Surgery

Surgery to remove the cancer may be an option when your cancer is in only one lung or present in one lung and in nearby lymph nodes. Lung surgery is called a thoracotomy. It usually is done only if your doctor thinks all the cancer can be removed and your general health is good enough for you to handle the surgery.

Surgery Choices

The type of surgery performed depends on the location and size of your lung cancer:

• Wedge resection (segmentectomy). The surgeon removes a small wedge-shaped piece of lung that contains the lung cancer and a margin of healthy tissue around the cancer.
• Lobectomy. The right lung has three lobes and the left lung has two lobes. A lobectomy removes the entire lobe of your lung that contains the cancer. Your lungs can function with the lobes that remain.
• Pneumonectomy. A pneumonectomy removes your entire lung that contains the lung cancer.

Lung function studies and a lung scan are often done before surgery to predict how much of your lung function you will still have after surgery.

Surgery to remove lymph nodes in the center of the chest is usually recommended at the time of lung surgery, to find out whether the cancer has spread.

What to Think About

You may have side effects from your surgery.

Chemotherapy may be given before (neoadjuvant) or after (adjuvant) surgery to destroy any cancer cells.

Other Treatment

Radiation therapy

Radiation therapy is the use of high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy, also called brachytherapy). Radiation therapy is often used in combination with surgery or chemotherapy or both.

People who cannot have surgery may have stereotactic body radiation therapy (SBRT). In SBRT, high doses of radiation therapy are targeted to the cancer. One form of SBRT that may be used to treat tumors that have spread to the brain is called gamma knife radiosurgery. This is a radiation treatment (rather than surgery) that uses a machine to target radiation beams from many different angles all focused on the tumor area.

Radiofrequency ablation

Radiofrequency ablation uses a small needle inserted through the skin and into the tumor. Energy passes through the needle into the tumor. This heats and kills cancer cells. It also closes up the little blood vessels in the area so there is less bleeding.

Laser therapy

Laser therapy uses a narrow beam of very intense light to destroy cancer cells. Laser therapy usually is used as a palliative care to remove tumors that block the airway. Laser therapy does not cure lung cancer.

Photodynamic therapy

Photodynamic therapy (PDT) uses laser light and a special light-activated substance (Photofrin) to kill cancer cells. It is approved for palliative treatment to destroy tumors that block the airway but it does not cure the lung cancer. Few lung cancers are treated with this therapy. Surgery is still the standard treatment for early-stage lung cancer.

In clinical trials, PDT appears to help relieve coughing, shortness of breath, and coughing up bloody mucus. Additional research is being done.

Cryosurgery

Cryosurgery (also called cryoablation) freezes the tumor and kills it. Cryosurgery for lung cancer is experimental and is being used only in certain clinical trials.

Cautery

Cautery is used to burn (cauterize) and remove tumors that block the airway.

What to think about

Radiation may cause side effects.

Radiation therapy may be used to prevent small cell lung cancer from growing in your brain. This is called prophylactic cranial irradiation (PCI).

Sometimes radiation therapy may be given during your surgery. In this procedure, radiation is focused directly on the tumor during surgery and affects as little healthy tissue as possible.

Radiation therapy also may be used as palliative care to:

• Shrink tumors that make it hard for you to swallow.
• Reduce tumors that block your airway and make it hard for you to breathe.
• Relieve pain from cancer that has spread to your bones or spinal cord.

Other Treatment Choices

Oxygen therapy

Oxygen therapy may relieve your shortness of breath. It may be used after surgery or if you get an infection like pneumonia. Some people who have pulmonary conditions, such as chronic obstructive pulmonary disease (COPD), may use oxygen as regular therapy.

Thoracentesis

Thoracentesis is used to remove fluid from around your lungs (pleural effusion). A large amount of fluid may cause pain and shortness of breath.

Pleurodesis

Pleurodesis is used to prevent fluid buildup around your lungs. Pleurodesis is a procedure that is intended to cause inflammation of the lining around your lungs. The irritated tissue reacts by producing scar tissue, which causes the two layers of the lung lining to stick together. This removes the space where fluid can build up around your lungs. Pleurodesis is commonly used to treat fluid buildup around your lung that returns after repeated thoracentesis.

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

• Acupuncture to relieve pain.
• Meditation or yoga to relieve stress.
• Light massage (not deep tissue or intense pressure) or biofeedback to ease tension.
• Breathing exercises for relaxation.

For people with lung cancer, studies have shown that mind-body treatments like those mentioned above may help you feel better and cope better with treatment. These treatments also may reduce chronic low back pain, joint pain, headaches, and pain from treatments. Acupuncture may also help with nausea and vomiting from chemotherapy.⁹

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.