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Rehab Before Cancer Treatment Can Help Patients Bounce Back

Lung cancer occurs when a malignant tumor grows inside the lungs, in structures such as the bronchi. Like many types of cancer, lung cancer is capable of spreading to other parts of the body. Cancer that begins in the lungs most commonly spreads to the brain, bones, adrenal glands and liver. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary lung cancers, are carcinomas that derive from epithelial cells.

1. Non-Small Cell Cancers

Non-small cell cancers include squamous cell carcinoma (tumor), adenocarcinoma and large cell carcinoma. Bronchioloalveolar cell is a subtype of adenocarcinoma and typically treated in a similar way. Adenocarcinoma, the most common type of lung cancer, is usually located on the outer surface of the lungs (periphery) and can spread to lymph glands, the bloodstream and other organs. Squamous cell carcinoma may be found in the lining of the large bronchi (air passages) or in the periphery of the lung. Large cell carcinoma usually occurs in the periphery.

2. Small Cell Cancers

Small cell lung cancer usually develops in the central areas of the lung. It can spread aggressively and occurs almost exclusively in current or former smokers. This cell type has the strongest association with smoking. Read about small cell cancer treatment.

Treatment of Lung cancer is depends on the type and stage of cancer. Lung cancer can be treated with surgery, chemotherapy, radiation therapy, or a combination of these treatments. The decision about which treatments will be appropriate for a given individual must take into account the location and extent of the tumor as well as the overall health status of the patient.

Surgery for Lung Cancer: If your cancer has not spread beyond the lungs, your general health is reasonably good and your breathing capacity is sufficient, the treatment that gives the best chance of cure is surgery. The most common operation is called a lobectomy, removes the affected part of the lung. Sometimes, the whole lung needs to be removed and this is called a pneumonectomy.

In patients with reduced lung function, smaller parts of the lung are removed to try to preserve breathing capacity. While these operations preserve breathing capacity, there is more likely to be a recurrence. Your doctor will advise you of the best operation for you.

Chemotherapy: This is the treatment of cancer with anti-cancer drugs. The aim is to destroy cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from multiplying.Chemotherapy is the treatment of choice for patients with small cell carcinoma. As this type of cancer spreads quickly, chemotherapy works well in treating it.

CyberKnife Radiosurgery: World’s Most Advanced Technology to treat tumors with pin-point accuracy and precisely deliver treatment to the tumor alone, sparing surrounding healthy tissue.

A new hope for patients who have inoperable or surgically complex tumors, or who may be looking for a non-surgical option.Cyberknife radiosurgery is a non -invasive, high-energy radiation treatment that delivers very precise beams of radiation from many angles outside the body. The accuracy of Cyberknife is so precise that radiation can be ‘matched’ to the shape of small complex tumors, even those located near critical organs. This ability allows Cyberknife to treat many lesions including some considered inoperable or untreatable with surgery.

Minimally invasive surgical techniques have been developed to diagnose and treat lung cancer. These procedures are performed with the use of a video camera that is inserted through a small 3 inch incision of the chest. This enables the surgeon to clearly see the tissue being operated on without having to make a large incision in the chest and spreading the ribs . The minimally invasive technique can provide a more accurate surgery with less recovery time, less risk of infection, less bleeding and less discomfort than the traditional procedure.

Benefits of Minimally Invasive Procedures

Not only do these procedures usually provide equivalent outcomes to traditional ‘open’ surgery (which sometimes require a large incision), but minimally invasive procedures (using small incisions) may offer significant benefits as well:

  • Quicker Recovery – Since a minimally invasive procedure requires smaller incisions than conventional surgery (usually about the diameter of a dime), your body may heal much faster.
  • Shorter Hospital Stays – Minimally invasive procedures help get you out of the hospital and back to your life sooner than conventional surgery.
  • Less scarring – Most incisions are so small that it’s hard to even notice them after the incisions have healed.
  • Less pain – Because these procedures are less invasive than conventional surgery, there is typically less pain involved.

Advancements in technology have led to the development of more individualized treatment modalities. While chemotherapy agents aim to destroy rapidly dividing cells, new types of drugs interfere with the development of cancer at the molecular level. This new method is called targeted therapy.

Diagnosis of the Lung Carcinoma with a good tissue biopsy and molecular testing is needed to ensure that the toxic chemotherapy procedure is avoided and the patient gets the appropriate targeted and personalized lung cancer therapy with the help of biomarkers.

Targeted therapy blocks the growth and spread of cancer by inhibiting cancer cells from dividing or terminating them directly.

Standard chemotherapy affects all body cells, but targeted therapy directs drugs or other specially created substances to attack only the cancer cells. Chemotherapy can be used once the disease progresses on the targeted therapies.

Please scan and email your medical reports for a Free, No Obligation Opinion from India’s leading Surgeons/ Specialist Doctors at India’s Best Hospitals with in 48 Hours of receipt.

