Treatment Details

Lung cancer surgery

Lung Cancer surgery

Pros

Surgery for lung cancer can often be curative when it is caught in the earlier stages. Having an understanding of when surgery is most effective, what types of procedures are commonly done, and what it entails can help you discuss with your cancer care team whether or not this is the best option for you.

Overview

When discussing treatment options for lung cancer it's helpful to first separate these treatments in two categories: local treatments and systemic treatments.

 

Local treatments treat cancer cells (tumors) where they originate but do not treat any cells which have spread away from the original tumor. Both surgery and radiation therapy are local treatments. Systemic treatments, in contrast, treat cancer cells wherever they happen to be in the body and not just at the site where the tumor began. Chemotherapy, targeted therapies, and immunotherapy are considered systemic treatments.

Is Surgery Right for Me?

Several things are considered when deciding if surgery is the best option for treating lung cancer. These include:

 
  • The stage of lung cancer - The stage of lung cancer is one of the most important things to consider when thinking about surgery. Surgery is most effective for those with stage 1, stage 2, and stage 3A non-small cell lung cancer. Stage 3B and stage 4 cancer are often treated with a combination of radiation and chemotherapy. With stages 1B to 3A cancers, surgery is often combined with chemotherapy and/or radiation (adjuvant chemotherapy.)
  • The location of the cancer – If a tumor is close to a vital organ, such as the heart, treatments other than surgery may be considered safer regardless of the stage. Sometimes chemotherapy and/or radiation are given before surgery in order to reduce the size of a tumor and make it more operable. This is referred to as neoadjuvant therapy.
     
  • General health/lung function – Your general state of health, other medical conditions, and lung function can determine if a surgical procedure is relatively safe for you. In recent years, a type of radiation therapy (stereotactic body radiotherapy, also known as cyber knife) has been found effective in treating some small tumors which are otherwise difficult to do surgery on due to their location.

What Happens Before Surgery?

Before surgery is considered your oncologist will need to confirm the diagnosis of lung cancer, order tests to determine the stage of your cancer, and evaluate whether surgery is possible based on the location of the tumor. You will be given a physical exam to check on your general health, and lung tests will be done to make sure you are healthy enough to go through surgery, and breathe well afterward.

Different Types of Surgery?

Three major types of surgery are done are done to remove lung cancer. These vary from removing only the cancerous tissue and nearby tissue, to complete removal of a lung, depending on the size and location of the tumor. These are:

  • Wedge resection (segmental resection) - A wedge resection for lung cancer involves removing a portion of the lung that includes the tumor and some surrounding tissue. This surgery is used when a tumor is caught very early.
  • Lobectomy - A lobectomy is the most common surgery used to treat lung cancer, and involves removing a lobe of the lung. (The right lung has 3 lobes and the left lung has 2 lobes.)
  • Pneumonectomy - A pneumonectomy involves removal of an entire lung.

These surgeries may be performed through a large incision in the chest wall (a thoracotomy) or via video-assisted thoracoscopy (VATS), a procedure in which a scope is inserted through several small incisions in the chest wall and through which a tumor is removed. While people who are able to have VATS procedures recover more rapidly, this technique does not work for all lung tumors and is not done at all cancer centers.

What Are the Risks?

Risks from lung cancer surgery include damage to structures in or near the lungs, general risks related to surgery, and risks from general anesthesia. Your surgeon and anesthesiologist will discuss these risks with you prior to surgery. The most common risks include:

  • Bleeding
  • Infection
  • Collapse of a lung (pneumothorax)
  • Damage to nearby structures such as the heart
  • Risks from general anesthesia
  • Blood clots (Blood clots - deep vein thrombosis and subsequent pulmonary embolism are common with lung cancer, and the risk is increased further by treatments such as surgery and chemotherapy.)

Recovery

  • Pain following surgery is common and can persist for several weeks. Your surgical team will make sure you have medications to control this both in the hospital and after your return home. Sometimes pain occurs months after surgery as nerves begin to grow back. It is important to let your healthcare team know if you experience this so they can provide you with methods to control this.
  • Chest tube. After surgery, a chest tube will be left in place, with one end inside your chest where the surgery was done and the other attached to a bottle outside your body. This is used to help your lungs fill back up with air, and to drain any blood or fluid that build up in your lungs. This may be left in place for several days.
  • Breathing exercises. After surgery, you will be asked to do breathing exercises to help expand your lungs and prevent pneumoni

 

Reference Link

TUESDAY, Nov. 10, 2015 (HealthDay News) -- Surgery to remove part of the lung can be a safe and effective treatment option for people with early stage lung cancer, even those traditionally considered "high-risk," a new study finds.

