Lung Cancer Surgery

Lung Cancer: A Comprehensive Guide to Symptoms, Diagnosis, Treatment, and Surgery

Lung cancer is one of the most common and serious forms of cancer worldwide and remains a leading cause of cancer-related deaths. Despite its severity, advances in early detection, imaging, targeted therapies, immunotherapy, and surgery have significantly improved outcomes for many patients. Understanding lung cancer, its risk factors, symptoms, diagnostic methods, and available treatment options is essential for early intervention and effective management.

This detailed guide provides an in-depth overview of lung cancer, helping patients and caregivers understand the disease, recognize early warning signs, explore treatment options, and appreciate the importance of timely medical care.

For expert cancer care, evaluation, and treatment guidance, visit
https://drashishgoel.com/

Understanding Lung Cancer

Lung cancer originates in the tissues of the lungs, typically in the cells lining the air passages. It is broadly classified into two main types:

  1. Non-Small Cell Lung Cancer (NSCLC) – Accounts for approximately 85% of all cases. Subtypes include adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.
  2. Small Cell Lung Cancer (SCLC) – Less common but more aggressive.

Primary Risk Factors

  • Tobacco Smoking: The leading cause, responsible for 80–90% of lung cancer deaths. Even light or occasional smoking increases risk.
  • Secondhand Smoke: Non-smokers exposed to tobacco smoke face a 20–30% higher risk.
  • Environmental Exposures: Asbestos, radon gas, air pollution, and industrial chemicals (e.g., arsenic, chromium).
  • Genetic Predisposition: Family history may increase susceptibility.

Notably, 10–20% of lung cancer patients in India are non-smokers, with a higher proportion among women. This under scores the importance of awareness beyond smoking-related stereotypes.

Early Warning Signs of Lung Cancer

Unlike many cancers, lung cancer often presents no symptoms in its early stages. When symptoms do appear, they are frequently mistaken for common respiratory ailments like bronchitis or tuberculosis—a dangerous misconception in a country where TB is endemic.

Key warning signs that persist for three weeks or more include:

  • Persistent or worsening cough
  • Coughing up blood (hemoptysis)
  • Shortness of breath or wheezing
  • Chest pain that worsens with deep breathing, coughing, or laughing
  • Hoarseness or change in voice
  • Unexplained weight loss and fatigue
  • Recurrent infections like pneumonia or bronchitis
  • Swelling in the neck or face

Critical Note: In India, any unexplained shadow or fluid on a chest X-ray should never be automatically labeled as pulmonary tuberculosis without thorough investigation. Misdiagnosis can delay life-saving cancer treatment.

Diagnostic Process for Lung Cancer

Accurate diagnosis is the cornerstone of effective treatment. The process typically involves:

1. Imaging Studies

  • Chest X-ray: Initial screening tool, but lacks sensitivity for small tumors.
  • CT Scan of the Chest: Gold standard for detecting lung nodules, assessing tumor size, and evaluating lymph node involvement.
  • PET-CT Scan: Crucial for staging—determines if cancer has spread beyond the lungs.

2. Biopsy and Histopathology

A tissue sample is essential to confirm malignancy and determine the cancer subtype. Methods include:

  • Bronchoscopy: A scope is passed through the airways to collect tissue.
  • CT-guided Needle Biopsy: For peripheral lung lesions.
  • Endobronchial Ultrasound (EBUS): Allows sampling of mediastinal lymph nodes.

Contrary to popular myth, biopsy does not cause cancer to spread. It is a safe, necessary step for precise treatment planning.

3. Molecular and Genetic Testing

For NSCLC, testing for mutations (e.g., EGFR, ALK, ROS1, PD-L1) guides targeted therapy or immunotherapy options—part of modern precision oncology.

Staging Lung Cancer: Why It Matters

Staging determines the extent of disease and directly influences treatment strategy. The TNM system (Tumor, Node, Metastasis) is used:

  • Stage I: Tumor confined to the lung; no lymph node involvement.
  • Stage II: Larger tumor or spread to nearby lymph nodes.
  • Stage III: Locally advanced—tumor invades nearby structures or extensive lymph node involvement.
  • Stage IV: Metastatic disease—spread to distant organs (e.g., brain, bones, liver).

Only 15–20% of lung cancer cases in India are diagnosed at Stage I or II, highlighting the urgent need for public awareness and early screening in high-risk individuals.

Role of Surgery in Lung Cancer Treatment

Surgery is the primary curative treatment for early-stage non-small cell lung cancer (Stages I–IIIA). It aims to remove the tumor along with a margin of healthy tissue and affected lymph nodes.

When Is Surgery Recommended?

