Lung Cancer Treatment

Hi, my name is David Affleck, I’m a cardiothoracic surgeon at St.  Mark’s Hospital in Salt Lake City. I’ve been asked to talk to you today about lung cancer treatment.

Most commonly, the nodules that we find on low-dose CT scan are benign. In fact, over 90% of those are benign. But importantly, those that we detect that are cancer, over 90% of those could be resected for cure. At an early stage, we’re fairly aggressive about finding these cancers and treating them appropriately. For example, a patient who is found to have a suspicious nodule on CT scan may go down various different arms.

First of all, we need to know, is this nodule cancer or is it benign? One option is a needle biopsy. So that’s where using radiology techniques,we pass a needle into the tumor and take a small amount of cells and look at them under the microscope. That can often give us an answer. And that, success of that depends on the location of the nodule in the lung and how accessible it is from a needle. The next stage would be to have an open biopsy.

So, a common thing that we do at St.  Mark’s Hospital is video assisted resection of the nodule. Prior to that, I always have a discussion with the patient about possible need for further surgery if the nodule is cancer. The lung is interesting in that it’s divided into lobes. Each of those lobes has its own lymph node drainage.

So, lymph drainage is tissue and fluid that’s draining off of this tumor. It’s important for complete cure of lung cancer that not only the small little tumor,but the entire lymph node drainage is taken with the lung, with the lung tumor. So for example, a patient who comes in that has, let’s say a 2 centimeter nodule found on low-dose CT scan. They have a 30 pack year smoking history. We’re kind of worried that this would be cancer.

We send the patient for a needle biopsy. The biopsy comes back as cancer. At that point I would sit down with the patient and have a discussion about the options that would include assessment of the breathing function or what’s called lung volume function studies to determine how their lungs would perform after surgical resection.

Following that the patient would undergo removal of that lung lobe. So the tumor in that lung would come outwith the entire lobe. And that is really the only true cure of cancer. Sometimes patients will be referred to oncology before surgery to assess evidence for spread of the cancer prior to surgical removal. If a patient has a needle biopsy that’s indeterminate, a needle biopsy that is not conclusive, sometimes we have to take the tissue out and look at it under the microscope. Prior to surgery I discuss the options with the patient.

Usually this includes discussions that if we find cancer on the biopsy of the tissue that we remove the lobe of the lung that the tumor is located in. This allows us to remove the tumor at the earliest possible stage and thereby provide them with a possibility for a cure. Again, the only cure for lung cancer is resection. Complete resection with negative lymph nodes at an early stage.