Rehab Before Cancer Treatment Can Help Patients Bounce Back

At MD Anderson, some of the nation’s top lung cancer specialists focus their extraordinary expertise on you. We customize your treatment to deliver the most advanced, least invasive treatments available for lung cancer. And because your peace of mind is important to us, we specialize in techniques and therapies than can help preserve lung function.

MD Anderson offers the most advanced lung cancer treatments, many available at only a few locations in the United States. Your lung cancer therapy may include:

  • Proton therapy
  • Targeted therapies
  • Cyberknife® stereotactic radiosurgery
  • Gene therapy and use of nanoparticles to deliver chemotherapy
  • Minimally invasive operations
  • Treatment for lung cancers that elsewhere might be considered inoperable
  • Special techniques for treating cancers that invade the spinal column

And we’re constantly researching newer, safer, more-effective lung cancer treatments – with fewer side effects. We are proud to be one of the few cancer centers in the nation to house a prestigious federally funded lung cancer SPORE (Specialized Program of Research Excellence) program. This translates to a wide variety of clinical trials for new treatments.

If you are diagnosed with lung cancer, your doctor will discuss the best options to treat it. This depends on several factors, including:

  • The stage and type of lung cancer
  • Other lung problems, such as emphysema or chronic bronchitis
  • Possible side effects of treatment
  • Your general health

Your treatment for lung cancer will be customized to your particular needs. It may include one or more of the following therapies to treat the cancer or help relieve symptoms.


Like all surgeries, lung cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure.

MD Anderson lung surgeons are among the most skilled and recognized in the world. They perform a large number of surgeries for lung cancer each year, using the least invasive and most effective techniques. For some patients, our advanced Cyberknife® stereotactic radiosurgery system provides an effective minimally invasive approach.

Lung cancer may be treated with surgery alone or combined with other treatments. Chemotherapy or radiation may be given:

  • Before surgery to shrink tumors. This is called induction or neoadjuvant therapy.
  • After surgery to help destroy cancer cells that may remain in the body. This is called adjuvant therapy.
  • Surgery is used less often for small cell lung cancer because this type of cancer spreads more quickly through the body and is not often found in the early stages when it is confined to the lungs.

The most common types of surgery for lung cancer are:

  • Wedge resection: Removal of the tumor and a pie- or wedge-shaped piece of the lung around the tumor
  • Lobectomy: Removal of the lobe of the lung with cancer
  • Segmentectomy or segmental resection: Removal of a segment, or part, of the lobe where the cancer is located
  • Pneumonectomy:Removal of the entire lung
  • Sleeve resection: Removal of part of the bronchus

In addition, lymph nodes in the chest will be removed and looked at under a microscope to find out if the lung cancer has spread. This will help doctors decide if you need further treatment after surgery.

Video-assisted thoracic surgery (VATS): MD Anderson surgeons are specially trained and highly skilled at performing this minimally invasive surgery, and they use the latest equipment available.

Other types of surgery

Sometimes surgery is needed to help problems caused by lung cancer or its treatment. This may include:

  • Laser surgery to open a blocked airway
  • Placement of small tubes (stents) to keep airways open
  • Cryosurgery to freeze and destroy cancer tissue
  • Placement of a Pleurx-Denver catheter to drain fluid that may accumulate in the pleural cavity (the layer of tissue that surrounds the lungs)
  • Cyberknife® stereotactic radiosurgery


MD Anderson offers the most up-to-date and effective chemotherapy options for lung cancer. Chemotherapy is often the main treatment for small cell lung cancer or if the cancer has spread (metastasized). MD Anderson offers techniques to help make chemotherapy more effective, including delivery by nanoparticles. If surgery is not an option for you, your doctor may suggest chemotherapy and radiation.

Targeted Therapies

MD Anderson is among just a few cancer centers in the nation that are able to offer you targeted therapies for some types of lung cancer. These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.

Radiation Therapy

New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target lung cancer more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. Radiation therapy may be used with chemotherapy and/or surgery.

The Thoracic Center provides the very latest radiation treatments for lung cancer, including:

  • Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
  • 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
  • Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor

Proton Therapy

The Proton Therapy Center at MD Anderson is one of the world’s largest and most advanced centers. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.

Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. For many patients, this results in better cancer control with fewer side effects.

Photodynamic Therapy (PDT)

In photodynamic therapy, a light-sensitive chemical is injected into the body, where it remains longer in cancer cells than it does in normal cells. The chemical is activated with a laser that initiates the destruction of cancer cells. PDT often is used on very small tumors or to reduce certain symptoms of lung cancer.

Lung Cancer Surgery India, Low Cost Lung Cancer Treatment India, Lung Cancer Surgery Benefits India, Lung Cancer Treatment Benefits India

Lung cancer develops when a cell in the lung becomes abnormal and begins to duplicate uncontrollably. These abnormal cells eventually form a mass, or tumor, and can spread to other parts of the body if not treated. Lungs are the breathing organs located in the chest surrounded by a thin, protective membrane called the pleura. Each lung is divided into lobes; the right lung has three lobes, and the left lung has two lobes. Within the lungs are flexible airways called bronchi, which branch out into many smaller airways called bronchioles. The bronchioles lead to small, grape-like clusters of air sacs called alveoli. Oxygen and carbon dioxide pass to and from the alveoli into capillaries and carry blood throughout the body.

