Lung Cancer Treatment Timeline: What to Expect From Start to Finish

Perhaps a recent chest X-ray or ongoing cough, wheezing, and shortness of breath caused your doctor to suspect lung cancer and order imaging tests. Check each year for lung cancer with a low-dose CT scan if you:

• Are between 50 and 80 years old,and
• Have a 20 pack-year history, and 
• Smoke or have quit within the past 15 years

You’ll talk to your doctor about next steps in about a week. They’re still gathering clues, and they may order a biopsy.

Imaging scans can see the spot on your lungs, but only a biopsy can diagnose cancer. Depending on your symptoms and CT scan, your doctor takes a small piece of lung tissue. 

Biopsy is done during a bronchoscopy through your mouth or a needle biopsy — the needle goes into your chest guided by imaging like an ultrasound. It takes about a week for your doctor to look at the tissue under a microscope and review your pathology report.

Your report tells you if you have small-cell (SCLC) lung cancer or the most common type, non-small-cell (NSCLC) lung cancer. This information helps decide what to do next. 

Your doctor can stage your lung cancer and order biomarker testing. You'll probably get more imaging tests to see if the cancer has spread, measure tumor size, and location, such as:

• Chest X-ray
• CT scan
• Bone scan
• MRI
• PET scan

Your doctor stages your lung cancer and can often use leftover biopsy tissue for biomarker testing — a test to find changes in cancer cells called driver mutations. If there's not enough tissue, you'll get a second biopsy or blood test. 

The driver mutations allow the cancer cells to grow and help your doctor choose the best medicine for you. This special testing can take a few weeks, but it can help to have a lung cancer care team set up.

Your lung cancer care team puts it all together. They'll review your pathology reports, imaging scans, and biomarker testing to make a personalized plan. You'll work with your team of lung cancer doctors, like your:

• Thoracic (chest) surgeon
• Medical oncologist
• Radiation oncologist
• Radiologist
• Pathologist

It’s also a good idea to get a second opinion, ideally within a couple of weeks of diagnosis but before your surgery.

Surgery is usually an option with early-stage lung cancer, especially NSCLC that hasn't spread to other parts of your body. It depends on the location and how big your tumor is, but your surgeon may opt to remove:

• Part of a lung lobe (segmentectomy)
• An entire lobe of your lung (lobectomy)
• An entire lung (pneumonectomy)

Studies show that having surgery sooner (less than eight weeks) can help lower your risk of the cancer coming back.

Each person heals differently depending on health, age, and type of surgery. Some people may go home the day after a segmentectomy, but you may need to stay a full week if you had an entire lung removed.

You might feel some chest and back pain for several weeks after surgery. Try not to lift more than 10 pounds for four to six weeks. You may get back to driving around three weeks, but complete recovery may take about 12 weeks.

If needed, medicine before and after surgery can help shrink your tumor, kill cancer cells, and ease symptoms:

• Neoadjuvant means chemotherapy along with radiation before surgery. 
• Adjuvant means chemoradiation that starts six to eight weeks after surgery, but it still helps if you start four months later. 

You'll get chemo in cycles, every 21 to 28 days, and radiation therapy five days a week for five to seven weeks.

Your biomarker testing lets you know which driver mutation helps your lung cancer grow, most often EGFR-mutated NSCLC. The best medicine can block this gene change in the cancer cells to stop growth and kill them. Targeted lung cancer treatment includes gene changes like:

• ALK
• BRAF
• EGFR
• HER2
• KRAS
• MET
• NRG1
• NTRK
• RET
• ROS1

Research suggests the greatest benefits if you start treatment as soon as possible, ideally within a few months of diagnosis.

Immunotherapy helps your immune system find and stop cancer growth — they're called checkpoint inhibitors. Lung cancer immunotherapies block:

• PD-1 protein found on certain white blood cells (T cells) to slow growth and shrink tumors
• PD-L1, a protein like PD-1
• CTLA-4, another protein found on T cells to slow cancer cells and shrink tumors

After you've finished treatment, your doctor will watch you closely as you continue to recover. They may also suggest CT scans and blood tests every three months for the next two years, then six months for the next three.

Your doctor will check for any signs that the cancer has come back. After five years, you might switch to yearly check-ins.

Your lung capacity can go down after surgery or chemotherapy, making breathing harder. During pulmonary rehabilitation, a respiratory therapist teaches you breathing techniques to get your lungs stronger. It's like physical therapy for your lungs! 

You can start your pulmonary rehab about two weeks after surgery or any time during your other treatments.

Lung cancer is most likely to come back within the first five years of finishing treatment, but after that, your risk drops. You can also lower your risk more if you protect your lungs.

• Don't smoke.
• Stay away from secondhand smoke.
• Stay indoors if outside air quality is poor.
• Eat healthy.
• Get enough vitamin D.
• Stay active.

Take time to celebrate your five-year mark. Your mental and emotional health matter, too.