Lung Cancer

The best hope of a cure is through early diagnosis and surgical skill.

The most common cause of cancer deaths globally is lung cancer. It is commonly diagnosed at an advanced stage since the disease is not common in its symptoms at an early stage. Surgery is the best treatment for non-small cell lung cancer not spread beyond the chest, and with the recent progress of minimally invasive surgery, more patients can now undergo surgery as it is safer and recovers faster.

Understanding Lung Cancer

Lung diseases are formed as a result of malignant cells that appear in the lung and multiply uncontrollably. These are divided into two broad categories: Non-Small Cell Lung Cancer (NSCLC), which comprises about 85 percent of all cases, and Small Cell Lung Cancer (SCLC), which spreads early and grows at a rapid rate. NSCLC is further classified as adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, which have different characteristics, molecular profiles, and treatment implications.

The greatest risk factor is tobacco smoking, which causes approximately 85 per cent of lung cancers. Nevertheless, an increasing percentage of lung cancers, especially adenocarcinoma, are found in non-smokers, particularly females in India, and are likely to be associated with indoor air pollution, cooking fumes, and inherited predispositions such as EGFR mutations.

Symptoms and Presentation

Silently, early lung cancer is infamous. With the growth of the tumour, patients can have a persistent new cough or alteration of an existing cough, haemoptysis (coughing blood), breathlessness, chest pain, hoarseness, frequent chest infections, unexplainable weight loss, and fatigue. Symptoms of metastases, such as bone pain, neurological or abdominal discomfort, may be a sign of advanced disease.

Staging: Why It Determines Treatment

The stage of lung cancer (I- IV) identifies the possibility of surgery and extra interventions. Stages I-IIIA can be surgically resected. The disease at stages IIIB and IV is usually treated with systemic therapy, chemotherapy, targeted therapy, or immunotherapy, usually in combination with radiation. Proper staging is thus very important with the use of CT, PET-CT, endobronchial ultrasound (EBUS), and mediastinoscopy.

Surgical Treatment of Lung Cancer

The gold standard of resectable NSCLC is surgery. The nature and the amount of resection chosen should be based on the location of the tumour, size, association with central airways and vessels, as well as the amount of lung function reserve available to the patient. Resection of the involved lobe and mediastinal lymph nodes to stage the disease properly is known as the standard operation, which is a lobectomy. A sublobar resection (segmentectomy or wedge resection) can be done in selected patients with small peripheral tumours and limited lung reserve.

Pneumonectomy: ectomy of the whole lung is necessary in cases where the tumour extends into central airways or main pulmonary vessels that cannot be spared. It is a large surgery with increased perioperative risk and high effects on the enduring performance of lungs; however may be effective in the right patient chosen.

Long resections of the chest wall, diaphragm, pericardium, or superior sulcus (Pancoast tumours) are complicated procedures, and they need multidisciplinary planning and surgical skills in chest wall reconstruction.

Minimally Invasive Lung Surgery (VATS)

Video- Assisted Thoracoscopic Surgery (VATS) has revolutionized lung cancer surgery. Small incisions and camera-guided technique provide patients with the same oncological benefits as open surgery with much less pain, shorter stays in the hospital, shorter recovery time, fewer complications, and better immune preservation, making VATS lobectomy and segmentectomy the best choice to be on adjuvant chemotherapy sooner. Robotic-assisted thoracic surgery is also more precise when it comes to complicated dissections.

Multimodal Treatment

In case of locally advanced yet possibly resectable tumours (stage IIIA), the neoadjuvant (pre-operative) chemotherapy or chemoradiation can be employed to stage down the tumour prior to surgery. Stage II and III disease suggest adjuvant postoperative chemotherapy. Targeted oral therapy plays a vital role in tumours that have had an EGFR mutation, as well as other driver mutations. Checkpoint inhibitor immunotherapy has radically transformed the advanced disease treatment scene.

Risk Factors

Passive smoking of tobacco, exposure to radon gas, asbestos, occupational carcinogens, COPD, pulmonary fibrosis, family history, and EGFR mutations in non-smokers.

Screening

High-risk people who should undergo low-dose CT (LDCT) SC are heavy smokers between 50 and 80 years old. The screening and early detection of the disease significantly increases the survival rates, as it helps detect the stage I disease.

Prognosis and Follow-Up

Stage I NSCLC that is fully resected has a survival of more than 70-90%. For stage II, it ranges from 50–70%. Stage-dependent deterioration and continuous improvement of better-targeted therapies and immunotherapy were noted to significantly decrease outcomes. Follow-up with CT is another important step that should be done regularly to prevent recurrence early and observe the rest of the lung against new primary tumours.

Expert Lung Cancer Surgery

Timely surgical opinion is also likely to be a critical difference in lung cancer outcomes. Dr. Bhanushali provides extensive analysis and low-risk surgery of lung cancer.

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The doctor looks at the hologram of Lungs, checks the test result on the virtual interface and analyzes the data. Pneumonia, donation, innovative technologies, medicine of the future.

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9920024001