Endobronchial therapies for lung cancer

An endobronchial therapy removes a blockage caused by the cancer inside the airway tubes of the lung (the bronchi or bronchioles). When lung cancer grows and blocks the airway tubes, this causes coughing, problems breathing, bleeding and pain. If you cannot have surgery to remove the cancer because of poor health or because of where the cancer is, endobronchial therapies can help with these symptoms by reducing the blockage inside the airway tubes.

Endobronchial therapies are done during a bronchoscopy. A bronchoscopy uses a bronchoscope, which is a long thin tube with a light on the end. For endobronchial therapies to be effective, the bronchoscope must be able to reach the tumour.

The following are different types of endobronchial therapies used for lung cancer.

Bronchial debridement removes as much of a tumour as possible to open up the airway and quickly relieve symptoms. Cutting tools passed through the bronchoscope remove tissue that is causing the blockage. Sometimes a small tube (stent) needs to be put in place to keep the airway tube open.

Bronchial debridement can be done again if the tumour grows back.

Brachytherapy is a type of internal radiation therapy that places radioactive material in the body. This is done using a small tube called a catheter that goes through the bronchoscope. At the end of the treatment, which usually takes less than 30 minutes, the radioactive material is removed from the lung through the catheter. No radioactive material is left inside the body. As the radiation effect kills the cancer cells over 2 to 4 weeks, the tumour shrinks.

A stent is a small metal or plastic tube that is placed into the airway tube to keep the airway open and allow air into the lungs.

A stent may be left in place permanently or it may be removed if the tumour shrinks with chemotherapy or radiation. If necessary, a larger stent can be put in place if the tumour continues to grow and block the airway.

Stents are used when an airway has to be opened quickly.

Laser surgery uses an intense, narrow beam of light (called a laser beam) to destroy cancer cells. The most common type of laser used for lung cancer is the Nd:YAG laser. The laser is passed through the bronchoscope to reach the tumour.

Laser surgery can quickly remove a blockage that is causing symptoms. It can be done again if the tumour continues to grow and blocks the airway again.

Electrocautery uses a high-frequency electric current to destroy cells or tissues. It may be used to stop bleeding from the blood vessels in the tumour or to remove parts of a lung cancer tumour that is near a blood vessel.

Photodynamic therapy (PDT) destroys cancer cells with a drug called a photosensitizer, which makes cells very sensitive to light.

PDT is done in 2 stages. First, the photosensitizer drug is injected into the body and is absorbed by all cells. Over time, the photosensitizer leaves most normal cells but stays in the cancer cells. After about 48 hours, cancer cells containing the photosensitizer are exposed to a low-intensity laser light. The photosensitizer in the cancer cells absorbs the light and a chemical reaction occurs that kills the cancer cells. Most normal cells are not affected.

PDT is used to treat a tumour that could block an airway as it grows. It is not used to treat blockages causing symptoms that need treatment right away. PDT can be done again if needed.

The photosensitizer makes the skin and eyes sensitive to light (known as photosensitivity) for 4 to 6 weeks or more after the treatment. Your healthcare team will explain any safety measures that you need to follow.

Cryosurgery (also called cryotherapy) is a procedure that destroys cancer cells by freezing them. Cryosurgery delivers an extremely cold liquid or gas to the tumour in the lung through a metal tube called a cryoprobe that goes through the bronchoscope. The area is allowed to thaw and is frozen again. The freeze-thaw cycle may need to be repeated a few times.

Cryosurgery is not used as often as other endobronchial therapies for non–small cell lung cancer because you need to have another bronchoscopy to remove the tissue that has been destroyed.

It may be used to stop bleeding from the blood vessels of the tumour or remove part of a tumour.

Side effects can happen with any type of treatment for lung cancer, but everyone's experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after endobronchial therapy.

Side effects of endobronchial therapy will depend mainly on the type of treatment and your overall health.

Endobronchial therapies for lung cancer may cause these side effects:

• pain

• bleeding

• breathing problems

• coughing

• sore throat

• chest infection

• collapsed lung