Lung cancer is the most common malignancy seen in the world today. It is often associated with smoking, but can occur in non-smokers as well. Patients may be asymptomatic or present with a chronic cough; a chronic pulmonary infection or pneumonia that does not respond to antibiotic therapy; shortness of breath or wheezing; blood in the sputum; or chest wall pain.
Lung cancer is suspected when a chest X-ray or chest CAT scan reveals an abnormal density. Diagnostic workup may include a bronchoscopy, abdominal CAT scan, bone scan, head CAT scan or MRI, PET scan, mediastinoscopy, and occasionally, a percutaneous needle biopsy. Staging of the tumor to determine whether it is confined to the lung or has spread to other sites, including the lymph nodes, is standard.
Lung cancers can be divided into two main groups: small cell lung cancer and non-small cell lung cancer. Most often, small cell lung cancer is treated with chemotherapy and/or radiation therapy. Non-small cell lung cancer is primarily treated with surgery, with or without preoperative or postoperative chemoradiation therapy, depending upon the stage of the tumor. Surgical resection could entail the removal of a small portion of the lung, a lobe of the lung, or an entire lung, depending upon the size of the tumor and the patient's pulmonary reserve. In preparation for surgery, cardiac and pulmonary function testing is performed to assess fitness for surgery. At Lahey, it is our practice to review patients who might need multimodality therapy – any combination of surgery, chemotherapy and radiation therapy – through our multidisciplinary Thoracic Oncology Conference. The risk of surgery has significantly decreased due to advances in our ability to diagnose and treat lung cancer and in the perioperative management of patients. Our multidisciplinary Thoracic Oncology Center draws on the combined expertise of specialists from Radiation Oncology, Medical Oncology, Thoracic Surgery and other services to provide the best possible care to patients.
Lahey thoracic surgeons are also skilled in a type of minimally invasive (or minimal access) surgery for patients with stage 1 lung cancer. A traditional lobectomy, or removal of an entire lobe of the lung, requires a large incision in the chest wall and spreading of the ribs to expose the lung. A video assisted thoracoscopic, or VATS, lobectomy is done through several small incisions. Spreading the ribs is not required because the surgeon uses specially designed instruments that fit between the ribs. Advantages to the patient include less postoperative discomfort in the chest wall, shorter stays in the hospital and typically, a more rapid recovery of lung function. The procedure is not recommended for patients who have had preoperative chemotherapy or radiation, or those with enlarged lymph nodes, which may indicate a more advanced stage of disease. To learn more, talk to your doctor.