Satisfactory results are achieved in treatment of lung cancer, which is one of the most prevalent cancer types, with surgical methods when the condition is diagnosed early. Prof. Bülent Tunçözgür, M.D. from Thoracic Surgery Department of Güven Health Group provides information about lung cancer and surgical treatment of lung cancer.
What is lung cancer?
Lung cancer implies the abnormal cell groups that develop as a result of changes in form and behavior of pulmonary cells, grow uncontrollably and replace the healthy cells. These cells that form mass lesion, in other words tumor, as a result of uncontrolled growth prevent healthy pulmonary cells from performing their normal functions. Moreover, the condition may spread to the surrounding tissues/organs like the heart, esophagus and chest wall and even to other parts of the body such as brain, liver and bones, resulting in dysfunctions in these areas. It is the second most common cancer type following breast cancer among women and prostate cancer among men. However, unfortunately, this condition is the most common cause of cancer-related deaths in both men and women. The major underlying causes are smoking and tobacco use, air pollution and asbestos exposure on the background of genetic predisposition.
Is surgical treatment indicated for all lung cancer patients? For which conditions are surgical treatment methods used in lung cancer?
The most effective treatment method for lung cancer is surgical excision of the tumor. If the disease originating from the lungs has not spread to the chest cavity or other parts of the body, in other words, if it has been detected at early stage, the success rate of surgical treatment is very high. Al scientific researches have proven that the most important factor affecting the success of treatment is total excision of the tumor without leaving any cancer cells behind. Efforts are made to investigate this condition through tests before deciding on surgery. First, patients with suspected lung cancer or biopsy proven diagnosis of lung cancer are assessed regarding suitability for surgery. If it is not possible to excise the tumor totally or cancer cells have spread to other regions even if the tumor can be excised, chemotherapy or radiotherapy is applied first. After such treatments are completed, it is investigated whether surgical treatment can be performed for the shrunk tumor.
For patients who need surgery due to lung cancer, assessment is done to investigate comorbidities and identify potential risks of the procedure to be performed. Today, in addition to limited lung capacity, many comorbidities and advanced age increase the risks of the surgery, although they do not contraindicate the operation.
What are the surgical methods used in treatment of lung cancer?
The lungs consist of three main portions on the right and two main portions on the left. Depending on patient’s condition and severity of the disease, one of these portions can be removed surgically. This procedure is called lobectomy. If the disease has developed in one of these portions and has not involved any other area, it is an important advantage for the patient and the disease can be treated by excising the relevant portion. If the disease has involved all portions at the relevant side, treatment can be performed by totally removing the relevant side of the lung. This procedure is called pneumonectomy. Although this condition poses higher risk, the success rate of treatment is also very high. If the tumor has involved other structures like chest wall, esophagus and diaphragm, such non-vital organs can be removed together with the relevant lung portion where the tumor is located. In addition to excision of the tumor together with the relevant lung portion, the nodes in an area called mediastinum in thorax, located around the trachea and major vessels, which can also be present in healthy individuals, are excised too; analysis is done to investigate whether cancer cells spread to these nodes and classification is made. Considering this classification, the decision regarding whether additional treatment can be given after surgical treatment is made.
Does the surgical treatment of lung cancer pose risks?
Generally, the operation is performed through a skin incision (15-20 cm) made between the fifth and sixth ribs. During the procedure, the space between these two ribs is enlarged and the diseased area is reached. The surgical site where vital organs like heart, lungs and major vessels are located is critical. In this sense, the operation poses high risk compared to many other operations. Scientific studies indicate that the risk is around 2%-3% for lobectomy procedure. However, it should be noted that the patients with high risk factor due to comorbidities are also included in this ratio. The risk of chemotherapy applied for the patients who do not undergo surgery is not lower than this ratio. The patients are monitored at the intensive care unit for at least one day depending on postoperative general health status. Mean hospital stay is one week as long as no complication occurs. After 1 week of resting period at home, the patients can continue routine daily life and return to their normal social and work lives within approximately 1 to 1.5 month. The patients without preoperative respiratory distress do not experience postoperative respiratory distress although a portion of the lung has been excised. Although complaints like poor exercise capacity occur within the first 3 months, this condition disappears 6 months later and the patients achieve their preoperative performances.
Could you give information about the success rates of surgical treatments of lung cancer?
Although lung cancer is one of the cancer types that are associated with highest number of cancer-related deaths, the recovery rate is around 80%-90% if early diagnosis is made and surgery is performed successfully. Even if the condition is not detected at early stage, the success rate of the surgical treatment is not low. The recovery rate is almost 50% in the patients undergoing surgery. The major problem for lung cancer is difficulty of detecting the condition at operable stage. Only 25% of the patients diagnosed with lung cancer are deemed operable. Unfortunately, the disease is generally detected at advanced stages. The most important cause of this situation is that the disease is not manifested by severe symptoms at early stages or complaints are ignored by the patients. Especially those whose family history is notable for cancer, smokers and those with risk factor like occupational exposure should have low dose computed tomography of lung once in two years after the age of 50. Thus, the disease can be detected at very early stages and complete recovery can be achieved with treatment.
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