calcified granuloma

What is calcified granuloma

Calcified granuloma is granuloma (small area of inflammation) that has become calcified over time. A granuloma is a pathological term defined as a collection of macrophages and then maturation into epithelioid cells that attempt to wall off the antigenic but indigestible substance 1). Granulomas are formed by the process of granulomatous inflammation, which is a specific type of chronic inflammation that occurs following cellular injury as a response to the mediators that are released. A broad range of insults, including infections, autoimmune, foreign bodies, allergens and neoplastic disease, may trigger the formation of granulomas. This inflammatory response is seen at all ages and in all body tissues. Calcium may deposit in the granuloma very slowly. Thus, a calcified granuloma often means the presence of a granuloma for a long time.

Granulomas frequently occur in the lungs, but can occur in other parts of the body and head as well. Granulomas seem to be a defensive mechanism that triggers the body to “wall off” foreign invaders such as bacteria or fungi to keep them from spreading.

Common causes of granuloma include infections, vasculitis, sarcoidosis, foreign bodies, and neoplasm. A prime example is Histoplasma capsulatum (Histoplasmosis), which give rise to a variety of calcified intrathoracic calcific deposits including calcified mediastinal lymph nodes, broncholithiasis, mediastinal granuloma and solitary or multiple intrapulmonary calcified histoplasmomas (Figure 1) 2). Histoplasma capsulatum is a dimorphic fungus that remains in a mycelial form at ambient temperatures and grows as yeast at body temperature in mammals. Histoplasma capsulatum infection causes histoplasmosis, which is an infection caused by breathing in spores of a Histoplasma capsulatum fungus often found in bird and bat droppings. The infection is most commonly spread when these spores are inhaled after taking to the air, such as during demolition or cleanup projects. Soil contaminated by bird or bat droppings also can spread histoplasmosis, putting farmers and landscapers at a higher risk of the disease. Although the fungus that causes histoplasmosis can be found in temperate climates throughout the world, in the United States histoplasmosis is endemic in the Ohio, Missouri, and Mississippi River valleys, though it can occur in other areas, too. Histoplasmosis also occurs in river valleys in Central and South America, eastern and southern Europe, and parts of Africa, China, India, Southeast Asia, and Australia 3).

Besides larger histoplasmomas, there may be multiple, small, diffuse, calcified pulmonary nodules in asymptomatic patients. This type of calcification most probably results from either hematogenous or bronchogenic dissemination of Histoplasma capsulatum (Histoplasmosis) 4).

Most people with histoplasmosis never develop symptoms and aren’t aware they’re infected. But for some people — primarily infants and those with compromised immune systems — histoplasmosis can be serious  5). Treatments are available for even the most severe forms of histoplasmosis.

Tuberculosis (TB) is a common cause of intrathoracic calcifications. Most calcific deposits in TB are dystrophic and may present as parenchymal granulomas, mediastinal lymph nodes, and fibronodular areas of lung involvement (Figure 2). Diffuse nodular calcification of the lungs may be the result of a hematogenous infection. Re-evaluation with high-resolution computed tomography (HRCT) for controversial lesions is needed. It has been shown that patients with TB can develop hypercalcemia caused by excessive production of endogenous 1,25 vitamin D 6). Rarely, sarcoidosis may produce multiple micronodular calcifications, radiographically similar to pulmonary alveolar microlithiasis 7). However in sarcoidosis, calcification is within epitheloid granulomas, while in pulmonary alveolar microlithiasis, there are distinct intra-alveolar microliths 8).

Hypercalcemia secondary to granulomatous infections or supplemental vitamin D is a rare occurrence but may contribute to calcification of intrathoracic granulomas 9).

Calcified lung granulomas secondary to Coccidioides immitis infection is a rare occurrence. Dystrophic calcification may occur in healing coccidioidal granulomas 10).

