Lung Cancer Surgery

While a variety of treatments are available, surgery that removes the tumor and surrounding tissue offers the best chance of recovery. However, surgical treatment has some very real restrictions. Tumor size, metastasis to the lymph nodes, and the type of cancer must all be considered.

The Surgical Candidate: Non Small Cell Lung Cancer

Early stage non small cell lung cancer (NSCLC) is usually the only form of the disease treated with surgery. Small cell tumors, unless detected in their earliest stages, are usually too far advanced at the time of diagnosis.

Stage 1 and 2 non small cell lung cancer have the best surgical prognosis: According to a Swedish study, five year survival rates average between sixty to seventy percent. Stage 3A NSCLC sometimes meets the criteria for surgery, but survival rates drop to ten to twenty percent. Stage 3B and 4 non small cell lung cancer patients are typically not candidates for lung surgery.

Other Considerations

Tumor location determines, in part, if surgery is possible. Malignant growth too close to the heart, windpipe or other important organs may make lung surgery too risky. If the disease has spread to the lymph nodes or to other organs, a lobectomy, or even complete lung removal, will not improve survival rates. Chemotherapy and radiotherapy are possible alternatives in these cases.

Types of Lung Surgery

Wedge Resection and Segmentectomy: A wedge resection is performed if the tumor is confined to one area of the lung. This procedure removes the tissue affected and a small margin of normal tissue. Should a larger section need to be removed, the procedure is called a segmentectomy.

Lobectomy: The lungs are composed of sections called lobes; the right has three, the left two. A lobectomy removes an entire lobe. By removing the entire lobe, the lobectomy hopefully removes all traces of cancer cells. Surrounding lymph nodes may be removed at the same time in a procedure called a lymphadenectomy.

Pneumonectomy X-ray.Pnumonectomy: A pnumonectomy removes an entire lung. Removal may be called for if cancer appears to have spread throughout the entire organ, but the exact location is hard to pinpoint. Pneumonectomy is performed only when absolutely essential and the patient’s breathing capacity is good enough that the remaining lung will be sufficient.

Lymph Node Removal: Nearby lymph nodes are commonly removed during lung surgery. A pathologist biopsies the lymph nodes immediately and reports back to the surgeon. If the lymph nodes contain cancer cells, which indicates metastasis, the surgeon may choose not to remove any lung tissue at all.

Surgical Complications

As with any surgery, lung surgery carries potential complications: Internal bleeding and infection are possible. A condition called lymphocytopenia may also occur. Lymohocytopenia is a chronically low white blood count. The condition has been noted in cases of advanced lung cancer, and appears to lower survival rates.

Finally, any candidate for surgery must understand that a possible relapse may occur. Removing all malignant cells is extremely difficult. Tumor regrowth, or metastasis to other organs is possible. The earlier the tumor is removed, the less likely the chance relapse.

Recovering from Lung Surgery

Cancer patients are likely to spend up to a week in the hospital following lung surgery. The chest tubes put in place during the surgery to help drain the chest cavity and re-expand the lung(s) are removed in a few days.

Because to access the lung the ribs must be “spread,” or in some cases a small portion removed, pain around the incision and the local muscles may persist for months. Physical therapy can help

Shortness of breath is common following lung surgery. Patients are typically paired with a respiratory therapist who monitors the breathing treatments that improve lung function. Medication to make breathing easier may be prescribed.

Resources

American Cancer Society. (nd). What’s new in lung cancer research and treatment?

Bergman, B. (2001). Lungcancer. Lkemedelsboken. Apoteket AB, Farmaci/Marknad (ed.). BTJ Tryck AB, Lund, pp. 596-602.

National Cancer Institute. (updated 2002). What you need to know about lung cancer: Treatment for lung cancer [NIH Publication No. 99-1553].

Cancer Research UK. (updated 2002). Prognosis after lung cancer surgery.