Day 12 – IS SURGERY AN OPTION TO TREAT LUNG CANCER?
In lung cancer, surgery is usually only undertaken as part of a plan of curative intent, meaning to remove the primary tumor from your body and eliminate the cancer. It would often be followed by radiation and/or chemo to “clean up” any residual cancer cells that might still at the site of the tumor or have traveled in the body. Cancer that has become wide-spread around the primary tumor or lungs or traveled in measurable ways (i.e. visible on a scan) is not usually considered for surgery because removing the primary tumor would serve little purpose – and subject your body to the dangers, risks and harm from surgery – if there is active cancer elsewhere. Indeed, the surgery would weaken you, thus delaying systemic treatment for the rest of your cancer, and with cancer, the sooner the treatment the better.
For this reason, surgery is usually only considered for NSCLC if the cancer is contained to single or couple of nearby tumors in the same lung, without involvement of distant lymph nodes or deep into various lung tissues and airways (essentially stages 0-III). In general, the more advanced the cancer, the more likely you’ll have some sort of follow-up treatment.
Given its aggressive and highly metastatic nature, SCLC generally has not considered for surgery since the 1970’s. However, recent studies have shown that for very early stages – single lung tumors without lymph node activity – surgery may have an important role to play. Nevertheless, as SCLC is generally very fast-moving and typically has metastasized at the time of diagnosis, the patients this describes are relatively few in number (fewer than 1 in 20 according to the American Cancer Society). However, this is more testimony to the fact that, although highly lethal, SCLC can be cured.
Given the inherent risks of surgery and the fact that the recovery period may delay subsequent treatments, surgery should be weighed carefully, and for this reasons, earlier stage cancers are more likely to be treated surgically. Furthermore, extensive testing and scanning is normally done to confirm that the cancer has spread beyond the primary site, because surgery would not be advisable if it has.
There are four major types of lung cancer surgery:
- Pneumonectomy: This surgery removes an entire lung. Given the trauma this creates for the body as well as potential later impact on quality of life, this might only be performed if the tumor is close to the center of the chest, where it can more easily spread to multiple lobes.
- Lobectomy: The lungs are made up of 5 lobes (3 on the right and 2 on the left). In this surgery, the entire lobe containing the tumor(s) is removed. This is often the preferred type of operation of it can be done because it removes the entire lobe – enough to eliminate cancer that hasn’t spread while likely impacting future quality of life significantly less than if a whole lung was removed.
- Segmentectomy or wedge resection: In these surgeries, only part of a lobe is removed. This approach might be used, for example, if a person doesn’t have enough lung function to withstand removing the whole lobe.
- Sleeve resection: This operation may be used to treat some cancers in large airways in the lungs. If you think of the large airway with a tumor as similar to the sleeve of a shirt with a stain a couple of inches above the wrist, the sleeve resection would be like cutting across the sleeve above and below the stain and then sewing the cuff back onto the shortened sleeve. A surgeon may be able to do this operation instead of a pneumonectomy to preserve more lung function.
Parvaiz A. Koul, Lung India (2012): v.29(1).