Unlike the lung, skin can be affected by several routes, including direct inoculation, endogenous sources, and hematogenous spread. This broad basis of involvement introduces a variety of infectious agents, which can present as necrotizing or non-necrotizing granulomatous inflammation. Non-infectious causes require a thorough clinicopathologic review to narrow the scope of the pathogenesis which include: foreign body reaction, autoimmune, neoplastic, and drug related etiologies. Granulomatous inflammation of the kidney, often referred to as granulomatous interstitial nephritis (GIN) is unlike organ systems such as the skin or lungs. The differential diagnosis of granulomatous interstitial nephritis (GIN) is more frequently due to drugs and sarcoidosis as compared to infections (fungal and mycobacterial) 11).

Figure 1. Calcified granuloma in the lung due to Histoplasmosis

Calcified granuloma in the lung due to Histoplasmosis

Footnote: Thoracic histoplasmosis. Lung windows of the chest CT confirms a well-defined granuloma that was calcified on soft tissue windows (not shown). Additionally, there were many other nodules in both lungs that were not seen on the chest radiograph.

Figure 2. Calcified granuloma in the lung due to Tuberculosis (TB)

Calcified granuloma in the lung due to Tuberculosis

Footnote: Two chest radiographs 5-years apart showing a high-density solitary pulmonary nodule remaining unchanged over a 5-year period. One of the most reliable imaging features of a benign lesion is as a benign pattern of calcification and periodic follow-up with CT showing no growth for 2 years. The high density of the well-defined nodule suggest that this is calcified granuloma and no further follow-up is indicated except in patients with calcium producing tumors such as a primary osteosarcoma.

[Source 12) ]

Calcified pulmonary granuloma causes

The most common cause of lung nodule calcification is granuloma formation, usually in the response to healed infection.

  • Healed infection
    • calcified granulomata, e.g. thoracic histoplasmosis, recovered miliary tuberculosis (rare)
      • most common
      • 2-5 mm
      • calcification may be central or diffuse
      • usually with calcification of hilar/mediastinal nodes
    • healed varicella pneumonia
      • micronodular (1-3 mm)
      • no associated nodal calcification
  • Occupational disease/pneumoconioses
    • silicosis
      • associated with nodal egg-shell calcification
      • multiple small densely calcified nodules in mid and upper zones
    • coalworker’s pneumoconiosis
      • smaller nodules which may not be visible on plain film
      • associated with minimal symptoms
  • Pulmonary hamartomas
  • Metastatic pulmonary calcification
    • typically nodules are poorly defined and larger (3-10 mm)
    • calcium and phosphate metabolism abnormalities
      • chronic renal failure
      • multiple myeloma
      • secondary hyperparathyroidism
      • massive osteolysis caused by metastases
      • intravenous calcium therapy
  • Pulmonary hemosiderosis
    • Idiopathic pulmonary hemosiderosis
      • recurrent alveolar hemorrhage
      • centrilobular nodular opacities
    • Mitral stenosis
      • small multifocal calcified nodules
    • Goodpasture syndrome
  • Pulmonary alveolar microlithiasis
    • tiny micronodules
    • apparent calcification of interlobular septa
    • small subpleural cysts
  • Sarcoidosis
  • Calcifying fibrous pseudotumor of lung
  • Pulmonary amyloidosis
  • Pulmonary hyalinising granuloma
  • Calcified pulmonary metastases
    • osteosarcoma
    • medullary thyroid carcinoma 13)