Signsand Symptoms sometimes seen in lung cancer are as follows:

  • A cough that doesn’t go away and gets worse over time
  • Chest pain that doesn’t go away
  • Coughing up blood
  • Feeling short of breath
  • Wheezing
  • Losing your voice (hoarseness)
  • Getting sick with pneumonia and bronchitis a lot
  • Swollen neck and face
  • Not hungry, losing weight without trying
  • Feeling tired

Types of Lung Cancer:
There are two major types of lung cancer. Each type of lung cancer grows and spreads in different ways. Each type may be treated differently.

  • Non-Small Cell Lung CancerThis is the most common type of lung cancer, accounting for about 85% of all lung cancers. It usually spreads more slowly than other lung cancers. There are three major types of non-small cell lung cancer:

  • Small Cell Lung CancerSmall cell lung cancer accounts for about 15% of all lung cancers. As the name implies, small cell lung cancer involves cancer cells that are smaller in size than most other cancer cells. Although the cells are small, they are able to quickly reproduce and form large tumors, as well as to spread to other parts of the body. There are three major types of small cell lung cancer:

  • Mixed small cell/large cell
  • Combined small cell carcinoma

Causes of Lung Cancer:
Smoking tobacco is the main cause of lung cancer. People who live or work with people who smoke are also at increased risk because they are exposed to second-hand smoke. Other factors that increase the risk of lung cancer includes:

  • Family history
  • Exposure to Radon Gas
  • Asbestos
  • Metals like chromium, cadmium, arsenic
  • Chronic lung diseases such as tuberculosis

Diagnosis of Lung Cancer:
Because early lung cancer often has no symptoms, it is difficult to diagnose the disease in its early stages. Some diagnostic tests that may be used include:

  • Sputum Test -Phlegm, or spit, is studied to see if cancer cells from the lungs are present.

  • Chest X-ray – X-rays use low doses of radiation to create images of the body.

  • Positron Emission Tomography (PET) Scan– This is a technique to obtain three-dimensional, color images using short-lived radioactive substances. The PET scan can detect cancerous tumors because of their ability to absorb the radioactive material.

  • Surgical Lung Biopsy – The doctor also may look inside your chest cavity. The doctor can examine the chest cavity through a special instrument called a thoracoscope and take tissue samples (biopsies) from the lungs. Standard surgical sampling of the lung may also be required.

Stages of Lung Cancer:
The stage of a cancer describes its size and whether it has spread beyond its original site. Knowing the extent of the cancer helps the doctors to decide on the most appropriate treatment. Generally cancer is divided into four stages:

  • Stages 2 and 3 have spread into surrounding structures

  • Stage 4 has spread to other parts of the body.

Staging of Small Cell Lung Cancer:
Small cell lung cancers are divided into just two stages:

  • Limited disease – the cancer cells can be seen only in one lung, in nearby lymph nodes, or in fluid around the lung known as a pleural effusion.

  • Extensive disease – it is clear that the cancer has spread outside the lung, within the chest area or to other parts of the body.

However, small cell lung cancer often spreads outside the lung quite early on. So even if the doctor can’t see any spread of the cancer on your scans, it’s likely that some cancer cells will have broken away and travelled through the bloodstream or lymphatic system. To be safe, small cell lung cancers are usually treated as though they have spread, whether any secondary cancer can be seen or not.

Staging of Non-Small Cell Lung Cancer:
The overall staging for NSCLC uses I through IV, with I being the earliest stage and IV being the latest. Evaluation of the tumor, lymph nodes, and metastases are included in the overall stage.

    Stage IV – The tumor has spread to other parts of the lungs or distantly throughout the body

Types of Lung Cancer Surgery:
Surgery depends on the size and location of the tumour. Surgery is most commonly used for non-small cell cancers that are still small and have not spread. Surgery is not usually done for small cell lung cancer unless tumours are found at a very early stage, before the cancer has started to spread. Surgery for non-small cell lung cancer can be done in several ways.

  • Wedge Resection (segmentectomy) – The surgeon removes a small wedge-shaped piece of lung that contains the lung cancer and a margin of healthy tissue around the cancer. This is likely to be done when your lung function would be decreased too much by removing a lobe of lung (lobectomy). The risk of lung cancer coming back (recurring) is higher with this method..

  • Removing Lymph Nodes – During your operation your surgeon will remove some of the lymph nodes from around the lung. This is because the lymph nodes may contain cancer cells that have broken away from the main cancer. The surgeon sends the lymph nodes to the laboratory where they are examined under a microscope. If the nodes contain cancer cells this may affect the treatment that you need after the surgery.
  • Radiation Therapy for Lung CancerIn external beam radiation therapy, a large machine is used to carefully aim a beam of radiation at the tumour. The radiation damages the cells in the path of the beam – normal cells as well as cancer cells. In brachytherapy, or internal radiation therapy, radioactive material is placed directly into or near the tumour.

