Surgery for lung cancer can often be curative, when it is caught in the earlier stages. Having an understanding of when surgery is most effective and what it entails can help you discuss with your cancer care team if this is the best option for you.
What Helps Determine if Surgery Is Right for Me?Several things are considered when deciding if surgery is the best option for treating lung cancer. These include:
- The type of lung cancer – Surgery is most commonly done as a treatment for non-small cell lung cancer. Since small cell lung cancer tends to spread early, surgery is usually not effective except for very small tumors, and is often better treated with chemotherapy and/or radiation.
- The stage of lung cancer - The stage of lung cancer is the one of the most important things to consider when thinking about surgery. Surgery is most effective for those with stage 1, stage 2, and stage 3A small-cell lung cancer. Stage 3B and stage 4 cancer are often treated with a combination of radiation and chemotherapy. With stages 1B to 3A cancers, surgery is often combined with chemotherapy and/or radiation.
- The location of the cancer – If a tumor is close to a vital organ, such as the heart, treatments other than surgery may be considered safer regardless of the stage.
- General health/lung function – Your general state of health, other medical conditions, and lung function can determine if a surgical procedure is relatively safe for you.
What Happens Before Lung Cancer Surgery?Before surgery is considered your oncologist will need to confirm the diagnosis of lung cancer, order tests to determine the stage of your cancer, and evaluate whether surgery is possible based on the location of the tumor. You will be given a physical exam to check on your general health, and lung tests will be done to make sure you are healthy enough to go through surgery, and breathe well afterward.
Are There Different Types of Surgery for Lung Cancer?Three major procedures are done to remove lung cancer. These vary from removing only the cancerous tissue and nearby tissue, to complete removal of a lung, depending upon the size and location of the tumor. These are:
- Wedge resection (segmental resection) involves removing a portion of the lung that includes the tumor and some surrounding tissue. This surgery is used when a tumor is caught very early.
- Lobectomy - A lobectomy is the most common surgery used to treat lung cancer, and involves removing a lobe of the lung. (The right lung has 3 lobes and the left lung has 2 lobes.)
- Pneumonectomy - A pneumonectomy involves removal of an entire lung.
What Are The Risks?Risks from lung cancer surgery include damage to structures in or near the lungs, general risks related to surgery, and risks from general anesthesia. Your surgeon and anesthesiologist will discuss these risks with you prior to surgery. The most common risks include:
- Collapse of a lung (pneumothorax)
- Damage to nearby structures such as the heart
- Risks from general anesthesia
- Blood clots
What Can I Expect After Surgery?
- Pain following surgery is common and can persist for several weeks. Your surgical team will make sure you have medications to control this both in the hospital and after your return home. Sometimes pain occurs months after surgery as nerves begin to grow back. It is important to let your health care team know if you experience this so they can provide you with methods to control this.
- Chest tube. After surgery, a chest tube will be left in place, with one end inside your chest where the surgery was done and the other attached to a bottle outside your body. This is used to help your lungs fill back up with air, and to drain any blood or fluid that build up in your lungs. This may be left in place for several days.
- Breathing exercises. After surgery you will be asked to do breathing exercises to help expand your lungs and prevent pneumonia.
Questions to Ask Your Health Care Team
- Is surgery the best option for treating my cancer?
- What alternatives are available that might be as effective as surgery?
- Which type of surgery do you recommend?
- Will other treatments such as radiation or chemotherapy be combined with surgery?
- How long will I be in the hospital?
- How long after surgery can I return to my normal activities?
- How much pain can I expect, for how long, and what will be done to control my pain?
- What complications could occur?
- What will my breathing be like after surgery?
- What is the likelihood that surgery will cure my cancer?
National Cancer Institute. Non-Small Cell Lung Cancer Treatment. Health Professional Version. Updated 02/10/12. http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/HealthProfessional/page1