Thoracic tumor

Surgical operation

For patients with early-stage non-small cell lung cancer, surgery may be a good option. In some cases, patients may receive chemotherapy or radiation before surgery to shrink the tumor. This is called neoadjuvant therapy.

The most common types of surgery for lung cancer, in order of the amount of lung tissue removed, are:

Cuneectomy: Removal of the tumor and the flake or wedge of lung tissue surrounding the tumor. This procedure is usually used for lung nodule biopsies.

Segmentectomy or segmentectomy: The removal of a segment or part of the lobe in which the tumor is located. Segmentectomy and wedge-shaped resection are usually performed in patients with limited lung capacity who cannot tolerate the removal of larger lung segments. They are also a good option for patients with early-stage small tumors that are usually smaller than 2 cm. Both maintain lung capacity and the patient's quality of life.

Lobectomy: Removal of the lung lobe where the tumor is located. This is considered the "standard of care" for most lung cancer patients undergoing surgery.

Sleeve lobectomy: A more complex type of lobectomy, usually used for tumors in the center. It involves removing the lobe where the tumor is located and part of the connecting bronchus. The cut bronchus is connected to the remaining lobes. Although not always possible, sleeve lobectomy is preferable to total pneumonectomy (complete removal of the lung). To preserve more functional lung tissue.

Pneumonectomy: Removal of the entire lung. This surgery is occasionally required due to the location of the tumor. Pneumonectomy is well tolerated in otherwise healthy and functioning people.

In most of these surgeries, the surgeon will also remove lymph nodes from the chest. Because cancer often spreads through these lymph nodes, doctors will examine them under a microscope to determine if the lung cancer has metastasized outside the lungs. This will help the doctor decide if you need further treatment after surgery, such as chemotherapy, radiation therapy or targeted therapy. The treatment after surgery is called adjuvant therapy.

Surgical approach

For some lung cancer surgeries, there are different ways to perform the same procedure. Your surgeon will work with you to choose the best option. These methods include:

Open surgery: The traditional surgical method. The surgeon performs the operation through a 4-8 inch incision between the ribs.

Minimally invasive surgery: Minimally invasive surgery These procedures require several smaller incisions, usually between 1/2 inch and 1/2 inch, and typically have a shorter recovery time and less pain for the patient. For lung cancer patients, there are two main methods of minimally invasive surgery.

Video-assisted thoracoscopic surgery (VATS) or thoracoscope: This technique uses a small camera and instrument inserted into the chest cavity, allowing the surgeon to operate through small incisions. It is usually used in small, early-stage lung cancer patients.

Robot-assisted surgery: This newer minimally invasive method of surgery uses a robotic arm controlled remotely by a surgeon. Better images of the surgical site and increased instrument flexibility allow surgeons to perform more complex procedures than thoracoscopic surgery.

Statistically speaking, the more experienced the surgeon, the better the prognosis for lung cancer patients.

radiotherapy

Radiation therapy uses focused beams of high-energy photons to destroy lung cancer cells. It is performed by radiation oncologists, who are specially trained experts in treating cancer with ionizing radiation. In most hospitals, radiation oncologists are required to treat several different types of cancer.

Working alongside these radiation oncologists is a team of radiation therapy specialists, including dosimetry specialists and medical physicists. Together, this team of experts develops models for several different treatment types and determines which treatment is best for each patient. Radiation therapy for lung cancer patients includes:

Three-dimensional conformal radiation therapy: Several radiation bundles are given in the exact shape of the tumor. This is mainly used as a palliative care rather than a cure for the disease.

Brachytherapy: Tiny radioactive particles are placed in the body close to the tumor. Brachytherapy is mainly used to treat metastatic airway growth. Because most tumors can be treated with external irradiation, brachytherapy is rarely used in lung cancer patients.

Intensity modulated radiation therapy: Treatment is tailored to the specific shape of the tumor. This radiation is often used to treat cancers that invade nearby lymph nodes.

Volume-regulated arc therapy (VMAT) : This is a special type of intensity modulated radiation therapy. In this machine, the part that emits radiation rotates around the patient, forming an arc. This allows for more precise irradiation of the tumor and shorter surgical time.

Stereotactic radiation therapy (SBRT) : High-dose radiation therapy with several beams of rays of different intensity and angles to precisely target the tumor.

Proton therapy

Proton therapy is a type of radiation therapy that delivers high doses of radiation directly to tumors without harming nearby healthy tissues and organs.

Systemic therapy

Systemic therapy is an umbrella term that uses substances that travel through the bloodstream to reach affected cells throughout the body. Over the past few decades, there have been significant advances in the systemic treatment of lung cancer.

Targeted therapy

Cancer cells use specific molecules, usually in the form of proteins, to survive, reproduce, and spread. Targeted therapies work by interfering or targeting these molecules to stop or slow the growth of cancer. Currently, targeted therapies are available for many subtypes of adenocarcinoma.

immunotherapy

Immunotherapy uses the body's own immune system to fight tumors. The current standard of treatment for non-small cell lung cancer includes the use of checkpoint inhibitor immunotherapy, which disactivates the immune system's natural "brakes", allowing it to attack cancer cells. This treatment can lead to lasting responses and has revolutionized the care of lung cancer patients.

chemotherapy

Chemotherapy uses drugs to kill cancer cells directly by stopping their growth. This form of treatment is often combined with immunotherapy. The combination of the two drugs is more effective.

Angiogenesis inhibitor

Angiogenesis is the process of producing new blood vessels. Vascular endothelial growth factor (VEGF) is one of the main molecules controlling this process. Some cancerous tumors are very efficient at using these molecules to create new blood vessels, which increases the blood supply to the tumor, making it grow more rapidly.

Researchers have developed a class of drugs called angiogenesis inhibitors, or anti-angiogenesis therapies, to interfere with the growth process. These drugs seek out and bind to VEGF molecules, or receptor proteins, preventing them from activating angiogenesis.