  • Chemotherapy for Lung CancerChemotherapy may be given as pills or by injection. Chemotherapy drugs interfere with the ability of cancer cells to grow and spread, but they also damage healthy cells. Healthy cells can recover over time.

  • Targeted Therapies for Lung CancerTargeted therapies use drugs or other substances to block the growth and spread of cancer cells. These drugs are able to attack specific types of cancer cells. Targeted therapy is sometimes used to treat non-small cell lung cancer that has come back or that does not respond to chemotherapy.

  • Photodynamic Therapy for Lung CancerPhotodynamic therapy uses a special drug that starts to work when exposed to light. The drug is injected into your bloodstream and absorbed by the cancer cells. When exposed to a high-energy laser light, the drug becomes active and destroys the cancer cells. Photodynamic therapy can be used to treat some cases of early-stage lung cancer. It can also be used to help relieve symptoms of a blocked airway.

Benefits of Lung Cancer Treatment and Surgery:
Many people are frightened at the idea of having cancer treatments because of the side-effects that can occur. Although the treatments can cause side effects, these can usually be well-controlled with medicines. The potential benefits of treatment of Lung Cancer vary depending upon the individual situation and stage of Lung cancer. With the newer molecular targeted agents, similar or even greater symptomatic benefits are observed. With both first-line and second-line agents, there are palliative benefits. Such chemotherapy improves quality of life. The treatment increases your body’s natural ability to fight cancer. It does this by giving a boost to your immune system.

Risks from lung cancer surgery include damage to structures in or near the lungs, general risks related to surgery, and risks from general anesthesia. Your surgeon and anesthesiologist will discuss these risks with you prior to surgery. The most common risks include:

  • Bleeding
  • Infection
  • Damage to nearby structures
  • Risks from general anesthesia
  • Blood clots

Lung Cancer Treatment and Surgery in India:

Indian hospitals and physicians have saved lives by dramatically increasing five-year survival rates for all stages of lung cancer, which has become one of the leading causes of cancer deaths for both men and women across the world. Advanced research and study is taking place in most of the India hospitals that offers advanced lung-cancer patients free screenings of their tumors for genetic mutations, some of which might be targets for treatment with existing or experimental therapies. The Lung cancer team provides a range of radiation therapy options to treat all types of lung cancer. The welcoming, state-of-the-art cancer hospitals in India house the latest treatments and technologies where you can receive all of your treatment under one roof by an experienced medical team. The expert medical team in India consists of highly-skilled, compassionate doctors and other clinicians who work together to deliver a personalized treatment plan tailored to your needs. The hospitals in India provide aggressive cancer treatment, so you and your family can focus on healing.

Cities in India that offers Lung Cancer Surgery under the supervision of best surgeons, doctors and hospitals are as follows;

Cost of Lung Cancer Treatment and Surgery in India:

Having lung cancer might mean that you have to give up work or spend more money than usual on things like transport to appointments or extra prescriptions. This might make you worry about how you and your family are going to manage. For people without health insurance, prescription drugs can be too expensive in western countries. Often the cost of treatment of lung cancer deters people from getting the help they need. Indian has become a very popular destination for such patients. If you are looking for low cost Lung cancer surgery, India is the best option for all of them.

Below are the downloadable links that will help you to plan your medical trip to India in a more organized and better way. Attached word and pdf files gives information that will help you to know India more and make your trip to India easy and memorable one.

Click icon to Download Document

About India

Destinations in India

Indian Embassy List

Medical Tourism FAQ

Visa For India

Some of the common countries from which patients travel to India for surgery are:

Rehab Before Cancer Treatment Can Help Patients Bounce Back

Clinical Trials

Clinical trials use new treatment options to see if they are safe and effective. If you have cancer, you may want to take part. Visit the sites listed below for more information.

Complementary and Alternative Medicine

Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples.

Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor before you start any kind of complementary or alternative medicine.

Which Treatment Is Right for Me?

Choosing the treatment that is right for you may be hard. Talk to your cancer doctor about the treatment options available for your type and stage of cancer. Your doctor can explain the risks and benefits of each treatment and their side effects.

Sometimes people get an opinion from more than one cancer doctor. This is called a ‘second opinion.’ Getting a second opinion may help you choose the treatment that is right for you.

