Lung Cancer Diagnostic and Surgery
Recently, prevalence of lung cancer is ever increasing. Although lung cancer has been often diagnosed in men aged above 60 years in the past, it is now also prevalent in women.
Lung is the body organ that fulfills oxygen requirement. Similar to all other body organs, lung is comprised of many cells. Those cells divide depending on physiological needs in order to ensure that lungs function properly. Lung cancer is development of a mass (tumor) in lung secondary to uncontrolled and unnecessary proliferation of cells that are located in structurally healthy lung tissue. Next, this mass starts enlarging at development site and in subsequent phases, it invades surrounding tissues, followed by distant organs (liver, bone, brain etc.) as it spreads through blood circulation. This spread is called as metastasis. Lung cancers are divided into two main groups depending on how cells appear under microscope. 1. Small cell (oat cell) lung cancer. 2. Non-small cell lung cancer. As expressed above, this categorization is based on how cancer cell appears under microscope.
Surgical removal of tumoral lung tissue is the most efficient treatment method for early stage lung cancers.
If lung cancer is diagnosed and properly treated at early stage (i.e., Stage 1 or 2), total elimination of the disease is highly probable.
Which patients with lung cancer are eligible for surgical treatment?
1- There is no metastasis of cancer in any organ
2- Size and location of cancer is appropriate for surgical removal.
3- Cardiorespiratory functions of the patient allow a surgical intervention.
What are Surgical Methods used for Lung Cancer?
1- Open Method - Thoracotomy
2- Robotic Method
3- Closed Method – Thoracoscopy (VATS)
4- Single-port Closed Method
Which Surgical Method is recommended for Lung Cancer?
Guidelines for Treatment of Lung Cancer issued by American College of Chest Physicians emphasize that closed method should be preferred over open surgery in lung cancer.
Removal of the lobe, where tumor is located, is the preferred operation in lung cancer (lobectomy).
However, it may be required to remove right or left lung completely (pneumonectomy), if cancer involves main bronchus or a major vessel.
Segmentectomy implies removing a relatively smaller part of lung. This is usually preferred for patients with limited pulmonary function.
After the lung involved by cancer is removed, it is also necessary to excise lymph nodes. It is required to excise minimum 10 lymph nodes from 4 lymph node stations for pathological examination.
What is the success rate of operation?
Surgery is reserved only for Stage 1 or 2 lung cancers. For some circumstances, surgery can be required for Stage 3 cancer.
“Success of surgery” is based on postoperative 5-year survival rate. This does not imply that a patient with lung cancer has chance of living for 5 years.
5-year survival rate of patients with lung cancer who undergo surgery:
Stage I Lung Cancer: 71%
Stage II Lung Cancer: 48%
Stage III Lung Cancer: 35%