When Is Surgery Right for Lung Cancer?

The best treatment option to try to cure lung cancer is surgery to remove the tumor. But not every lung cancer patient is a good surgical candidate. The treatment depends on the type of cancer, where it is located and how advanced it is.

When lung cancer is caught early – before it has a chance to spread beyond the lung – surgery may be the only treatment needed. But if it has spread to lymph nodes or other organs, surgery will be combined with other treatments, including chemotherapy, radiation therapy or immunotherapy.

In some cases, the cancer may have spread too far for surgery to be an option. In most cases, the goal of surgery is to cure the cancer. If that’s not possible, other treatment options, for instance chemotherapy, can be used to shrink the tumor or slow its growth. In other situations, surgery provides symptomatic relief from complications caused by the cancer.

Surgical Options

If you have lung cancer and are a candidate for surgery, you’ll have several options. Very few situations require a large incision (thoracotomy) in your chest to access the lung for resection. In most cases, surgery is done through a minimally invasive procedure (thoracoscopy), involving one or more small incisions, with specialized instruments and a thoracoscopic camera. The latter procedures are often done with robotic assistance to improve precision and safety.

The types of surgeries:

• Wedge resection: This is the removal of a small wedge-shaped piece of lung tissue. The procedure is best for smaller tumors that are unlikely to spread. Your surgeon will pinpoint the location of the tumor and then remove it, along with some surrounding healthy tissue to achieve negative margins.
• Segmentectomy: Each of your lungs is divided into smaller functional units or segments – 10 in the right lung and generally eight in the left lung. Some tumors can be treated by removing one or more of these individual segments, while still preserving that lung’s ability to function. The procedure may be offered if you have smaller (2 centimeters or less) early-stage tumors.
• Lobectomy: Segments come together to form lobes. The right side has three and the left side has two (it’s smaller to make room for your heart). In this procedure, your surgeon will remove an entire lobe, often through a minimally invasive thoracoscopic approach. This is the most common type of lung cancer surgery performed, particularly for tumors larger than 2 centimeters. In some instances – when the tumor is in the right lung – two lobes may be removed (Bilobectomy).
• Pneumonectomy: When the tumor is more centrally located in the lung, it may be impossible to remove it entirely with a lobectomy. In those cases, your surgeon may remove the entire lung

Your surgeon will evaluate your lung function to make sure you will be able to tolerate resection of a portion of your lung. This test gives the surgeon a good idea of how much they can resect.

Importance of Lung Cancer Screening

Lung cancer is the leading cause of cancer death in the U.S, leading to more deaths than breast, prostate and pancreatic cancers combined. The vast majority (81 percent) of these cases are linked to cigarette smoking, which contributes to small cell lung cancer, an aggressive form of the disease.

A major reason for the lethality of this cancer is the fact that there are often no symptoms until the disease has spread to other parts of the body. That’s why it is critical if you are at risk to get annual screenings – in the form of low-dose computed tomography (CT) scans. According to the U.S. Preventive Services Task Force, this quick and painless procedure is recommended for people who meet all three of these criteria:

• Are between the age of 50 and 80
• Have a 20 pack-year smoking history (A pack-year is calculated by multiplying the number of packs of cigarettes smoked a day by the number of years you have smoked.)
• Currently smoke or quit within the past 15 years