep). A special laser light on the end of the bronchoscope is aimed at the tumor, which activates the drug and causes the cells to die. The dead cells are then removed a few days later during a bronchoscopy. This process can be repeated if needed.

PDT can cause swelling in the airway for a few days, which may lead to some shortness of breath, as well as coughing up blood or thick mucus. Some of this drug also collects in normal cells in the body, such as skin and eye cells. This can make you very sensitive to sunlight or strong indoor lights. Too much exposure can cause serious skin reactions (like a severe sunburn), so doctors recommend staying out of any strong light for several weeks after the injection.

For more information on PDT, see Photodynamic Therapy.

Laser therapy

Lasers can sometimes be used to treat very small tumors in the linings of airways. They can also be used to help open up airways blocked by larger tumors to help people breathe better.

The laser is on the end of a bronchoscope, which is passed down the throat and next to the tumor. The doctor then aims the laser beam at the tumor to burn it away. This treatment can usually be repeated, if needed. You are usually asleep (under general anesthesia) for this type of treatment.

Stent placement

If a lung tumor has grown into an airway and is causing problems, sometimes a bronchoscope is used to put a hard silicone or metal tube called a stent in the airway to help keep it open. This is often done after other treatments such as PDT or laser therapy.