CHAPTER NINE: SURGICAL OPTIONS FOR LUNG CANCER (Part of  A Complete Guide to Lung Cancer) 

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9.1 STAGE

Surgery is the preferred form of treatment for stage 1 lung cancer patients. Ideally, surgery removes the entire tumor and with it any cancer. This happens in approximately 50% of stage 1 patients. Where the patient has other significant health problems, surgery may not be recommended, for example, for an 84 year old man with significant heart problems. Surgery removes the lung tumor and surrounding tissue. If the patient has severe breathing problems, he may lack sufficient pulmonary reserve to permit surgery.

Surgery is more debatable for stage 2 and especially stage 3 patients since the chance of completely eliminating the cancer is appreciably less.

9.2 SURGICAL DIAGNOSTIC PROCEDURES

A medianstinoscopy is a diagnostic procedure to test whether mediastinal lymph nodes are positive. For example, if multiple nodes are positive, surgery might not be recommended because it would not eliminate the cancer and open chest surgery could involve significant risk. The procedure involves inserting a crop through a small incision in the neck or check into the mediastinum where the nodes in that areas are viewed and tested. A thorascopy is a limited surgical procedure that allows the lining of the chest wall and the lungs to be examined for tumor. A thorascopy is inserted through a small incision in the chest wall.  These procedures are diagnostic, they do not attempt to cure the cancer, but determine its existence and extent.

9.3 TYPES OF SURGERY

There are two basic types of surgery to remove a lung tumor, lobectomy and pneumonectomy. Lobectomy is surgical removal of one of the lobes of the lung. Less intrusive procedures like a wedge resection, removal of part of the lobe have been tried, but cancer reoccurred in greater percentages so they are not generally used. A pneumonectomy is the removal of the entire lung., and would be used where the cancer is found to involve more than one lobe. A thoractomy would refer to surgery to examine the lung and remove cancerous portions. Yahoo has a good brief explanation of this surgery:

A thoractomy is a surgical procedure to open the chest and repair or remove lung tissue

9.31 Video-Assisted Thorascopic Surgery

Benefits

In recent years, there has been a shift to utilize modern technology in surgery, particularly the television camera. Laparoscopic surgery, use of a laparaoscopy together with a television camera has been used in many gall bladder removals and certain gynecological procedures. Recently, some have begun using this type of television aided surgery in lung procedures. The advantages of the camera-aided procedures are as follows: by using and moving a camera during surgery, much smaller incisions can be used. For example, with laparascopic gall bladder removal, four small incisions are used instead of the large one with traditional surgery. Thus, there is an appreciably smaller scar and shorter recovery period. With this video-assisted lung surgeries, it may not be necessary to break a rib to enter the area where the lung is located, as is done with standard surgery.

Problems

Using our knowledge of laparoscopic procedures, we can suggest the following drawbacks with video-assisted thorascopic surgery. In nine out of ten procedures, the result is a quicker, less intrusive surgery, with a much smaller scar. However, using these new procedures requires signficant skill and there is a high learning curve. There is less, or at least different, visibilty with a video-assisted procedure; the surgeon relies on a television camera. Thus if there are anatomical anomalies or other problems, the surgeon could be hindered by his lack of direct visibility. If a serious problem arises, the procedure will have to converted to an open or traditional procedure, creating a small amount of added risk.

We can thus identify two potential problems. First, a surgeon inexperienced with this type of procedure will present greater risks. Someone will have to be among the first ten patients undergoing the procedure with him or her; don’t let it be you. Instead, with such a procedure, you want a surgeon highly experienced with this type of procedure, at a hospital which it is also routinely done. Note that the procedure is being advocated for cosmetic reasons and convenience, not to create a new or better result.

Secondly, given the reduced or at least different visibility and the need to convert the procedure if problems arise, it probably should not be used with paitents with other signficant health problems Indeed, with laparascopy, the procedure is not recommended for patients whose other health problem will hinder visibility or present other issues complicating the procedure. 

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OTHER CHAPTERS FROM A COMPLETE GUIDE TO LUNG CANCER 

Chapter 1-2   canceroverview How cancer develops, staging, different types of lung cancer, difference between non-small cell and small cell

Chapter 4 
    Non-small cell lung cancer   Non-Small Cell treatment categorized by stage, chemotherapy, radiation,  

Chapter 5     smallcelllungcancer Small Cell treatment and overview 

Chapter 6      Chemotherapy (What is chemotherapy, different types of drugs, cisplatin, clinical trial results, new developements).

Chapter 11       Lung Cancer clinical trial overview 

Chapter 17     HMO.htm  HMO problems and medical insurance issues.

                   Tumor stages ) Explanation of the TNM (Tumor, Node, Metastais) staging system for non small cell lung cancer. 

Lung Cancer Newsletter Lung Cancer Newsletter   The Lung Cancer Newsletter is a detailed newsletter published at least three times per year of about 20-25 pages per issue devoted to recent developments in treatment and diagnosis of lung cancer.  Clinical studies, research reports, and articles in major medical journals are reviewed and summarized.  Learn about the latest medical research, treatments, clinical trials, and developments in chemotherapy.  Order the Lung Cancer Newsletter for $95.00 and receive a complimentary copy of our book.  The newsletter is offered with a money-back guarantee. 

Legal Issues, Medical Malpractice, and Delay in Diagnosing Lung Cancer Claims

Sadly over 50% of lung tumors are diagnosed at advanced stages, reducing the patient's opportunity for long term survival.  Our book is designed to educated smokers, nurses, and public health persons about the need for prompt detection of lung tumors.  In some instances, a doctor's failure to promptly diagnose a lung tumor, order or interpret appropriate tests may be malpractice.  We handled cases throughout the United States (affiliating with attorneys in other states) dealing with failure to diagnose lung and other cancers.

CONTACT INFORMATION

Howard A. Gutman, Esq.
1259 Route 46
Parsippany, New Jersey 07054
(973)257-9400 e-mail Howian@aol.com