Lung cancer is a disease in which malignant cells in the lung tissue grow in an uncontrolled fashion with the ability to travel to other parts of the body and disrupt the normal function of the affected organ. It is caused by a genetic mutation in normal cells that turns them into malignant cells and can develop spontaneously or from environmental exposure such as smoking.
Lung cancer typically starts as a nodule in the lung that grows over time. When it first develops, patients do not have any symptoms associated with the cancer. Thus, patients who have a significant smoking history are recommended to undergo lung cancer screening with a CT of the chest to discover cancer at an early stage. Once patients develop symptoms, the cancer is typically in an advanced stage. Some symptoms of lung cancer include cough, shortness of breath, coughing up blood, hoarseness, weight loss, fatigue, and pain at different parts of the body.
Lung cancer is diagnosed and treated based on the type of lung cancer. There are two large categories of lung cancer: small cell lung cancer and non-small cell lung cancer.
Small cell lung cancer comprises about 15% of all lung cancers. This type of cancer is typically treated with chemotherapy and radiation therapy. Rarely, surgery is used as part of a treatment regimen.
Non-small cell lung cancer comprises about 85% of all lung cancers. Two of the most common types of non-small cell lung cancer are adenocarcinoma and squamous cell carcinoma. Surgery is the main treatment for early stage non-small cell lung cancer with additional systemic therapy and radiation therapy for more advanced stage non-small cell lung cancer.
Once the patient is diagnosed with lung cancer, he or she undergoes studies to determine the clinical stage of lung cancer. The following tests provide information on the degree of the spread of cancer. Typically, lung cancer is found in the lung and spreads to nearby lymph nodes, then to lymph nodes in the middle of the chest, and finally to other organs such as the brain, adrenal gland and bones.
- CT of the chest – This study is performed in radiology. It provides information about the size of the tumor, relationship of the tumor to vital structures and whether any of the lymph nodes near the tumor or middle of the chest are concerning for the spread of cancer.
- PET-CT – This study is performed in radiology. It provides information about the spread of cancer to lymph nodes and other parts of the body except for the brain.
- MRI of the brain – This study is performed in radiology. It provides information about the spread of cancer to the brain.
- EBUS or Mediastinoscopy – This study is performed to determine whether the tumor has spread to lymph nodes in the middle of the chest.
This provides clinical staging for patients with lung cancer. For patients with early stage cancer, we perform additional tests to determine if they can safely undergo surgery.
- Cardiac testing – These studies are typically performed by a cardiologist. These are a set of tests to determine if the patient’s heart can safely undergo the stress of surgery.
- Pulmonary function test (PFTs) – This study is performed in a pulmonary lab. This provides information on the patient’s lung function and provides information on the patient’s lungs’ ability to tolerate resection.
- V/Q scan – This is performed in radiology. This is performed if PFTs show a marginal lung function. It provides more accurate information about the patient’s ability to tolerate lung resection.
- Cardiopulmonary exercise testing (CPET) and maximal oxygen consumption (VO2 max) – This is performed in a pulmonary lab. CPET provides information on VO2 max or maximal oxygen consumption. This test is performed if PFTs show a marginal lung function. It provides the most accurate information on the patient’s ability to tolerate lung resection.
These studies allow us to advise patients with lung cancer about the best treatment option for them. The surgical options for patients with lung cancer are
- Pulmonary wedge resection
- Pulmonary segmentectomy
- Pulmonary lobectomy
- Pulmonary pneumonectomy
The standard operation for patients with lung cancer is a lobectomy with mediastinal lymph node dissection and flexible bronchoscopy.