Previous research had suggested that high-risk patients are more likely to have complications or to die after lung surgery. People aged 60 and older, long-term smokers, and people who have other health problems are considered high-risk for partial lung removal surgery, the researchers said.

One in five patients with early stage non-small-cell lung cancer is deemed high-risk or ineligible for lung surgery, according to the study, which was published online Nov. 10 in The Annals of Thoracic Surgery.

But the new findings show these patients shouldn't be denied surgery, because they may benefit from it, study leader Dr. Manu Sancheti, from Emory University School of Medicine in Atlanta, said in a news release from the journal.

Reference Link

 

When Morton Pollner was diagnosed with lung cancer at age 76, he thought it was a death sentence.

Michael Rubenstein for NPR

Every year when Morton Pollner had his checkup, he worried that doctors would find something on his lung. For years, they didn't. Then his luck ran out.

"My reaction was, 'Well, you smoked for 30 years. You got away with it for another 30 years and this is it.' I thought it was a death sentence," he says.

Pollner, who lives in Monroe, N.Y., was 76 when he was diagnosed with lung cancer. Like many patients his age, he didn't expect there would be any effective treatment. Lung cancer is the second most common cancer in men and women. And it is mainly a disease of older people. Only about 2 percent of lung cancer patients are under 45 and the average age at diagnosis is about 70.

Older patients are frequently not offered curative treatment like surgery, because they and their families and even their doctors often think they won't be able to tolerate it. So they are referred for supportive care to control symptoms, rather than surgery to remove the cancer.

 

It's been seven years since Pollner had surgery for lung cancer. He's now 82 and takes Tai Chi classes three times a week at the local synagogue.

Michael Rubenstein for NPR

But many patients can survive and even thrive after surgery, says Dr. Prasad Adusumilli, a thoracic surgeon at Memorial Sloan Kettering Cancer Center in New York. He was senior author of a study published in the Journal of Clinical Oncology inOctober. The study looked at more than 2,000 patients with Stage 1 non-small cell lung cancer who had surgery to remove their tumor. About 70 percent of the patients were 65 years old or older and about 30 percent were at least 75.

And he found that a surprising number of these older patients did quite well. One year after surgery, more people had died from other causes than died from lung cancer. And, after five years, almost 9 out of 10 patients were alive and cancer free.

"They did well and beat their lung cancer," Adusumilli says, proving that when it comes to surgery for early stage lung cancer, age should not be a limiting factor.

This was the case for Morton Pollner, who is one of Adusumilli's patients. His cancer had not spread, and Adusumilli told him there was a good possibility the cancerous tissue could be completely removed and he could go back to leading a normal life. That was seven years ago. Today, Pollner is 82, cancer free and enjoying life.

Morton and his wife Joan Pollner are both enjoying life.

Michael Rubenstein for NPR

"Whatever I get from here on, it's like gravy," he says.

Surgery isn't the answer for all older lung cancer patients, according to Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. Patients with heart or other health problems may not be candidates. At the same time, he says it's important to recognize that patterns of aging have changed over the past two decades.

Seventy today is not the same as it was 20 years ago, Lichtenfeld says. Older adults are more functional, both physically and mentally, than ever before, and he says the medical community needs to adjust its thinking about what treatments older cancer patients can tolerate.

"We shouldn't allow numerical age to be the deciding factor," Lichtenfeld says.

Reference Link

Cons

Side effects of lung cancer surgery 

Search Lung Cancer Online

 

Side effects of lung cancer surgery 

Side effects after lung cancer surgery will depend on the surgical procedure used, how much of the lung is removed and the overall health of the patient. Be sure to talk with your treatment team about any side effects you experience so they can be managed. 

 

Learn what to expect after lung cancer surgery

Patient's guide to lung surgery (University of Southern California's Keck School of Medicine)

Lung surgery - discharge (Medline Plus)

After surgery for lung cancer (thorocotomy)  (Cancer Research UK)

Pain

The degree of pain after lung cancer surgery again varies. Newer minimally invasive techniques typically result in less pain than traditional lung cancer surgery (thoracotomy) but not every person is a candidate for a minimally invasive approach. Discuss post-surgical pain with the treatment team so it can be managed.   

Patient's guide to lung surgery: Pain management and medication after lung surgery (University of Southern California's Keck School of Medicine)

Breathing (respiratory) problems

Breathing may be affected by lung cancer surgery but there are ways to cope with breathlessness, including exercises and pulmonary rehabilitation. Ask your treatment team for help managing any breathing problems you may experience.

Living with dyspnea - how to breathe easier (National Institutes of Health Clinical Center)

Struggling to breathe: Tips for managing dypsnea (Yale Medical Group)

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