The short answer is this: Surgery offers the best chance of cure in persons with Stage I or Stage II lung cancer; and can serve as an additional treatment in select patients with Stage III (usually after undergoing chemotherapy and radiation therapy).
Because lung cancer (the # 1 killer amongst all cancers in the USA) tries to spread early through lymph nodes, surgery for lung cancer does not just involve removing the tumor/cancer alone; Instead it requires removing the section of lung called a “lobe” which contains the cancer. Thus, the name of the surgical procedure is called a “lobectomy”.
The right lung has 3 lobes where as the left lung has only 2 lobes, thus taking out one lobe is almost equivalent to removing half a lung on one side!
The next natural question you might ask will be, “If you remove almost half-a-lung on one side, how am I going to be able to breathe?”. The answer is in a test called Pulmonary Function Testing (PFT). This test determines what your lung function is, then we calculate what your residual lung function would be after the lung lobectomy. If your residual lung function is adequate, then you’ll be a good candidate for lung lobectomy surgery.
In some cases, especially when the calculated residual lung function is borderline, then rather than removing a lobe of lung, we can remove half-a-lobe, called a “segment”. Thus, the surgical procedure in this case is called a lung segmentectomy. This is still an adequate lung cancer surgery when you consider the risk-benefits analysis (balancing residual lung function with curing lung cancer, without disabling you).
Regardless of what surgical procedure is done, during every lung cancer surgery, we also remove the lymph nodes around the lung lobes and also the lymph nodes in the middle of the chest (mediastinum), this way we are able to accurately determine the final stage of the lung cancer (based on tumor size, if any lymph nodes involved or not, and if there was spread elsewhere (metastasis) or not).
Finally, you should also know that in some circumstances, it may become necessary to remove the entire lung on one side (pneumonectomy) and leave behind an empty chest on that side, and in other circumstances when the tumor is attached to a rib, the affected part of the rib is also removed together with the affected lung lobe (chest wall resection). Whatever the case, we won’t do it unless we are reasonably certain that you’ll be able to breathe well and move about your normal business after surgery. If the risk of surgery is considered too much for you, then the best option would be non-surgical– radiation therapy with or without chemotherapy, depending on the cancer stage.
Regardless of what the case may be, whenever we offer surgery as an option for lung cancer, it means that the cancer can be completely removed (the cancer is resectable), and this is always a good thing in the world of lung cancer treatment. In this modern age, most lung lobectomy surgeries can be done using a minimally invasive surgical approach with small incisions – Video Assisted thoracic surgery (VATS) or Robotic Assisted Thoracic Surgery (RATS), so you don’t always have to have a large chest incision unless that’s the only way to go (tumors > 6 cm, tumors attached to ribs or attached to “dangerous” structures or if the entire lung on one side needs to be removed).
Read about the author: Ugo Ogwudu, M.D. Thoracic surgeon.
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