Surgical Procedures: Surgery and Staging for Lung Cancer

Author: OncoLink Team
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When there are cancerous cells in the lung(s), this is called lung cancer. You have two lungs in your chest, one on each side. The lungs take in oxygen and release the waste product carbon dioxide. Each of the two lungs has separate sections called lobes. The left lung has two lobes and the right lung has three. The bronchi are two tubes that attach the trachea to both lungs. The internal structures of the lungs include the alveoli and bronchioles.

Lung cancers are often classified into two groups: non-small cell cancer (includes squamous cell, adenocarcinoma and large cell carcinoma) and small cell lung cancer (oat cell carcinoma).

Other less common types of lung cancers include:

  • Combined small cell/non-small cell carcinoma.
  • Lung carcinoid tumor.
  • Other non-small cell cancers such as pleomorphic cancer, salivary gland carcinoma, unclassified carcinoma, carcinoid tumor, adenosquamous carcinoma, and sarcomatoid carcinoma.
  • Adenoid cystic carcinomas.
  • Mesothelioma.
  • Lymphomas.
  • Sarcomas.

What is staging and how is it performed?

Staging is a way to find out how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may include:

Physical Exam: This is a general exam to look at your body and to talk about past health issues. 

Imaging: Imaging such as a chest X-Ray and/or CAT scan (CT scan), magnetic resonance imaging (MRI), positron emission tomography (PET), an endoscopic ultrasound, and bone scans may be used to further evaluate the extent of your cancer.

Laboratory Testing: Certain laboratory testing may be done including sputum cytology, in which the sputum is evaluated under a microscope for cancerous cells. Additional tests may be light and electron microscopy and immunohistochemistry testing of the tumor.

Pulmonary function testing (PFT): This tests lung function by looking at lung capacity, oxygen use, carbon dioxide waste and the speed at which air moves through the lungs when inhaling and exhaling.

Procedures: These may include:

  • Biopsy: A tissue sample of the lung may be obtained during certain procedures including bronchoscopy, mediastinoscopy or other procedure.
  • Fine Needle Aspiration (FNA): Tissue or fluid is removed with the guidance of a CT scan, ultrasound or other radiologic imaging tool. This may require a small incision. Following the procedure, your healthcare team will evaluate for leaking air from the lung with an X-ray.
  • Bronchoscopy: Use of a thin, lighted tube that is placed down your nose or mouth and into your lung to look at the tumor and take samples of it. This can also be used to take samples of the lymph nodes. There are several bronchoscopy techniques that can be used. Your healthcare provider will determine which methods are best in your case based on the location of the lesion and if lymph nodes are being sampled.
  • Thoracoscopy: The surgeon inserts a small camera into the chest wall to look at the suspicious area, evaluate the extent of the tumor and take biopsies.
  • Video-assisted thoracoscopy or VATS: Can be used for a biopsy or surgery in early-stage lung cancer. This technique is similar to thoracoscopy but requires fewer/smaller incisions, which may result in quicker recovery.
  • Mediastinoscopy: Use of a scope (camera on a tube), placed through the chest wall, to look at the suspicious area and take samples of lymph nodes to evaluate for the presence of cancer cells.
  • Thoracotomy: This procedure may be needed to evaluate inaccessible organs, tissue or lymph nodes and requires a larger incision to open the chest.
  • Thoracentesis: A needle is inserted between the lining of the chest and lung, removing fluid for evaluation.
  • Lymph node biopsy: In some cases, lymph nodes may be removed for evaluation of cancer.

Lung cancer spreads to other parts of the body through the tissue, lymph and blood systems. Cancer stage determines how extensive the cancer is, how far it has spread and what treatment course will be recommended. Staging for non-small cell lung cancer includes occult/hidden stage through stage IV disease, whereas small cell lung cancer is described as limited or extensive stage.

Surgical Procedures for Lung Cancer

Surgery is not often used to treat small cell lung cancer. There are some common surgical procedures used to treat non-small cell lung cancer, depending on your particular stage, location and situation, including:

  • Wedge Resection: The tissue containing the tumor and a portion of healthy and normal tissue is removed.
  • Segmental Resection: This procedure is a more extensive version of a wedge resection, in which a larger portion of the lung is removed.
  • Lobectomy: Surgical removal of one lobe of the lung.
  • Pneumonectomy: Surgical removal of the whole lung.
  • Sleeve Resection: Surgical removal of a portion of the bronchus. During this procedure, a section of the bronchus is removed and re-affixed to the lung.

Note: In many cases, lymph nodes will also be removed at the time of surgery. Additionally, some cancers can be surgically treated with a video-assisted thoracic surgery (VATS) in which smaller incisions are used to allow for the placement of a thin tube and surgical tools versus a large incision. This surgical method is typically reserved for early-stage cancers that are located in the outer portion of the lung.

What are the risks associated with lung cancer surgery?

As with any surgery, there are risks and possible side effects. These can be:

  • Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and manage pain. Reactions can include wheezing, rash, swelling and low blood pressure.)
  • Pneumonia.
  • Bleeding.
  • Blood clots.
  • Infection.
  • Shortness of breath.

What is recovery like?

Recovery from lung cancer surgery will depend on the procedure you have had. Often, a short hospital stay is needed and full recovery from lung surgery can take several months.

You will be told how to care for your surgical incisions or drains and will be given any other instructions before leaving the hospital.

Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, constipation prevention and/or other conditions.

Your team will talk to you about activity restrictions depending on the surgery you have had. Often:

  • Showering is encouraged with gentle washing of the surgical incision; use only mild soap and warm water.
  • Slowly increasing activities, such as walking with periods of rest, is recommended.
  • No heavy lifting, yard work or other strenuous activity for 6 to 8 weeks following surgery, or until instructed otherwise.
  • Take all medications as directed.
  • If supplemental oxygen is needed, use it as directed.
  • Your healthcare team will let you know when it is safe to return to work, driving and sexual activity. Speak with your doctor about activity restrictions specific to your needs.

Contact your healthcare team if you have:

  • A fever, incisional redness and/or drainage, which can be a sign of infection.
  • Shortness of breath which is sudden and severe.
  • Chest pain that is sudden and sharp.
  • Chest "fluttering" or an increased heart rate.
  • Any other concerns or questions you may have.

How can I care for myself?

Depending on the extent of your surgery you may need a family member or friend to help with daily tasks until you are feeling better and the medical team gives the go ahead to resume normal activity.

Be sure to take all medications as directed to prevent pain, infection or other conditions and call your medical team with any concerning symptoms.

If constipation is present, speak with your healthcare team about recommendations they have to offer relief.

Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to encourage your child to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.

  • A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.

References

American Lung Association. Lung Cancer Surgery. 2019. 

American Cancer Society. Surgery for Non-Small Cell Lung Cancer. 2019. 

National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ®)–Patient Version. 2019. 

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