Lung cancer surgery: New treatments mean less is sometimes more

More people with lung cancer are living longer. That's thanks to regular screenings, better diagnostic tools and more personalized treatment options.

When it comes to effectively treating lung cancer, here are three key things to understand:

1. Type. “Lung cancer is not just one disease. In fact, there are many different types. And new ones are discovered as we learn more about the molecular profile of lung cancer, “says Bhanu Patibandla, MD, a PeaceHealth critical care specialist in Vancouver, Washington.

Lung cancer is broadly classified into two categories: small-cell lung cancer and non-small cell lung cancer. Non-small cell is the most common (80%). It has three different subtypes: adenocarcinoma, squamous cell carcinoma and large cell carcinoma. These types are based on how the cells look under the microscope.

2. Stage. This refers to how far the cancer has spread. Non-small cell lung cancer has four stages. Each one depends on several factors. These include the size and location of the tumor in the lung. Experts also consider whether the cancer has spread to lymph nodes in the chest or to other body parts.

“Your doctor may recommend testing to determine the stage of cancer,” says Dr. Patibandla. These tests might include a PET scan, bronchoscopy with endobronchial ultrasound, or an MRI of the brain. “The goal is to diagnose lung cancer in the earliest stage possible. That's when it's easier to treat and has the potential to be cured.”

Right now, about two thirds of cases are found in advanced stages.

3. Molecular profile.  This is a new advancement in understanding how lung cancer develops. Scientists now recognize that even cancer cells that look the same under a microscope are different. “It's based on the type of molecular profiles or mutations that are driving the cancer growth,” says Dr. Patibandla.

Knowing this means doctors can use treatments like targeted therapy and immunotherapy specific to each patient. Experts look at tumor tissue and blood samples to identify how the cells are different from normal cells. This type of testing is known as molecular testing, genomic testing or next generation sequencing. About 50% of lung cancer patients have these targetable mutations. They are most common in adenocarcinoma.

Personalized treatments

“Targeted therapy and immunotherapy are revolutionizing lung cancer treatment," says Dr. Patibandla. "And new drugs are being discovered now almost on a yearly basis. More lung cancer drugs have been discovered in the last decade than the previous 30 years combined.”

All of this means that if you have targetable mutations, you may be a candidate for personalized therapies. Compared to traditional chemotherapy, these treatments might have better results with fewer side effects.

Surgical advances

Surgical treatment for lung cancer has also advanced. Most lung cancer surgeries are now performed using a minimally invasive approach.  This means the surgeon makes tiny incisions (cuts) that allows them to reach the cancer cells. Because the incisions are so small, there is less damage to your body. This results in less pain and fewer complications. Specially trained surgeons use miniature surgical tools and cameras for these procedures.

"We’re learning that less can be more sometimes in lung cancer surgeries,” says Dr. Patibandla. “If the cancer is small and on the outer edge of the lung, it may be possible to remove only the tumor or the part of the lung with the tumor. That hasn’t always been the case.”

It’s helpful here to understand the anatomy of the lungs. Your right lung has three lobes with a total of 10 segments. The left lung has two lobes of eight segments.

Historically, lung cancer surgeries have removed a lobe. That’s a lobectomy. Depending on the diagnosis, surgeons may now choose to remove a segment of the lung instead of a whole lobe. Surgery to remove a segment is called a segmentectomy. If the tumor is small and found early, it’s even possible to remove just the tumor in a procedure called a wedge resection.

Studies show these “sub-lobar” surgeries can be as effective or better than lobectomies for early-stage lung cancer, notes Dr. Patibandla. And these are possible because of improving surgical techniques. It's also because screening exams are finding smaller cancerous nodules (growth of abnormal tissue) sooner.

Screenings are key

Lung cancer screenings are quick and easy. They’re done using low-dose CT scans. The process is painless and takes just a few minutes.

If you are 50-80 years old and have a history of heavy smoking, talk to your PCP about getting screened today. “Heavy” means:

• Currently smoking a pack a day
• In the past having smoked a pack a day for 20 years or two packs a day for 10 years

“All of these advances represent hope for people affected by lung cancer,” he says. “Knowing that more effective treatments are available is all the more reason to get screened for lung cancer early and yearly.”