Rehab Before Cancer Treatment Can Help Patients Bounce Back


Even in a universal access health- care system
as exists in Canada, there are barriers to care for patients with
lung cancer. The reasons are undoubtedly multiple; one important
issue is the attitude of those physicians who must decide whether to
refer a patient with advanced lung cancer for consideration of
chemotherapy. Most care providers believe that the prognosis of
patients with advanced non–small-cell lung cancer is poor, and
many would not accept treatment themselves if they had this
disease.[1] The survival of lung cancer patients is related to stage
at diagnosis, and at least one-third of Canadian patients present
with stage IV disease and another 25% to 30% have locally advanced
disease.[2] The median survival for stage III non–small-cell
lung cancer is 9 to 14 months and for stage IV, 17 to 33 weeks.[3] In
reality, even when the stage at presentation is advanced, current
therapies offer potential benefits by relieving cancer-related
symptoms and increasing survival.[4-10]

Multiple studies have shown symptomatic improvement in advanced
disease.[6-10] In addition, one randomized, controlled clinical
trial, incorporating a quality-of-life assessment, demonstrated a
significant improvement in quality of life for those patients who
received chemotherapy relative to those managed by best supportive
care alone.[10,11] These observations all suggest that patients
should at least be referred for consideration of treatment. Sometimes
a patient won’t be referred because there is concern from
physicians, health-care administrators, and insurers about the cost
of treatment for advanced and incurable disease. The following
information summarizes the evidence for the benefit of systemic
therapy in metastatic (stage IV) non–small-cell lung cancer, and
then focuses on the cost and cost-effectiveness of chemotherapy for
stages III and IV disease. The data demonstrate that chemotherapy for
stage IV non–small-cell lung cancer and combined modality
therapy for stage III disease are cost-effective treatments that are
competitive with commonly used health care interventions.

Evidence for Use of Chemotherapy

There are now eight randomized controlled clinical trials of
cisplatin (Platinol)-based chemotherapy in comparison to best
supportive care.[10,12-18] Best supportive care has, in general,
consisted of the judicious use of radiotherapy in patients with
localized cancer-related symptoms, as well as the use of antibiotics
and steroids to control infections, cerebral metastases, and
hypercalcemia. Almost all of the trials have been small, with
approximately 20 to 50 patients per arm. Although the response rate
to chemotherapy in metastatic disease has generally been low (range
20% to 25%), there has been a small but consistent increase in median
survival time. Those patients receiving best supportive care
generally have had a median survival of only 17 weeks, whereas the
median survival of those who received chemotherapy has been
approximately 24 weeks. Several of the trials[10,12, 15,18] have
shown a statistically significant survival advantage. Four
meta-analyses have shown a reduction in the hazard ratio for death in
chemotherapy-treated patients [19-22]. As demonstrated in the
Non–Small-Cell Lung Cancer Collaborative Study, the overall
survival advantage at 1 year is 10% in absolute terms.[20]

Five studies of chemotherapy in advanced non–small-cell lung
cancer have evaluated symptom improvement in patients undergoing
treatment.[6-10] The first of these, reported by Osoba et al in 1985,
used a regimen of bleomycin (Blenoxane), etoposide, and cisplatin and
yielded a 44% response rate, but a higher rate of symptom
improvement.[8] Cough improved in 68% of patients, hemoptysis was
relieved in 78%, pain in 68%, dyspnea in 31%, and anorexia in 44%.
Subsequent studies by Ellis,[6] Fernandez,[7] Kris,[9] Hardy,[10] and
Thatcher[24] have confirmed that chemotherapy yields symptomatic
improvement in 60% to 70% of patients.

Billingham has recently reported the results of a quality-of-life
study undertaken during a randomized comparison of MIC (mitomycin
[Mutamycin], ifosfamide [Ifex], cisplatin), compared to best
supportive care.[12] Patients with metastatic disease completed
quality of life questionnaires using the European Organization for
Research and Treatment of Cancer (EORTC) quality-of- life core
questionnaire, as well as the lung module. There was a statistically
significant benefit in terms of quality-of-life in the
chemotherapy-treated patients over the first 6 weeks of the study.

Estimating the Treatment Cost of NSCLC

With the evidence that chemotherapy produces a survival advantage as
well as symptomatic improvement and even benefit in the quality of
life of patients with advanced non–small-cell lung cancer,
resistance to the idea of offering systemic therapy to medically
appropriate patients has diminished. Nonetheless, there remain those
who believe that we cannot afford such treatment in a fiscally
constrained environment. The fiscal barrier appears to be the last
remaining barrier that needs to be dealt with to enable patients with
lung cancer to access the current best available care. An
understanding of what the costs of care are for patients receiving
lung cancer treatment is needed. In Canada, the Health Analysis
Modeling Group at Statistics Canada has undertaken a cost analysis of
the burden of care for common malignancies, including lung cancer.
These cost models are integrated into a microsimulation model of
Canadian health called the Population Health Model (POHEM).[25]

The lung cancer component of the Population Health Model incorporates
information on histologic cell type (small-cell vs
non–small-cell), age, gender, and stage, coupled with clinical
algorithms of care and the survival appropriate for stage of disease.
It assigns costs according to tumor cell type and treatment options.
Multiple databases were accessed to develop the model including the
Canadian Cancer Registry at Statistics Canada’s Health
Statistics Division. This database provided data on lung cancer
incidence, tumor cell type, and patient demographics.

