When a person living with lung cancer can’t undergo surgery for any reason, their condition is often called “inoperable lung cancer.” However, having inoperable cancer doesn’t mean that your condition is beyond treatment. Doctors can use several other types of treatments to help manage lung cancer, including radiation therapy, chemotherapy, targeted drug therapy, and immunotherapy. These treatments can sometimes make inoperable cancers operable, or slow the progression of cancer and extend life.

When Is Lung Cancer Inoperable?

Doctors most often use surgery to treat less advanced cases of lung cancer. However, there are certain situations in which surgery is not the best treatment option. People who are in worse overall health or who have advanced-stage cancer may have inoperable lung cancer.

Doctors may also use the term “unresectable” to describe a case of lung cancer in which a technical problem makes it impossible to surgically remove the tumor. It’s possible to have a tumor that’s resectable — technically possible to remove — but inoperable for reasons related to your overall health or other factors.

Overall Health

A person’s overall health is a big factor regarding whether surgery is a good option. Any major surgery comes with potential complications that may be too risky for some people. Complications are medical problems that develop as the result of a disease or its treatment.

Complications of lung cancer surgery can include:

• Bleeding problems
• Blood clots
• Infections
• Side effects from anesthesia

Some of these complications may be serious or even fatal. Even in cases where there are no complications, recovery may take months. People who have other health problems or are in worse general health may have a harder time healing after surgery.

Advanced-Stage Lung Cancer

When diagnosing lung cancer, doctors also assign a stage. The lung cancer stage describes how far the cancer has spread. The more advanced the lung cancer stage, the more cancer there is in the body and the harder it is to treat with surgery. Over half of people with non-small cell lung cancer (NSCLC) are not diagnosed until after they develop advanced-stage disease, in which cancer has spread to other parts of the body. NSCLC is staged with a number from 0 to 4 (sometimes rendered with Roman numerals, e.g., “stage IV” instead of “stage 4”). Stage 4 is the most advanced.

Small cell lung cancer (SCLC) is most commonly staged as either limited-stage (early stage) or extensive stage (advanced).

Doctors often treat stage 0, 1, or 2 NSCLC with surgery, if the person is healthy enough. This is sometimes also combined with radiation therapy or with chemotherapy.

Surgery is a less common treatment in people with stage 3 or stage 4 disease. More advanced-stage lung cancers have spread to multiple areas within the lung, other tissues or lymph nodes in the chest, or other parts of the body. It may not be possible to surgically remove certain tumors that are growing into or involving important organs. Additionally, if cancer cells are growing in multiple locations throughout the body, it may not be helpful to remove all or most of them.

Surgery may also not be an option for those who have more extensive types of lung cancer. Lung cancer surgery typically involves removal of all or part of the lung, depending on how large the lung tumor is or how much it has spread within the lung. In some cases, removing all of the cancerous parts of the lung would mean that a person doesn’t have enough healthy tissue left to function. These cases are considered unresectable.

Treatments for Inoperable Lung Cancer

People with more advanced stage 3 inoperable lung cancer or stage 4 inoperable lung cancer may have other treatment options. When coming up with a treatment plan, doctors may consider factors such as the type of lung cancer, lung cancer stage, gene changes within cancer cells, and other health problems.

Radiation Therapy

Inoperable NSCLC and SCLC are sometimes treated with radiation — most commonly external beam radiation therapy, in which a machine outside of the body delivers high-energy beams or particles to the tumor. Doctors may use external beam radiation therapy to treat tumors in the lungs or single tumors located in more distant locations. This type of treatment is not effective for treating widespread cancer, so people with stage 4 lung cancer don’t usually receive radiation therapy as their main treatment.

Another type of radiotherapy called “brachytherapy” may also be recommended during the early stages of lung cancer. During brachytherapy, doctors place radioactive material directly inside of the body, next to the tumor. Brachytherapy is most effective for treating lung cancer cells that are in or next to the main airways. There are also focused methods of radiation, but they may require special equipment to compensate for breathing movements of the lung.

Systemic Therapy

Systemic therapy includes medication that travels through the bloodstream to reach all parts of the body. Systemic therapy can kill cancer cells even in situations where a tumor can’t be surgically removed. Doctors may give people with lung cancer a single drug or combinations of several different types of medication. These treatments may help people live longer and have a better quality of life.

