Surgical Treatment For Lung Cancer
How should I go about finding a lung surgeon?
The Internet is a good resource to find local thoracic surgeons in your area who have expertise in lung cancer. Certainly, medical oncologists and your primary care physicians may also know who the good thoracic surgeons are in the area. A thoracic surgeon is a surgeon that has had substantial training, both in general surgery and sub-specialty training in thoracic surgery. These individuals are focused with their expertise in surgeries of the chest, and lung cancer is part of that. Generally, these people tend to be in tertiary medical centers, whether it be academic medical centers or private practice medical centers, but they are normally in the larger hospitals. Certainly, it is possible that some of the smaller community hospitals may have thoracic surgeons with this expertise, but what it really requires is a multidisciplinary team approach that involves not only surgeons, but also the other necessary physicians in medical oncology, radiation oncology and pulmonary medicine.
What is 'thoracic surgery'?
Thoracic surgery is surgery that is focused in the chest itself. Within thoracic surgery there are heart surgeons, cardiac surgeons. There are congenital heart surgeons that are focused on diseases of the heart in children and general thoracic surgeons who are focused in the chest, and the lungs and the esophagus predominantly. The general thoracic surgeons are the ones who are ideally suited and have the most expertise with lung cancer management.
In which cases do doctors only use surgery to treat lung cancer?
Surgery as the only treatment modality for lung cancer is really only for the early stage lung cancers. In non-small cell lung cancer, this tends to be Stage I. In some patients with Stage IB, there may be a role for chemotherapy; however, that remains controversial. So it's really just in the early stages of non-small cell lung cancer.
Is it common for lung cancer patients to be operated on before there is a diagnosis?
Although a lung cancer diagnosis can only be made histologically, meaning by a biopsy, it is not always necessary to have the diagnosis before proceeding with surgery. If this is a lung nodular or mass that's radiographically early stage, and this appears to be receptible surgically, then the patient is a good candidate for surgery. And finally, if the radiographic appearance of the lung nodular mass is very suspicious for lung cancer, then you don't need to have a tissue diagnosis and the patient can proceed directly to staging mediastinoscopy where we biopsy the lymph nodes in the center of the chest, followed by lung surgery. If it turns out that that's lung cancer, then the entire lobe or lobectomy can be performed as a surgical operation. And all of this is done without having a pre-operative diagnosis of lung cancer.
What is a 'lobectomy'?
Lobectomy is an anatomic description. The lung is divided into three lobes on the right side, and on the left side there are two lobes, and this is defined by the pulmonary blood flow. The ideal standard operation for lung cancer is a lobectomy. The lung cancer study group determined a number of years ago that the recurrence rates and mortality rates are lower if you get a lobectomy performed.
What is a 'lymph node dissection'?
Lymph node dissection is something that the surgeon does at the time of your lung surgery. During thoracoscopy or thoracotomy, when the surgeon is in the chest and takes the lung tumor out, there are lymph nodes in the mediastinum which are dissected and cut out as well. This is referred to as lymph node dissection, and it helps in staging and ultimately predicting your prognosis overall.
What is a 'wedge resection'?
Wedge resection is referred to what the surgeon does when he or she cuts out the lung. This is a non-anatomic way of taking out a lung nodule or a lung mass that is not defined by the pulmonary blood flow. This is different from what we refer to as a segmentectomy or lobectomy where the piece of lung that is taken out is really defined by anatomic planes and by the pulmonary blood flow. The wedge resection is important when we make a diagnosis of your lung nodule when we are not sure if it is lung cancer or not and we limit the amount of lung that is being taken out and this is literally a high piece of the lung that is really cut out.
What is a 'pneumonectomy'?
A pneumonectomy refers to taking the entire one lung out. In certain lung cancers which are certainly located, meaning it's closer to the mediastenum or closer to where the heart is, in these instances, it may not be technically possible to just take out a section of your lung but in that situation your entire lung may need to come out and this is referred to as a pneumonectomy.
What is 'thoracoscopy' or 'VATS'?
Thoracoscopy or video assisted thoracic surgery, referred to as VAT's surgery, is a minimally invasive technique utilized by many chest surgeons. This is an approach that we take to actually do your lung surgery, whether it be to just obtain a diagnosis of the lining of the lung or the chest wall called the plea, or to biopsy the lung tissue with a wedge section or a pie piece of the lung, or whether it be definitive cancer surgery to take your lobe or a section of that lung out for lung cancer. All of these things are pursued by using thoracoscopy. This has been shown to reduce hospital stays, have less pain and quicker recovery.
What is 'thoracotomy'?
Thoracotomy' refers to another approach performed by thoracic surgeons. This is the traditional open operation for your lung cancer surgery. And this is different from what we call 'thoracoscopy' or video-assisted thoracic surgery, often referred to as 'VATS' surgery. So a thoracotomy is an open incision. It's made at the side or towards the back of your chest, and we spread the ribs; so this is a more invasive and larger operation.
How will I know if I'm a good candidate for lung surgery?
The thoracic surgeon will order a number of studies to evaluate what your risks for lung surgery are. This is referred to as pulmonary function studies and based on the numbers that we obtain (this is a breathing study that you will inhale and exhale into). We're able to predict complications and your risks of undergoing lung surgery. Furthermore, there is another test called the Quantitative lung perfusion study. This is a nuclear medicine study where we figure out how much blood flow actually goes to certain parts of your lung. The use of pulmonary function studies and the Quantitative lung perfusion study, means that we're able to predict how well you will do with lung surgery.