Because staging information was not available from the Canadian
Cancer Registry, a retrospective staging study was undertaken by the
Alberta Cancer Board and the Ontario Cancer Registry. The stage
distribution of cases diagnosed between 1984 and 1985 was entered
into all Canadian non–small-cell lung cancer cases. The
treatment approaches incorporated into the model of care were those
identified from cancer registry data supplemented by responses from a
questionnaire sent to all Canadian thoracic surgeons and radiation
oncologists. From this information, estimates were made of the
proportion of patients who would be treated by a particular treatment approach.

The questionnaire was also used to estimate the average number of
treatment fractions and the total dose of radiation used on
radiotherapy patients, according to stage of disease. It was assumed
that patients with stage IV disease were managed by best supportive
care, as this has been the usual care provided to most patients in
Canada presenting with metastatic disease. At the time the model was
developed, it was estimated that only about 10% of patients with
stage IV non–small-cell lung cancer received chemotherapy in Canada.[1]

Comparison of Hospitalization

Statistics Canada’s 1992-1994 Person Oriented Hospital Morbidity
Information Database provided the duration of hospitalization for
diagnostic work-up and initial treatment for non–small-cell lung
cancer. Costs for hospital and outpatient chemotherapy treatment were
extracted from an economic analysis of a National Cancer Institute of
Canada Clinical Trial (BR.5), which compared chemotherapy vs best
supportive care in advanced non–small-cell lung cancer.[25]

A record linkage study was performed in the province of Manitoba for
all patients diagnosed with lung cancer in 1990 (approximately 600)
to determine if the hospital utilization data from the BR.5 study
were still relevant. The study confirmed that patients with advanced
non–small-cell lung cancer who received chemotherapy used fewer
hospital bed days than those managed by best supportive care and that
the difference in the length of hospital stay was similar to that
observed in the BR.5 study.[26]

Lung cancer stages

TNM stands for Tumour, Node, M etastases. This staging system describes

  • The size and position of the tumour (T)
  • Whether cancer cells have spread into the lymph nodes (N)
  • Whether the tumour has spread anywhere else in the body – secondary cancer or metastases (M)

The doctor gives each factor a number. So, a very small cancer which hasn’t spread is T1 N0 M0. A cancer that is larger and has spread into the lymph nodes and to another part of the body is T3, N1, M1.

You can find more about lung cancer staging on the next page in this section. It has a detailed explanation of the TNM lung cancer staging system.

Rehab Before Cancer Treatment Can Help Patients Bounce Back

If you’ve been diagnosed with cancer, how much your chemotherapy treatment will cost and how to deal with all the bills that will inevitably follow should not be at the forefront of your concerns.

Unfortunately, treating cancer is not cheap: medical expenses typically include doctor and clinical visits, imaging tests like X-rays and MRIs, radiation treatments, hospital stays, surgery costs, home care, and the cost of chemotherapy, including expensive drugs. Here is what you might expect to pay for treatment, plus some ways to potentially help manage the costs.

What is chemotherapy?

Chemotherapy is a cancer treatment that uses strong drugs to destroy or slow the growth of fast-spreading cancerous cells.

In a best-case scenario, chemotherapy treatment will destroy cancer cells to the point where they are no longer detectable in the body and are not able to grow back.

There are currently more than 100 chemotherapy drugs used today, with doctors using certain drugs based on the type of cancer and its stage. Doctors will often use more than one drug to treat a patient-a process known as combination chemotherapy as the drugs work together to kill more cancer cells, according to the American Cancer Society.

Chemotherapy drugs can be given to patients in several ways: as a pill or liquid that you swallow; injected into the body like a flu shot; or put into your blood via a plastic tube called a catheter, according to the American Cancer Society.

While chemotherapy can be very effective, the success rate varies based on the type of cancer, how early it was spotted and the effectiveness of your treatment plan. For example, the five-year survival rate for those with lung cancer is 17%, while the same survival rate for men with testicular cancer is 95%, according to

A 2012 study by the National Cancer Institute showed that women with breast cancer who received chemotherapy after surgery had better overall survival rates, with a risk of recurrence 41% lower than women who were not treated with chemotherapy. Overall survival after five years was 88% with chemotherapy and 76% without it, the study said.

Keep in mind that there can be numerous side effects to chemotherapy, including nausea, vomiting, diarrhea, hair loss, fever, loss of appetite, and fatigue; long-term risks include heart and kidney problems, nerve damage, and risk of a second cancer, according to the Mayo Clinic.

Why chemotherapy costs vary

The costs of chemotherapy will vary depending on the type of cancer; which type of drugs are used; where you buy the drugs from; where you are treated; whether the costs are covered by insurance; and how often and how long you’ll need treatment.

You can receive cancer treatment in either a hospital outpatient department (HOPD) or in an office-managed setting, such as a physician’s office. Treatment for patients receiving chemotherapy in hospitals cost an average of 24% more than treatment in a physician’s office, according to a study by Avalere Health.

