Lung Cancer

What causes lung cancer?

Cigarette 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.

How is lung cancer discovered?

The 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.

Are there different kinds of lung cancer?

Lung 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.

What tests are performed once an abnormal chest x-ray is discovered?

The 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

What is the treatment for lung cancer?

The 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 (PFT's).

Can all patients with lung cancer undergo this operation?

No, 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.

What types of operation are done for lung cancer?

If 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 function.
• 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.

Is a thoracotomy incision painful?

A 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

A 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.

Is lung cancer always fatal?

No. 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.

What is the usual hospital stay and recovery time after a thoracotomy?

The 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.

What is VATS (Video Assisted Thoracoscopic Surgery)?

VATS 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 the lung.

Thoracic Oncology/Lung Cancer Program

Patient Video Testimonial

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