© Steven C. Immerman, MD, FACS

Lung cancer is usually diagnosed by finding a "spot" on the lung on a chest x-ray or other type of x-ray study. Some times a patient with lung cancer has symptoms of cough, chest pain, shortness or breath, pneumonia, weight loss or coughing up blood. Other times there are no symptoms. It is the second most commonly occurring cancer among men and women. It has been estimated that there will be 164,100 new cases of lung cancer in the U.S. in 2000 alone. Lung cancer is related to smoking, radon exposure, and exposure to other industrial chemicals. However, sometimes there is no obvious explanation of why a patient has developed a lung cancer.

Lung Cancers are divided into two major types:

• Non-small cell which is the most common type of lung cancer. This includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. 
• Small cell which can spread fairly quickly. Small cell lung cancer (also called oat cell cancer) is the less common lung cancer type, accounting for about 20% of all lung cancer.

Treatment of Lung Cancer
Surgery provides the best chance of curing lung cancer. It is used when the cancer is limited to the lung itself, and has not spread outside the lung. Radiation therapy and chemotherapy are also used either by themselves, together, or in combination with surgery.

The exact treatment recommended depends on the size, location and degree of spread of the tumor. In addition, the general health of the patient and the health of the heart and lungs help determine what is safe and appropriate treatment.

About lung surgery
The most common reason to remove all or a portion of the lung is to diagnose and treat lung cancer. Any operation in which we open up the chest cavity is called a "thoracotomy". Sometimes we have a diagnosis before the thoracotomy and know what we expect to find. On other occasions, the operation itself is to find out what an x-ray abnormality means. Often, we can treat the problem at the same time. The body has a lot of built in reserve and is usually able to tolerate removal of all or part of a lung without too much difficulty. 

What is the operation like?
The operation is done with a patient asleep and lying on their side. The incision goes between the ribs on the side, and may curve up along the spine in the back. Sometimes it is necessary to divide or remove part of a rib. If appropriate, all or a portion of the lung is removed. The size and location of the lump or tumor determines how much lung has to be removed. Sometimes a small tumor in a critical location makes removal of the entire lung necessary.

After the surgery on the lungs has been done, clear plastic drainage tubes are put in the chest to drain unwanted fluid and air that may accumulate. The incision is closed with stitches around the ribs and muscle, and dissolving stitches in the skin.  This operation takes between two and four hours.

After the operation
Patients routinely  go to the recovery room to wake up after the operation, and then  to the intensive care unit. It is not unusual to stay there for a few days. 

A large part of the recovery revolves around breathing treatments and  exercises. These will help the lungs recover their normal function, and prevent pneumonia. Most patients are in the hospital about a week if all goes well. 

We are very concerned about our patients having adequate pain control after the operation. Whenever possible, we recommend use of an "Epidural Catheter". This is inserted by the anesthesiologist and allows him to administer pain medication directly to the spinal cord and central nervous system. This is best method we have for pain control, and is very effective. We usually leave the catheter in for about five days. After that, the pain level is usually low enough that oral pain medications are adequate.

At Evergreen Surgical we are very experienced with this kind of surgery, and have been very pleased with the rapid recovery of our patients.