The study also found that the average cost of care per episode (three to four months of treatment) in office-managed settings was around $20,000, while the cost of care in a HOPD setting was just over $26,000, or 34% higher.

However, the average cost of treatment varies the most depending on the type of cancer. The most expensive cancer treatment was for colon cancer, which cost around $46,000 for both office-managed and HOPD settings, according to the study. The least expensive treatment was for genitourinary system cancer (urinary and genital organs), which cost $8,960 in office-managed settings and $19,592 in HOPD, the study found.

How much do cancer drugs cost?

One reason for the high costs of cancer treatment is the costs of new drugs. Of the 12 drugs approved by the Food and Drug Administration for cancer conditions in 2012, 11 were priced above $100,000 for a year of treatment, according to a report by

Here are some of the most popular drugs used to treat cancer, and what you might pay for them:

This drug is approved to treat types of colon, lung, kidney and brain cancers. A typical fill of Avastin can cost more than $5,000 for just two vials, according to GoodRx. Over the course of a year, this can cost patients up to $100,000 in the United States, according to

Instead, cancer patients might want to try a cheaper generic alternative to Avastin that works the same way, such as Adrucil, with a typical fill costing just $8 to $10, according to GoodRx.

This drug is approved to treat early-stage breast cancer. A typical fill of Herceptin can cost $4,000 or more for one kit, with full-year costs around $70,000, according to

However, patients might be eligible to receive financial assistance covering at least 80% of the out-of-pocket costs for each Herceptin prescription, according to

This drug treats head, neck and colorectal cancer. A typical fill of this drug can cost $1,109 or more for one vial, according to GoodRx. Patients might be eligible for financial assistance from the drug’s manufacturer, Bristol-Myers Squibb.

This drug treats cancer of the colon or rectum. A typical fill of this drug can cost $340 or more for two vials, according to GoodRx. While it is less expensive, it is often used in combination with others, according to

Find help paying for your cancer treatment

Most health insurance policies should cover at least part of the cost of chemotherapy, according to

Medicare, the national social insurance program for the elderly and those with certain conditions, covers chemotherapy for cancer patients who are hospital inpatients (requiring at least a one-night stay) and outpatients (not expected to stay overnight), as well as for patients in a doctor’s office or freestanding clinic. You will have to pay a copayment as a hospital outpatient and 20% of the Medicare-approved amount if you get treatment in a doctor’s office or freestanding clinic, according to

Federal and state programs may be able to provide financial assistance for people with cancer. The American Cancer Society list several organizations which might be able to help cancer patients facing economic hardships. You might also consider starting a fundraiser with a crowdfunding site like GiveForward to get help with your bills from friends, family and/or strangers.

You can also apply for Social Security Disability benefits, which is paid to people who cannot work due to a medical condition that is expected to last at least one year or result in death. Visit the website to apply for disability benefits, or call them toll-free at 1-800-772-1212.

Chemotherapy photo via Shutterstock.

Rehab Before Cancer Treatment Can Help Patients Bounce Back

Lung cancer is divided into two main types: non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Since the management of cancer depends greatly on the extent of the disease-encapsulated tumor versus widespread metastatic disease, for example-oncologists have developed staging systems for virtually every type of cancer, including lung cancer. The behavior of NSCLC and SCLC in the body are quite different and are treated in very different ways, thus their staging systems are different.

Staging of Non-Small Cell Lung Cancer (NSCLC)

Cancer staging of non-small cell lung cancer NSCLC is based on a number of clinical findings, diagnostic studies, and laboratory findings. Since accurate staging in lung cancer is extremely important, particularly in NSCLC, once a diagnosis is made additional testing will be done to properly classify the tumor. Staging for lung cancer takes into consideration:

  • The patient’s medical, family, and social history
  • Findings on physical examination
  • Blood tests: Complete blood count (CBC), Serum electrolytes (CMP; Chem-10), Liver function tests (LFTs)
  • Radiological studies: Chest X-ray, Chest CT (possibly abdomen and pelvis also)

If the oncologist suspects a distant metastasis of the lung cancer based on history and physical exam, additional tests may be considered for the purposes of NSCLC staging. Positron emission tomography (PET) scanning is used to look for collections of cancerous cells throughout the body. Bone scintigraphy can be used if metastasis to bone is suspected and magnetic resonance imaging (MRI) is performed when the brain or spine are likely compromised by spread of the primary tumor.

Identifying the histological type of NSCLC tumor cell is important as well, which means that a pathological diagnosis is required. In order to obtain a pathological diagnosis, a biopsy of the tumor must be taken. This can be done through bronchoscopy, thoracosopy, fluoroscopic-guided biopsy, or open thoracotomy (rarely).