Table 1. Granulomatous inflammation organized by commonly affected organ system

LungSkinKidneyLiverLymph Node
InfectiousInfectiousInfectiousInfectiousInfectious
BacterialBacterialBacterialBacterialBacterial
Actinomyces spp.Actinomyces spp.Bartonella henselaeActinomyces spp.Actinomyces spp.
Brucella spp.Bartonella henselaeBrucella spp.Bartonella henselaeBartonella henselae
Francisella tularensisChlamydia trachomatis (L1, L2, L3 serovars)Malakoplakia (various bacteria)Brucella spp.Brucella spp.
Mycobacterium tuberculosisMalakoplakia (various bacteria)Mycobacterium tuberculosisChlamydia trachomatis (L1, L2, L3 serovars)Chlamydia trachomatis (L1, L2, L3 serovars)
Mycoplasma pneumoniaMycobacterium tuberculosisNon-tuberculous mycobacteriaCoxiella burnetiiCoxiella burnetii
Nocardia spp.Non-tuberculous mycobacteriaXanthogranulomatous pyelonephritisFrancisella tularensisFrancisella tularensis
Non-tuberculous mycobacteriaFungalFungalListeria monocytogenesListeria monocytogenes
Rhodococcus equi (malakoplakia)Aspergillus spp.Aspergillus spp.Malakoplakia (various bacteria)Malakoplakia (various bacteria)
FungalBlastomyces dermatitidisBlastomyces dermatitidisMycobacterium tuberculosisMycobacterium tuberculosis
Aspergillus spp.Coccidioides spp.Coccidioides spp.Non-tuberculous mycobacteriaNon-tuberculous mycobacteria
Blastomyces dermatitidisCryptococcus spp.Histoplasma capsulatumRickettsia spp.Yersinia granulomatosis
Coccidioides spp.Dematiaceous fungi causing chromoblastomycosisMucoralesSalmonella typhiFungal
Cryptococcus spp.Histoplasma capsulatumNon-InfectiousYersinia spp.Aspergillus spp.
Histoplasma capsulatumMucoralesAutoimmuneFungalBlastomyces dermatitidis
MucoralesSporothrix shenckiiCrohn DiseaseAspergillus spp.Coccidioides spp.
Viral and ParasiticViral and ParasiticGranulomatosis with polyangiitisBlastomyces dermatitidisCryptococcus spp.
Acanthamoeba spp.Acanthamoeba spp.SarcoidCandida spp.Histoplasma capsulatum
Balamuthia mandrillarisBalamuthia mandrillarisTubulointerstitial nephritis and uveitis (TINU)Coccidioides spp.Mucorales
CytomegalovirusCytomegalovirusNeoplasticHistoplasma capsulatumSporothrix schenckii
Dirofilaria spp.Dirofilaria spp.Chronic lymphocytic leukemiaMucoralesViral and Parasitic
Toxoplasma gondiiLeishmania spp.OtherViral and ParasiticCytomegalovirus
Non-InfectiousPrototheca spp.Chronic pyelonephritisCytomegalovirusEpstein-Barr virus
AutoimmuneNon-InfectiousDrugsEchinococcus spp.Leishmania spp.
Churg StraussAutoimmuneEnterobius vermicularisToxoplasma gondii
Granulomatosis with polyangiitisChurg StraussEpstein-Barr virusNon-Infectious
Lymphoid interstitial pneumoniaCrohn diseaseHepatitis AAutoimmune
SarcoidGranuloma annulareHepatitis CChurg Strauss
NeoplasticGranulomatosis with polyangiitisLeishmania spp.Granulomatosis with polyangiitis
Hodgkin LymphomaOrofacial granulomatosisSchistosoma spp.Sarcoid
Langerhans cell histiocytosisRheumatoid noduleToxoplasma gondiiNeoplastic
MetastasisSarcoidNon-InfectiousDendritic cell sarcoma
Rosai-Dorfman diseaseSystemic lupus erythematosusAutoimmuneErdheim-Chester Disease
OtherNeoplasticChronic granulomatous diseaseHemophagocytic lymphohistiocytosis
Chronic granulomatous diseaseGranulomatous mycosis fungoidesCrohn’s diseaseHistiocytic sarcoma
Chronic pneumoniaHodgkin lymphomaPrimary biliary cirrhosisHodgkin lymphoma
DrugsJuvenile xanthogranulomaSarcoidInterdigitating cell sarcoma
Foreign body reactionLangerhans cell histiocytosisNeoplasticLangerhans cell histiocytosis
PneumoconiosesMetastasisHemophagocytic lymphohistiocytosisLangerhans cell sarcoma
ReticulohistiocytomaHodgkin lymphomaMetastasis
Rosai-Dorfman diseaseMetastasisRosai-Dorfman disease
OtherRosai-Dorfman diseaseOther
Actinic granulomaOtherForeign body reaction
Chronic granulomatous diseaseBerylliosis
DrugsDrugs
Foreign body reactionForeign body reaction
Necrobiosis lipoidica
Rosacea
[Source 14) ]

Symptoms of calcified granuloma

Usually there are no symptoms associated with pulmonary calcified granuloma. If present, symptoms would be related to the condition that led to the calcified granuloma developing. If the calcified granuloma is from a lung cancer, the patient is often without symptoms but may have a new cough, or cough up blood.