Systemic therapy for NSCLC includes:

• Chemotherapy — Drugs that kill cancer cells or prevent them from making copies of themselves
• Targeted therapy — Medications that recognize genes or proteins found on cancer cells, killing them while leaving healthy cells alone
• Immunotherapy — Drugs that help the body’s immune system better fight cancer

There are several targeted drug options for NSCLC, such as bevacizumab (Avastin), erlotinib (Tarceva), and dabrafenib (Tafinlar), each with its own very specific indication.

Immunotherapy drugs your doctor may consider for inoperable NSCLC include:

• PD-1 inhibitors, such as pembrolizumab (Keytruda)
• PD-L1 inhibitors, like atezolizumab (Tecentriq)
• CTLA-4 inhibitors, such as ipilimumab (Yervoy)

SCLC is also treated with chemotherapy, targeted therapy, and immunotherapy. The U.S. Food and Drug Administration (FDA) approved sotorasib (Lumakras) in 2021 as a targeted therapy for SCLC. Atezolizumab has also shown benefit in SCLC when added to chemotherapy.

Read more about specific medications in this list of treatments for lung cancer.

Bronchoscopic Treatment Options

Some other nonsurgical treatments use a technique called “bronchoscopy” to treat cancer. During bronchoscopy, doctors pass a long, thin tube into the windpipe. Cameras or devices for treatment are sometimes attached to this tube. Bronchoscopy allows doctors to see and treat cancer cells growing in or near the airways. The goal of these therapies is to open an obstructed air passage.

Bronchoscopic procedures may be used to treat or even cure people with inoperable early-stage lung cancer, including the following:

• Photodynamic therapy uses light treatments to damage cancer cells.
• Laser therapy kills cancer cells using beams of light.
• Argon plasma coagulation, electrosurgery, and radiofrequency ablation are all treatments that deliver damaging heat energy to cancer cells.
• Cryotherapy freezes and kills cancer cells.

Palliative Care

Lung cancer treatment often involves palliative care. Palliative treatments reduce symptoms and help people feel more comfortable. Inoperable lung cancer that has spread more widely often requires palliative care.

Some of the same treatments used for early-stage inoperable lung tumors may also be used as palliative treatments for later-stage inoperable disease. For example, radiation or even surgery can be used as palliative treatments by reducing the size of tumors that cause symptoms. Bronchoscopic treatments are also sometimes used to relieve symptoms. For example, they can shrink tumors that are blocking the airways.

How Long Can You Live With Inoperable Lung Cancer?

A person’s lung cancer stage is the main factor that affects their prognosis (outlook). Earlier-stage inoperable tumors can often be cured or kept under control. Later-stage lung cancer is less often cured.

Lung cancer survival rates are often grouped based on how far cancer has spread. Survival rates for people with NSCLC are as follows:

• People with cancer only in the lung are 65 percent as likely to be alive five years or more after receiving a lung cancer diagnosis, compared with people who don’t have lung cancer.
• People with cancer that has spread to nearby tissues are 37 percent as likely to be alive five years or more.
• People with cancer that has spread to distant tissues are 9 percent as likely to be alive five years or more.

Among people with SCLC, the survival rates are as follows:

• People with cancer only in the lung are 30 percent as likely to be alive five years or more after diagnosis, compared with people who don’t have lung cancer.
• People with cancer that has spread to nearby tissues are 18 percent as likely to be alive five years or more.
• People with cancer that has spread to distant tissues are 3 percent as likely to be alive five years or more.

Other factors, like the subtype of lung cancer and gene changes found in the tumor, also play a role in prognosis. These survival rates were estimated based on people who were diagnosed with lung cancer five to 10 years ago. Treatments are constantly improving, and people who are diagnosed today may have better outcomes than people who were diagnosed a decade ago.

It’s important to remember that everyone’s situation is different and your prognosis will depend on your personal health factors. Participating in a clinical trial can help advance cancer research and potentially provide you with effective treatment. Ask your doctor if you may be a good candidate for any current clinical trials.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 12,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Are you living with inoperable lung cancer? How does your oncology team help you manage symptoms like shortness of breath when aggressive treatments aren’t an option? Share your experience in the comments below, or start a conversation by posting on your Activities page.