There are four stages in NSCLC, Stage I through Stage IV. Stages I, II, and III are further divided into A and B subtypes. Technically there is also a fifth stage, Stage 0, which is not an invasive cancer. These numbered stages are assigned based on a TNM staging system. TNM is an acronym that stands for Tumor, Node, and Metastasis. TNM staging is used to stage virtually every type of cancer; however, each TNM classification correlates to different stages across various types of cancer. In other words, Stage III lung and breast cancer may have different TNM stages.

TNM Staging System for Non-Small Cell Lung Cancer*

* Based on 1997 guidelines. International Association for the Study of Lung Cancer is expected to release new TNM stagin guidelines within the next year.

Once the size of the primary tumor is known, whether there are local/regional lymph nodes containing cancer cells, or if there are distant cancer cells (metastasis), the TNM classification is used to assign a stage based on the four-tiered scale.

Stage Grouping Correlated TNM Stagin System for Non-Small Cell Lung Cancer*

Stage 0

Cells, No Tumor

Carcinoma in situ

Stage IIB

T 2 N 1 M 0 OR
T 3 N 0 M 0

Tumor > 3cm in diameter, Lymph node spread OR
Tumor invaded surrounding structures, No lymph node spread

Stage IIIA

T 3 N 1 M 0 OR
T 1-3 N 2 M 0

Tumor invaded surrounding structures, Local lymph node spread OR
Regional lymph node spread, any T stage (except 4)

* Based on 1997 guidelines. International Association for the Study of Lung Cancer is expected to release new TNM stagin guidelines within the next year.

Treatment for NSCLC is based largely on the stage of the disease according to these four stages. While there are guidelines for what therapy should be used in a particular NSCLC stage, significant variability exists between oncologists since treatment is tailored to the needs and wishes of the patient. The table includes treatment for the first occurrence of NSCLC only (not recurrence). Also, if the lung cancer is causing significant, intractable pain or if the tumor is causing functional problems with other organs like the heart or brain, additional treatment may be used to reduce symptoms (rather than try for a cure).

Treatment Guidelines for Non-Small Cell Lung Cancer
StageStandard TreatmentAlternate Theraphy, clinical trials, for symptom control, or palliation

Stage IIIA

Surgery then chemotherapy
Chemotherapy and radiation

Neoadjuvant chemotherapy and radiation

Stage IV

Radiation therapy (palliative)
Surgical resection (palliative)

Combination therapy, internal radiation, targeted therapy, laser therapy

* Based on 1997 guidelines. International Association for the Study of Lung Cancer is expected to release new TNM stagin guidelines within the next year.

Staging of Small Cell Lung Cancer (SCLC)

Unlike non-small cell lung cancer (and most cancers), it does not help oncologists or other medical professionals to use the TNM staging system to describe small cell lung cancer (SCLC). Currently, experts agree that it is more useful to separate SCLC into two stages: limited stage and extensive stage. This does not mean that the staging workup is less involved; in fact, there may be more tests and studies done for the purpose of staging SCLC than NSCLC. The staging workup of SCLC involves:

  • Complete history
  • Complete physical examination
  • Blood tests
    • Complete blood count (CBC) with differential
    • Serum chemistry including blood urea nitrogen, creatinine, calcium, alkaline phosphatase(CMP; Chem-10)
    • Liver function tests (LFTs)
    • Serum lactate dehydrogenase (LDH)
  • Chest X-ray
  • CT of chest, abdomen and pelvis
  • MRI of brain (in most cases)
  • Bone scan
  • Bone marrow aspiration (if it will help direct treatment based on the rest of the workup)

There have been some discrepancies and disagreements about what constitutes limited stage SCLC. The most common definitions for both stages are listed, but individual oncologists may have slightly different definitions regarding the precise scope of limited stage SCLC.

Limited Stage

Limited stage disease is small cell lung cancer that is confined to one half of the chest, essentially. This can include any location within one lung, the entire mediastinum, and local lymph nodes. The National Cancer Institute defines local lymph nodes as those that can be reached with a single radiation that also treats the primary tumor. If cancer cell-containing lymph nodes are outside of the radiation port, the affected patient would warrant extensive stage status. A malignant pleural effusion qualifies as extensive stage.

Extensive Stage

Extensive stage small lung cancer is disease that cannot be included within or exceeds the limited stage criteria. It generally indicates cancer has spread to the opposite lung or to distant sites in the body. Metastatic lung cancer is a very challenging problem for the treating oncologist.

Treatment of lung cancer is based mostly on whether the cancer is limited or extensive stage. Small cell lung cancer tends to be very sensitive to radiation therapy, which means if it can be treated with a single radiation port, it should be tried. Generally radiation therapy is only used to treat limited stage SCLC. Surgery is rarely indicated in either limited or extensive stage SCLC. Chemotherapy is indicated in both SCLC stages, however the particular stage does guide which chemotherapeutic drugs should be used. Various chemotherapy regimens have been tried and continue to be used in SCLC. The major distinction is that sometimes only one drug can be used to treat limited stage disease when combined with radiation therapy while extensive stage disease is treated with more than one chemotherapeutic drug.