If bowel cancer has spread to the lungs
Your healthcare team will refer you to the lung (thoracic) team. You may choose to have one or more of the following treatments, depending on where else the cancer is in your body. Treatment options include:
Chemotherapy uses drugs to kill cancer cells. Your healthcare team may offer you chemotherapy to shrink the cancer and relieve any symptoms. You may have one chemotherapy drug or a combination of two or three drugs.
If your cancer comes back after treatment, you may be able to have chemotherapy again. This is called ‘second line’ chemotherapy.
Biological therapies are also called targeted therapies. They help your body control the way cancer cells grow. You may have them as a drip into a vein or you may take them as tablets, depending on which drug you’re having.
Biological therapies may be used together with chemotherapy to treat bowel cancer that has spread to other parts of the body.
Biological therapies include the following drugs:
- Cetuximab (Erbitux)
- Panitumumab (Vectibix)
- Bevacizumab (Avastin)
- Aflibercept (Zaltrap)
- Regorafenib (Stivarga)
Cetuximab and Panitumimab work by blocking messages that tell cancer cells to grow. They won’t work if your cancer cells have a change (mutation) in some of the RAS genes.
Bevacizumab, Aflibercept and Regorafenib stop the cancer cells growing their own blood supply.
Biological therapies are not routinely available on the NHS. Your doctor can apply for NHS funding for Cetuximab but the process is difficult and not always successful. It can be hard to accept this decision if you can’t get the treatment you need. Macmillan Cancer Support has information on what to do if a treatment isn’t available.
In Scotland, you can have Aflibercept together with FOLFIRI (irinotecan, 5-fluorouracil and folinic acid) as a second line treatment if you have already had oxaliplatin.
Cancer Research UK provides information on biological therapies to treat advanced bowel cancer.
If you have been diagnosed with advanced (metastatic) bowel cancer, your specialist may offer you a biomarker test. This looks for changes (mutations) in a group of genes, called RAS genes. If the cancer has a normal RAS gene, we call it ‘wild type’. If is abnormal, it is called a ‘mutated’ RAS gene.
Cancer cells are collected during endoscopy or surgery and are usually stored in a laboratory. So if you can’t have biomarker testing straight away, you may be able to have it in the future.
Your cancer specialist can use the results of biomarker testing to see which treatments would work best and which ones are unlikely to work for you. This is called personalised medicine, because your treatment is being tailored to the genetic make up of your cancer. For example, if you have a mutated RAS gene, you will not benefit from two biological therapies, called Cetuximab and Panitumimab.
Biomarker testing is not offered to everyone and we are campaigning for this to change. If you have been diagnosed with advanced bowel cancer, ask your specialist if you can be tested.
Your specialist lung (thoracic) team may offer you surgery to treat cancer that has spread to the lungs, depending on the number, size and location of the tumours. You must be fit enough for the operation and you will need to have scans and tests to make sure the surgery is likely to help you.
You may have chemotherapy before lung surgery to shrink the cancer and make it easier to remove. You may also have chemotherapy after surgery if the cancer has spread to the lymph nodes or if there is a high chance of it coming back.
It may be possible to take a small section of lung tissue (called a wedge) from the affected lung to remove one or two isolated metastases without losing too much of the function of the remaining lung. If your metastases have affected a bigger area of the lower parts of the lung, it may be that your surgeon recommends removing a larger part of the lung – this is known as a lobectomy.
If you have metastases in both lungs, it may also be possible to treat them, one lung at a time. If necessary, a combination of treatments may be used to ensure that the disease is treated as effectively as possible.
Cancer Research UK has more information on surgery for bowel cancer that has spread to the lungs.
Your healthcare team may offer you radiofrequency ablation to treat bowel cancer that has spread to the lungs.
Doctors sometimes use radiofrequency ablation to treat cancer that has spread to the lungs and can’t be removed by surgery. You may have this treatment if the areas of cancer in the lung are small and if the cancer hasn’t spread anywhere else in the body.
Treatment involves placing one or more needles into the affected parts of the lungs. The doctor uses a CT scan to guide the needle into the tumour. Radio waves passing through the needle destroy the cancer cells by heating them to a high temperature.
Microwave ablation is a fairly new treatment so there isn't as much information about how well it works compared to other treatments. If you are thinking about having it, your healthcare team will explain the benefits and risks to you.
Microwave ablation is similar to radiofrequency ablation but uses microwave energy to heat and destroy cancer cells in the lung. One or more needles are inserted into the tumour, using a CT scan or ultrasound can to make sure they're in the right place. The microwave energy passes through the needles into the cancer cells.
Stereotactic ablative radiotherapy (SABR) / Cyberknife
If you can't have other treatments, you may be able to have stereotactic radiotherapy to treat secondary cancer in the lung. This is a new way of using radiotherapy from different angles. The beams overlap at the tumour. This gives a very high dose of radiotherapy to the cancer while limiting damage to the surrounding healthy tissue, reducing the risk of side effects.
Macmillan Cancer Support has more information on stereotactic radiotherapy.
Cancer Research UK describes radiofrequency ablation and its side effects.
Updated August 2018. Due for review March 2019