I have had surgery to remove a non-small cell lung cancer. My surgeon says it is all clear but I wonder if I should have chemotherapy as well?

Even when non-small cell lung cancer (NSCLC) has been removed by surgery, there is a risk that some cancer cells have been left behind. These cells are too small to be seen on a scan and can cause the cancer to come back later on.

Having chemotherapy after surgery (called adjuvant chemotherapy) can help to reduce the risk of NSCLC coming back and help some people to live for longer. But, not everyone is helped by chemotherapy. So, some people have the side effects of treatment with little or no benefit.

There have been a number of studies that have used chemotherapy after surgery. In one study, people with stage 1 and stage 2 non-small cell lung cancer, had either surgery alone or surgery followed by chemotherapy. After 5 years 69 out of every 100 people who had chemotherapy were alive compared to 55 out of every 100 people who had surgery alone.

The most common side effects of chemotherapy were:

• a lowered white blood cell count
• a low red blood cell count (anaemia)
• tiredness
• feeling sick
• hair loss
• poor appetite
• tingling and numbness in hands and feet (neuropathy).

Only about half of the people were able to complete all of their planned chemotherapy. But, for most people the side effects were not severe.

Based on the results of this and other studies, the bodies that give guidance about cancer treatments in the UK have made the following recommendation. After curative surgery for NSCLC you should be considered for chemotherapy after talking through the possible risks and benefits. Usually a doctor who specialises in giving chemotherapy (an oncologist) would discuss this with you. They will be able to outline the possible advantages and disadvantages of chemotherapy in your particular situation. But, often the final decision is a personal one and down to what feels right for you.

References

• National Institute for Health and Clinical Excellence. Lung cancer: the diagnosis and treatment of lung cancer. February 2005. NICE clinical guideline 24.
• Scottish Intercollegiate Guidelines Network clinical guideline 80. 2005
• Winton T et al Vinorelbine plus cisplatin vs observation in resected non-small cell lung cancer. New England Journal of Medicine. 2005; 352 2589-2597