smoking is the major causative factor for development
of lung cancer. Other factors include industrial and
environmental pollutants such as asbestos and radon
gas from natural sources in the ground.
majority of patients present late in the disease process
with signs or symptoms of tumor growth or invasion. Patients
present with cough, hemoptysis (blood in sputum), shortness
of breath or recurrent pneumonia. Lung cancer is detected
in only five to 15 percent of patients without symptoms,
usually on a routine chest x-ray or a chest x-ray before
some other surgery.
cancer can be divided into two categories: small cell
(or oat cell) and non-small cell lung cancer. Non-small
cell lung cancer can be further divided into adenocarcinoma,
squamous cell, and large cell lung cancers.
patient will undergo a thorough history and physical exam.
Usually a chest CT (Computed Tomography Imaging ) scan
will be performed. A CT scan of the chest gives a more
detailed picture, showing a more specific location of
the disease and if it has spread. To obtain a tissue diagnosis,
a fiber optic bronchoscopy or a needle biopsy may be performed.
For a bronchoscopy, a patient is sedated and a fiber optic
tube is inserted through the nose. The airway is inspected
and biopsies may be taken. A needle biopsy is performed
with radiologic guidance by inserting a needle through
the chest wall into the lung mass. Tissue is extracted
and examined under a microscope
treatment of lung cancer depends on the type of lung cancer
and how far advanced (or in what stage) the cancer is. Generally, small or oat cell lung cancer is not a surgical
disease. Patients with small cell lung cancer are treated
with chemotherapy, radiation therapy, or possibly both.
Non-small lung cancer is a surgical disease if found early.
For non-small lung cancer, the stage of the tumor and
the condition of the patient determine the best approach
to treat that person.
Staging of the tumor is determined by tumor size, location,
and if the cancer has spread to lymph nodes or to other
parts of the body.
The overall state of health and lung function of the patient
determine if they are acandidate for lung resection. Lung
function is usually determined by pulmonary function testing
if the cancer is too far advanced there is no benefit
for the person to undergo an operation. Radiation therapy
or possibly a combination of chemotherapy and radiation
may be attempted. If the lung function of the patient
is poor, they might be unable to tolerate removal of any
lung tissue. If the overall health of the patient is poor,
they may not tolerate any type of operation.
it is determined that a person is a candidate for lung
cancer surgery, there are three general types of operations
which can be performed.
- Wedge Resection. In
a wedge resection either through a thoracotomy or a VATS,
the tumor is identified and, using special stapling devices,
the tumor is removed with a margin of normal lung tissue.
A wedge resection can be used to diagnose a lung mass
and as a treatment method. A wedge resection removes the
tumor and only a small amount of normal lung. It is generally
tolerated by most patients even if they have poor lung
- Lobectomy. The
lungs are divided into different portions called lobes:
there are three lobes on the right (upper, middle and
lower) and two lobes on the left (upper and lower).
People with better lung function can tolerate removal
of an entire lobe. A lobectomy is believed to be a better
cancer operation since more surrounding normal lung
tissue is removed. Therefore, if there are microscopic
cancer cells present, removal of more tissue would be
beneficial. A lobectomy is usually performed via a thoracotomy,
but in some instances VATS can be used.
- Thoracotomy. A
thoracotomy is any type of chest incision. The usual thoracotomy
for a lung cancer operation is performed on the patient's
side. A six- to 10-inch incision is made under the person's
arm. The ribs are spread with a chest retractor.
A thoracotomy incision gives the surgeon an excellent
view of the inside of the chest and allows the surgeon
to operate safely. Through this type of incision a wedge
resection, lobectomy and pneumonectomy can be performed.
thoracotomy incision is considered one of the more painful
incisions to have. The pain is mainly due to the cutting
of the muscles between the ribs and spreading the ribs
apart. After surgery, every breath the patient takes expands
their chest and spreads the incision to cause pain. The
pain can be controlled with epidural (or spinal) anesthesia
and pain medication.
pneumonectomy is the most invasive type of operation for
lung cancer. In a pneumonectomy, an entire lung is removed.
If the tumor is located centrally or involves more than
one lobe, a pneumonectomy may be the only way all of the
cancer can be removed. This operation is performed on
patients with normal or near normal lung function. A pneumonectomy
is performed through a thoracotomy.
Lung cancer is potentially curable if discovered early.
Stage 1 non-small cell cancer has a cure rate of 60-70%
with lung resection. The cure rate or five-year survival
drops off for more advanced lung cancer.
hospital stay after a thoracotomy is dependent on three
main factors: the overall health of the patient, what
type of lung resection was done, and how long the chest
tube needs to stay in after the operation. If a person
is in otherwise good health and has a wedge resection
the typical hospital stay is three to five days. For a
lobectomy and pneumonectomy, the average hospital stay
is four to six days. Patients are restricted from heavy
lifting for six to eight weeks until their incisions are
fully healed. They usually are able to go back to work
in six to eight weeks.
is minimally invasive chest surgery using special telescopes,
video cameras, and instruments to look and operate inside
the chest through two to four small one- to two-inch incisions.
VATS uses instruments similar to the instruments used
routinely now for gall bladder surgery. With these special
instruments and video equipment, a surgeon can perform
a lung or pleural biopsy, a wedge resection or, in some
cases, a lobectomy. Lung nodules or tumors which are located
on the outer portion of the lung are easier to resect
with VATS than masses located in the central portion of
Thoracic Oncology/Lung Cancer Program
See what patients have to say about their experiences of the disease before, and after their surgery. click here