Treating Lung Cancer - Non-Small Cell

Surgery

Depending on the type and stage of a lung cancer, surgery may be used to remove the cancer along with some surrounding lung tissue. Surgery is usually recommended (often along with other treatments) for early stage lung cancers. If surgery can be done, it provides the best chance to cure NSCLC.

If your doctor thinks the lung cancer can be treated with surgery, pulmonary function tests will be done beforehand to determine whether you will have enough healthy lung tissue remaining after surgery.

Types of surgery

Several different operations can be used to treat (and possibly cure) non-small cell lung cancer:

• pneumonectomy: the entire lung is removed in this surgery.
• lobectomy: a section (lobe) of the lung is removed in this surgery.
• segmentectomy or wedge resection: part of a lobe is removed in this surgery.

With any of these operations, lymph nodes are also removed to look for possible spread of the cancer.

These operations require general anesthesia (where you are in a deep sleep) and a surgical incision between the ribs in the chest (thoracotomy). You will generally need to spend 5 to 7 days in the hospital after the surgery.

Video-assisted thoracic surgery (VATS): Recently, some doctors have begun to use a less invasive procedure for treating some early stage lung cancers called video-assisted thoracic surgery (VATS). During this operation, a thin telescopic tube with a tiny video camera on the end is placed through a small hole in the chest to help the surgeon see the chest cavity. One or two other small holes are created in the skin, and long instruments passed though these holes are used to remove the tumor. Because only small incisions are needed, there is a little less pain after the surgery. Another advantage of this surgery is a shorter hospital stay -- usually around 4 to 5 days. Most experts recommend that only early stage tumors smaller than 3 to 4 centimeters (about 1 1/2 inches) be treated this way. The cure rate after this surgery seems to be the same as with older techniques. But it is important that the surgeon performing this procedure is experienced since it requires a great deal of technical skill.

Surgery for cancers with limited spread to other organs: If the lung cancer has spread to the brain or adrenal gland and there is only one tumor, you may benefit from removal of the metastasis. This surgery should be considered only if only if the tumor in the lung can also be completely removed. Even then, not all lung cancer experts agree with this approach, especially if the tumor is in the adrenal gland.

For tumors in the brain, this is done by surgery through a hole in the skull (craniotomy). It should only be done if the tumor can be removed without damage to vital areas of the brain that control movement, sensation, and speech.

Possible side effects of surgery

Possible complications depend on the extent of the surgery and a person's health beforehand. Serious complications can include excessive bleeding, wound infections, and pneumonia. While it is rare, in some cases people may not survive the surgery, which is why it is important that surgeons select patients carefully.

Because the surgeon must spread ribs to get to the lung in patients undergoing a thoracotomy, the incision will hurt for some time after surgery. Your activity will be limited for at least a month or two.

If your lungs are in good condition (other than the presence of the cancer) you can usually return to normal activities after a lobe or even an entire lung has been removed. If you also have non-cancerous diseases such as emphysema or chronic bronchitis (which are common among heavy smokers), you may become short of breath with activities after surgery.

Surgery to relieve symptoms of NSCLC

If you can't have major surgery because of reduced lung function or other serious medical problems, or if the cancer is widespread, other types of surgery may be used to relieve some symptoms. For example, laser surgery can be used to relieve blockage of airways that may be causing pneumonia or shortness of breath. Other techniques, such as photodynamic therapy (described later in the document) may also be used.

Sometimes fluid can build up in the chest cavity (outside of the lungs) and interfere with breathing. To remove the fluid and keep it from coming back, doctors sometimes perform a procedure called pleurodesis. A small cut is made in the skin of chest wall, and a hollow tube is placed into the chest to remove the fluid. Either talc or a drug such as doxycycline or a chemotherapy drug is then instilled into the chest cavity. This causes the linings of the lung (visceral pleura) and chest wall (parietal pleural) to stick together, sealing the space and preventing further fluid buildup. The tube is generally left in for a day or two to drain any new fluid that might accumulate.

For more general information about surgery, please see our separate document, Surgery.