Most of the time, a patient is unaware that he or she has a lung calcified granuloma until a chest X-ray or computed tomography scan (CT scan) of the lungs is performed.

Histoplasmosis symptoms

Symptoms of histoplasmosis may appear between 3 and 17 days after a person breathes in the fungal spores. The mildest forms of histoplasmosis cause no signs or symptoms, but severe infections can be life-threatening.

Most people who are exposed to the fungus Histoplasma never have symptoms. Other people may have flu-like symptoms that usually go away on their own.

Symptoms of histoplasmosis include 15):

  • Fever
  • Dry cough
  • Fatigue (extreme tiredness)
  • Chills
  • Headache
  • Chest pain
  • Body aches

Some people with histoplasmosis also get joint pain and a rash. People who have a lung disease, such as emphysema, can develop a chronic form of histoplasmosis.

For most people, the symptoms of histoplasmosis will go away within a few weeks to a month 16). However, some people have symptoms that last longer than this, especially if the infection becomes severe.

In some people, usually those who have weakened immune systems, histoplasmosis can develop into a long-term lung infection, or it can spread from the lungs to other parts of the body, such as the central nervous system (the brain and spinal cord) 17). Signs of chronic histoplasmosis can include weight loss and a bloody cough. The symptoms of chronic histoplasmosis sometimes mimic those of tuberculosis.

Severe histoplasmosis

The most severe variety of histoplasmosis occurs primarily in infants and in people with compromised immune systems. Called disseminated histoplasmosis, it can affect nearly any part of your body, including your mouth, liver, central nervous system, skin and adrenal glands. If untreated, disseminated histoplasmosis is usually fatal.

Tuberculosis (TB) symptoms

Although your body may harbor the bacteria that cause tuberculosis (TB), your immune system usually can prevent you from becoming sick. For this reason, doctors make a distinction between:

  • Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn’t contagious. It can turn into active TB, so treatment is important for the person with latent TB and to help control the spread of TB. An estimated 2 billion people have latent TB.
  • Active TB. This condition makes you sick and in most cases can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later.

Signs and symptoms of active TB include:

  • Coughing that lasts three or more weeks
  • Coughing up blood
  • Chest pain, or pain with breathing or coughing
  • Unintentional weight loss
  • Fatigue
  • Fever
  • Night sweats
  • Chills
  • Loss of appetite

Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, signs and symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine.

Lung cancer symptoms

Lung cancer is a type of cancer that begins in the lungs. Lung cancer is the leading cause of cancer deaths worldwide.

Lung cancer typically doesn’t cause signs and symptoms in its earliest stages. Signs and symptoms of lung cancer typically occur when the disease is advanced.

Signs and symptoms of lung cancer may include:

  • A new cough that doesn’t go away
  • Coughing up blood, even a small amount
  • Shortness of breath
  • Chest pain
  • Hoarseness
  • Losing weight without trying
  • Bone pain
  • Headache

Sarcoidosis symptoms

Sarcoidosis is a disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of your body — most commonly the lungs and lymph nodes. But it can also affect the eyes, skin, heart and other organs.

Signs and symptoms of sarcoidosis vary depending on which organs are affected. Sarcoidosis sometimes develops gradually and produces symptoms that last for years. Other times, symptoms appear suddenly and then disappear just as quickly. Many people with sarcoidosis have no symptoms, so the disease may be discovered only when a chest X-ray is done for another reason.

