Lung Cancer

Cancer is the second most common cause of death in the United States. Lung cancer is the most common cause of cancer deaths. Cancer is the result of uncontrolled cell growth usually caused by a failure of the normal cellular mechanisms that regulate growth. The two hit hypothesis states that two things must go wrong to affect the normal cell signal pathways. One can be genetics and the other being environmental factors such as smoking. Lung cancer incidence has been increasing in the United States. Previously most lung cancer was found in people who had a smoking history, but up to 20% of current lung cancers occur in non smokers.

Risk factors for developing lung cancer can include:

• Smoking
• Genetic mutations
• Second hand smoke exposure
• Age
• Previous lung cancer
• Environmental exposure such as coal mines, asbestos

What are the symptoms of lung cancer?

Often when the cancer is small there may be no symptoms. Many cancers are found because a CT scan was performed for another unrelated reason.

However, certain cancer locations may present with symptoms. These include:

• Coughing up blood
• Repeated lung infections or an infection that won’t clear
• Chest, Shoulder or Back pain
• Voice changes

How is lung cancer diagnosed?

The first step to diagnosis is an evaluation by your doctor including medical and family history, physical exam, and risk factor evaluation. A strong history of smoking may result in your doctor ordering a screening CT scan. Most lung cancers are seen on radiographic imaging. Some cancers can be seen with a chest X-ray others may require a more sensitive CT scan.
Cancer is not diagnosed by imaging alone. A biopsy is usually required since several benign (non cancerous) lesions may occur that look like cancer on imaging. Some other tests include bronchoscopy, CT guided needle biopsy, endobronchial ultrasound.

How is lung cancer treated?

Lung cancer is treated based on the stage of the cancer. Lung cancer is staged based on the size of the tumor, the involvement of any lymph nodes, and if there are any areas outside of the lung that are involved (metastases).

Stage I lung cancers are good cancers for surgical resection. Stage II cancers are also amenable to surgical resection. Stage III cancers may be amenable to resection depending on the response to chemotherapy or radiation therapy. Stage IV cancers are treated with chemotherapy and are not amenable to surgical resection. Based on the above information screening for lung cancer has become more widely adopted to hopefully lung cancer at its earlier stage.

Most often, if a lung cancer is amenable for surgical consideration your doctor will refer you to a thoracic surgeon. A thoracic surgeon specializes in treating diseases of the chest such as lung cancer. Depending on the size and location of the tumor your surgeon may talk to you about a mediastinoscopy to look at the lymph nodes in your chest. Or she may review a PET/CT or endobronchial ultrasound. These tests are to help confirm the stage of the lung cancer.

If you are considered for surgery pulmonary functions will need to be performed to make sure your body can tolerate having a portion of your lung removed. Some patients will require oxygen after removal of part of their lung. This dependence on oxygen can be lifelong.

Most often the surgery is performed through three small incisions with the use of a camera. This is often referred to as a VATS or video assisted thoracic surgery. The VATS performs the same lung resection as done through a traditional large incision but with a quicker healing time and less negative effect on the oncologic outcome. During the VATS lobectomy the lymph nodes that drain the lung tissue will also be harvested. This will provide microscopic evidence of whether or not the lymph nodes are involved. By thoroughly removing the lymph nodes we can determine the true stage and guide further treatment with your oncologist.

Lung surgery requires a stay in the hospital from 3 to 4 days up to a week. A chest tube will be placed inside your ribs but outside your lung to help drain any fluid accumulation by the body and any air that can leak from the remainder of the lung. This tube will drain to a box called a pleurevac and will measure how much fluid drains every day. When it is safe to take the tube out it will be removed at the bedside.

Want to know more? https://ctsurgerypatients.org/lung-esophageal-and-other-chest-diseases/lung-cancer