When discussing treatment options for lung cancer, it’s helpful to first separate these treatments into 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.
Choosing If Surgery Is Right for You
Several things are considered when deciding if surgery is the best option for treating lung cancer. These include:
The type of lung cancer: Surgery is most commonly done as a treatment for non-small cell lung cancer. Since small cell lung cancer tends to spread early, surgery is usually not effective except for very small tumors and is often better treated with chemotherapy and/or radiation. (The following article discusses the guidelines and prognosis for surgery for small cell lung cancer. ) 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.
In addition to choosing the right surgery, it’s important to find the right surgery. Research tell us outcomes for lung cancer surgery are better at medical centers that perform large volumes of these procedures.
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 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.
Surgical Approaches (Open vs. Minimally Invasive)
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.
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 (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
The recovery after lung cancer surgery depends on the type of procedure as well as your individual health. 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.
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.
After surgery, you will be asked to do breathing exercises to help expand your lungs and prevent pneumonia. Some surgeons recommend pulmonary rehabilitation (not right away but when you are feeling better) to maximize your recovery.
Possible Complications
A few of the more complications of lung cancer surgery include difficulty in removing the ventilation tube and chest tube following surgery, which can take some time. Some people are bothered by lasting chest pain following surgery - something that has been called postpneumonectomy syndrome or post-thoracic pain syndrome. There has been a lot of research looking into this pain syndrome in recent years, evaluating methods both to help people cope with discomfort following lung cancer surgery, and ways to prevent this from occurring in the first place.
Questions to Ask Your Healthcare Provider
The following questions may be helpful, but be sure to add your own to the list.
Is surgery the best option for treating your cancer?What alternatives are available that might be as effective as surgery?Which type of surgery does your healthcare provider recommend?How many of these procedures has your healthcare provider performed?Will other treatments such as radiation or chemotherapy be combined with surgery?How long will you be in the hospital?How long after surgery can you return to your normal activities?How much pain can you expect, for how long, and what will be done to control your pain?What complications could occur?What will your breathing be like after surgery?What is the likelihood that surgery will cure your cancer?
A Word From Verwell
Surgery for lung cancer offers the chance for a cure, but the success rate and risks can vary between different procedures. Newer techniques such as VATS are making surgery less risky and allowing people to return to their regular activities much more rapidly than in the past, but can’t be used for everyone. Finding a surgeon you trust at an institution that performs a large volume of these surgeries is your best insurance for making sure the procedure is right for you with the fewest complications over the long term.