General symptoms

Sarcoidosis can begin with these signs and symptoms:

  • Fatigue
  • Swollen lymph nodes
  • Weight loss
  • Pain and swelling in joints, such as the ankles

Lung symptoms

Sarcoidosis most often affects the lungs and may cause lung problems, such as:

  • Persistent dry cough
  • Shortness of breath
  • Wheezing
  • Chest pain

Skin symptoms

Sarcoidosis may cause skin problems, which may include:

  • A rash of red or reddish-purple bumps, usually located on the shins or ankles, which may be warm and tender to the touch
  • Disfiguring sores (lesions) on the nose, cheeks and ears
  • Areas of skin that are darker or lighter in color
  • Growths under the skin (nodules), particularly around scars or tattoos

Eye symptoms

Sarcoidosis can affect the eyes without causing any symptoms, so it’s important to have your eyes checked regularly. When eye signs and symptoms do occur, they may include:

  • Blurred vision
  • Eye pain
  • Burning, itching or dry eyes
  • Severe redness
  • Sensitivity to light

Heart symptoms

Signs and symptoms related to cardiac sarcoidosis may include:

  • Chest pain
  • Shortness of breath (dyspnea)
  • Fainting (syncope)
  • Fatigue
  • Irregular heartbeats (arrhythmias)
  • Rapid or fluttering heart beat (palpitations)
  • Swelling caused by excess fluid (edema)

Sarcoidosis can also affect calcium metabolism, the nervous system, the liver and spleen, muscles, bones and joints, the kidneys, lymph nodes, or any other organ.

Calcified granuloma diagnosis

Diagnostic approach for various granulomatous diseases may range from simple to very complex workups.

People who have calcified granulomas may not even know that they’re there. They’re often discovered when you undergo an imaging procedure such as an X-ray or CT scan.

Your doctor may also perform additional tests to determine what has caused the granulomas to form.

Your doctor may suggest searching for evidence of the disease in samples of:

  • Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.
  • Lung secretions
  • Blood or urine
  • Biopsied lung tissue. Your doctor can perform a biopsy in a number of ways, including bronchoscopy, in which your doctor examines abnormal areas of your lungs using a lighted tube that’s passed down your throat and into your lungs.
    • Mediastinoscopy, in which an incision is made at the base of your neck and surgical tools are inserted behind your breastbone to take tissue samples from lymph nodes is also an option.
    • Another option is needle biopsy, in which your doctor uses X-ray or CT images to guide a needle through your chest wall and into the lung tissue to collect suspicious cells.
    • A biopsy sample may also be taken from lymph nodes or other areas where cancer has spread, such as your liver.
  • Bone marrow

Your doctor may also recommend tests such as:

  • Lung (pulmonary) function tests to measure lung volume and how much oxygen your lungs deliver to your blood
  • Electrocardiogram (ECG or EKG) to detect heart problems and monitor the heart’s status
  • Eye exam to check for vision problems that may be caused by sarcoidosis
  • Positron emission tomography (PET) scan. A PET scan can also help to find out if a calcified granuloma is malignant or benign. A PET scan uses a radiolabeled substance such as glucose that is absorbed by the calcified granuloma, and provides a picture of the calcified granuloma’s metabolic activity level. Malignant cells have faster metabolic rates than normal cells, so they require more energy and thus absorb more of the radiolabeled substance. Nodules can light up on PET imaging if they are malignant or if there is active inflammation. We have to be careful with the PET scan interpretation when someone has calcified granulomas smaller than 8-10 mm because they are not seen well by PET imaging.
  • Magnetic resonance imaging (MRI) if sarcoidosis seems to be affecting your heart or central nervous system

Other tests may be added, if needed. If the nodule has a very concerning appearance or growth pattern, or it is somewhat concerning and its nature is not able to be clarified by the above tests, the best step may be to remove the nodule. This will clarify its nature while treating it. This requires the patient be fit enough to undergo the surgery.

Usually, the first sign that a pulmonary calcified granuloma is present is a spot on the lung that shows up on a chest X-ray or a CT scan. These tests are usually done when a person sees the doctor for a respiratory illness.