  • Confirmed NSCLC
  • Tumor localized to the lung or regional lymph nodes
  • Patient medically fit for anesthesia and major surgery
  • No evidence of distant metastasis

Surgery is generally not recommended for SCLC due to its rapid spread, though rare exceptions exist in very early cases.

Types of Lung Cancer Surgery

Dr. Ashish Goel specializes in a range of advanced surgical techniques tailored to tumor location, size, and patient health:

1. Lobectomy

  • Most common and preferred procedure for early lung cancer.
  • Removal of an entire lobe of the lung (the lung has 3 lobes on the right, 2 on the left).
  • Offers the best chance of cure and lowest recurrence rate.

2. Pneumonectomy

  • Removal of the entire lung.
  • Reserved for centrally located tumors involving the main bronchus or pulmonary artery.
  • Higher risk; requires excellent cardiopulmonary reserve.

3. Segmentectomy or Wedge Resection

  • Removal of only a segment or wedge of lung tissue.
  • Used for small tumors (<2 cm), elderly patients, or those with poor lung function.
  • Less invasive but carries a slightly higher recurrence risk than lobectomy.

4. Mediastinal Lymph Node Dissection

  • Systematic removal of lymph nodes in the central chest (mediastinum).
  • Critical for accurate staging and reducing recurrence.
  • Performed alongside the primary resection.

Minimally Invasive and Robotic Approaches

At leading centers in Noida and Delhi, including Max Super Speciality Hospital (where Dr. Goel previously served as Head of Surgical Oncology), minimally invasive techniques are now standard:

  • Video-Assisted Thoracoscopic Surgery (VATS): Uses small incisions and a camera, resulting in less pain, shorter hospital stays (3–5 days), and faster recovery.
  • Robotic-Assisted Surgery: Offers enhanced precision, 3D visualization, and greater dexterity for complex resections.

These approaches are especially beneficial for patients with comorbidities or reduced lung capacity.

Multimodality Treatment: Beyond Surgery

Lung cancer  is rarely controlled by surgical alone. Dr. Goel emphasizes a multimodal approach, integrating:

  • Neoadjuvant Therapy: Chemotherapy or immunotherapy before surgery to shrink large tumors.
  • Adjuvant Therapy: Post-surgery chemotherapy/ targeted therapy/radiation to eliminate microscopic disease.
  • Radiation Therapy: For inoperable cases or local control.
  • Targeted Therapy & Immunotherapy: For advanced or metastatic disease with specific biomarkers.

Sequence matters: The correct order of surgery, chemotherapy, and radiation is critical for optimal outcomes—a principle Dr. Goel strictly adheres to.

Debunking Common Myths About Lung Cancer

Misinformation can cost lives. Let’s address persistent myths:

Myth 1: “Only smokers get lung cancer.”

Fact: Up to 20% of women with lung cancer have never smoked. Environmental and genetic factors play significant roles.

Myth 2: “A shadow on X-ray is always TB in India.”

Fact: While TB is common, lung cancer must be ruled out with CT scan and biopsy before starting anti-TB treatment.

Myth 3: “Biopsy spreads cancer.”

Fact: No scientific evidence supports this. Biopsy is essential for diagnosis and treatment planning.

Myth 4: “Lung cancer is always fatal.”

Fact: Early-stage lung cancer has a 5-year survival rate of 60–80% with proper surgery and follow-up.

Myth 5: “Quitting smoking after diagnosis doesn’t help.”

Fact: Quitting improves surgical outcomes, reduces complications, and enhances response to therapy—even after diagnosis.

Prevention and Early Detection

While not all lung cancers are preventable, risk reduction is possible:

  • Quit smoking—seek professional help if needed. Many hospitals, including those in Noida, offer cessation programs.
  • Avoid secondhand smoke and occupational carcinogens.
  • Consider low-dose CT screening if you’re a high-risk individual (e.g., aged 50–80 with 20+ pack-year smoking history).

Early detection saves lives. If you have persistent respiratory symptoms, do not assume it’s TB—get evaluated for lung cancer.

If you or a loved one has symptoms suggestive of lung cancer or has been diagnosed with the disease, professional evaluation can help determine the most effective treatment plan. Learn more about lung cancer diagnosis, treatment, and expert care by visiting
https://drashishgoel.com/

Dr Ashish Goel was previously Director and Head Of Surgical Oncology at Max Super Speciality Hospital Noida. Presently he is Director and Unit Head at Action Cancer Hospital and Balaji Action Hospital, Delhi. He has keen interest in Breast, Head Neck, Thoracic and Esophageal, Urogenital, Gynaecological and GI cancer surgeries. He is an expert in Robotic Cancer Surgery

Early action and expert guidance can make a significant difference in outcomes.