If the X-ray film or CT scan indicates there is a pulmonary calcified granuloma, your doctor will ask you about your medical history, including whether you have had cancer in the past. He or she will want to know whether you are a smoker or former smoker and about any exposure to environmental chemicals that may be toxic.

The doctor will look at the X-ray to evaluate the size and shape of the calcified granuloma, its location, and its general appearance. Single pulmonary calcified granulomas seen on chest x-rays are generally at least 8 to 10 millimeters in diameter. If they are smaller than that, they are unlikely to be visible on a chest X-ray. The larger the calcified granuloma is, and the more irregularly shaped it is, the more likely it is to be cancerous. Those located in the upper portions of the lung are also more likely to be cancerous.

If you have any older chest X-rays, you should let your doctor look at them to determine the growth rate of the calcified granuloma. In general, malignant calcified granulomas double in size every one to six months. Nodules with a slower or faster growth rate are less likely to be cancerous.

Your doctor may recommend that you undergo a CT scan to obtain a more detailed image of the calcified granuloma, or your calcified granuloma may have first been identified by a CT scan. CT scans can give information about the specific features of the calcified granuloma, including its shape, size, location and internal density. CT scans are more accurate than chest x-rays in determining the nature of the calcified granuloma. A CT scan can find very small calcified granulomas, as small as 1-2 mm in diameter.

If the calcified granuloma is small enough or if its features suggest a very low likelihood that it represents a cancer, your doctor is likely to follow the calcified granuloma over time with repeated chest imaging. If the calcified granuloma does not grow over time, it is confirmed to be benign. If a concerning pace of growth is noted, then additional evaluation would be suggested. The interval between scans and the length of follow-up depends on the size of the calcified granuloma and the risk of malignancy.

If calcified granulomas are discovered in your liver, your doctor may ask about your medical and travel history. They may also perform laboratory tests to evaluate your liver function. If needed, a biopsy can also be taken to confirm an underlying condition that has caused granuloma formation.

Calcified granuloma lung treatment

Calcified granuloma in the lung treatment involves reaching a diagnosis treating the underlying cause. However, granulomas in people without symptoms almost never require treatment or even follow-up imaging tests.

Histoplasmosis treatment

For some people, the symptoms of histoplasmosis will go away without treatment. However, prescription antifungal medication is needed to treat severe histoplasmosis in the lungs, chronic histoplasmosis, and infections that have spread from the lungs to other parts of the body (disseminated histoplasmosis). Itraconazole is one type of antifungal medication that’s commonly used to treat histoplasmosis. Depending on the severity of the infection and the person’s immune status, the course of treatment can range from 3 months to 1 year.

Tuberculosis (TB) treatment

Medications are the cornerstone of tuberculosis treatment. But treating tuberculosis (TB) takes much longer than treating other types of bacterial infections.

For active tuberculosis, you must take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance and the infection’s location in the body.

Most common TB drugs

If you have latent tuberculosis, you may need to take only one or two types of TB drug. Active tuberculosis, particularly if it’s a drug-resistant strain, will require several drugs at once. The most common medications used to treat tuberculosis include:

  • Isoniazid
  • Rifampin (Rifadin, Rimactane)
  • Ethambutol (Myambutol)
  • Pyrazinamide

If you have drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications, such as amikacin or capreomycin (Capastat), are generally used for 20 to 30 months. Some types of TB are developing resistance to these medications as well.

Some drugs may be used as add-on therapy to the current drug-resistant combination treatment, including:

  • Bedaquiline (Sirturo)
  • Linezolid (Zyvox)

Sarcoidosis treatment

There’s no cure for sarcoidosis, but in many cases, it goes away on its own. You may not even need treatment if you have no symptoms or only mild symptoms of the condition. The severity and extent of your condition will determine whether and what type of treatment is needed.

Medications

If your symptoms are severe or organ function is threatened, you will likely be treated with medications. These may include:

  • Corticosteroids. These powerful anti-inflammatory drugs are usually the first line treatment for sarcoidosis. In some cases, corticosteroids can be applied directly to an affected area — via a cream to a skin lesion or drops to the eyes.
  • Medications that suppress the immune system. Medications such as methotrexate (Trexall) and azathioprine (Azasan, Imuran) reduce inflammation by suppressing the immune system.
  • Hydroxychloroquine. Hydroxychloroquine (Plaquenil) may be helpful for skin lesions and elevated blood-calcium levels.
  • Tumor necrosis factor-alpha (TNF-alpha) inhibitors. These medications are commonly used to treat the inflammation associated with rheumatoid arthritis. They can also be helpful in treating sarcoidosis that hasn’t responded to other treatments.

Other medications may be used to treat specific symptoms or complications.

Other treatments

Depending on your symptoms or complications, other treatments may be recommended. For example, you may have physical therapy to reduce fatigue and improve muscle strength, pulmonary rehabilitation to decrease respiratory symptoms, or an implanted cardiac pacemaker or defibrillator for heart arrhythmias.

Lung cancer treatment

You and your doctor choose a cancer treatment plan based on a number of factors, such as your overall health, the type and stage of your cancer, and your preferences.

In some cases, you may choose not to undergo treatment. For instance, you may feel that the side effects of treatment will outweigh the potential benefits. When that’s the case, your doctor may suggest comfort care to treat only the symptoms the cancer is causing, such as pain or shortness of breath.

Surgery

During surgery, your surgeon works to remove the lung cancer and a margin of healthy tissue. Procedures to remove lung cancer include:

  • Wedge resection to remove a small section of lung that contains the tumor along with a margin of healthy tissue
  • Segmental resection to remove a larger portion of lung, but not an entire lobe
  • Lobectomy to remove the entire lobe of one lung
  • Pneumonectomy to remove an entire lung

If you undergo surgery, your surgeon may also remove lymph nodes from your chest in order to check them for signs of cancer.

Surgery may be an option if your cancer is confined to the lungs. If you have a larger lung cancer, your doctor may recommend chemotherapy or radiation therapy before surgery in order to shrink the cancer. If there’s a risk that cancer cells were left behind after surgery or that your cancer may recur, your doctor may recommend chemotherapy or radiation therapy after surgery.

Radiation therapy

Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing radiation to precise points on your body.

For people with locally advanced lung cancer, radiation may be used before surgery or after surgery. It’s often combined with chemotherapy treatments. If surgery isn’t an option, combined chemotherapy and radiation therapy may be your primary treatment.

For advanced lung cancers and those that have spread to other areas of the body, radiation therapy may help relieve symptoms, such as pain.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be given through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that you can recover.

Chemotherapy is often used after surgery to kill any cancer cells that may remain. It can be used alone or combined with radiation therapy. Chemotherapy may also be used before surgery to shrink cancers and make them easier to remove.

In people with advanced lung cancer, chemotherapy can be used to relieve pain and other symptoms.

Stereotactic body radiotherapy

Stereotactic body radiotherapy, also known as radiosurgery, is an intense radiation treatment that aims many beams of radiation from many angles at the cancer. Stereotactic body radiotherapy treatment is typically completed in one or a few treatments.

Stereotactic body radiotherapy may be an option for people with small lung cancers who can’t undergo surgery. It may also be used to treat lung cancer that spreads to other parts of the body, including the brain.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Many targeted therapy drugs are used to treat lung cancer, though most are reserved for people with advanced or recurrent cancer.

Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy treatments are generally reserved for people with locally advanced lung cancers and cancers that have spread to other parts of the body.

Palliative care

People with lung cancer often experience signs and symptoms of the cancer, as well as side effects of treatment. Supportive care, also known as palliative care, is a specialty area of medicine that involves working with a doctor to minimize your signs and symptoms.

Your doctor may recommend that you meet with a palliative care team soon after your diagnosis to ensure that you’re comfortable during and after your cancer treatment.

In one study, people with advanced non-small cell lung cancer who began receiving supportive care soon after their diagnosis lived longer than those who continued with treatments, such as chemotherapy and radiation. Those receiving supportive care reported improved mood and quality of life. They survived, on average, almost three months longer than did those receiving standard care.

References   [ + ]