Lung cancer: treatment, type, and subtypes
Before we discuss lung cancer treatment, it’s important to know its main types and subtypes. About 80% to 85% of lung cancers are non-small cell lung cancer (NSCLC), while 10% to 15% fall into the small cell lung cancer (SCLC) group.
NSCLC is typically adenocarcinoma, squamous cell carcinoma, or large cell carcinoma (undifferentiated). Other subtypes, such as adenosquamous carcinoma and sarcomatoid carcinoma, although rarer, can also occur.
On the other hand, SCLC is more likely to grow and spread rapidly, with about 70% of patients presenting with metastases at the time of diagnosis. In this context, surgery is rarely used as the primary treatment option – SCLC tends to respond better to chemotherapy and radiation therapy.
The main goal of surgery in lung cancer is to remove the tumor and eliminate the disease, but it can also be used to relieve symptoms in more advanced cases considered incurable.
Types of Surgery for Cancer
If surgery is recommended, a lung function test is first performed to verify if the patient will still have enough functional lung tissue after the procedure. Other tests will check the cardiac and other organs’ function to confirm that the person has adequate physical conditions for surgery.
Several types of surgeries for lung carcinoid tumors can be used to treat (and in some cases, cure) lung cancer, whether it is NSCLC or SCLC. In any of these surgeries, adjacent lymph nodes are removed to analyze possible metastases. The surgical procedures are performed under general anesthesia and require a large surgical incision between the ribs on the side of the chest or back, called a thoracotomy.
The technique chosen will depend on the size and location of the tumor, as well as lung function. The main ones are:
- Pneumonectomy: a procedure in which the entire lung is removed. It is usually adopted when the tumor is near the center of the chest;
- Lobectomy: the lungs have five lobes, three on the right side and two on the left. In this surgery, the lobe containing the tumor is completely removed. Whenever possible, this is the technique most used in NSCLC;
- Segmentectomy or wedge resection: only a part of the lobe is removed. It is usually done when the patient does not have normal lung function sufficient to support the removal of the entire lobe;
- Sleeve resection: can be used to treat some cancers in the larger airways of the lungs. To understand this technique, imagine that the airway affected by the tumor is the sleeve of a shirt and has a stain a few centimeters above the wrist.
Sleeve resection would be like cutting the sleeve (airway) above and below the stain (tumor) and then sewing the cuff back onto the remaining sleeve. It can be done instead of pneumonectomy to preserve more lung function.
With the development of robotic surgery, the applicability of technology for the treatment of lung cancer, both small cell and non-small cell, regardless of the chosen technique (pneumonectomy, lobectomy, or segmentectomy), has been increasing.
Possible adverse effects of surgery
Surgery for lung cancer is a complex procedure that can have some adverse effects and complications. The patient may experience reactions to anesthesia, excessive bleeding, shortness of breath, blood clots in the legs or lungs, pain, infection in the surgical wound, and pneumonia.
Recovery from lung surgery typically takes a few weeks. If it is performed through thoracotomy, the surgeon needs to separate the ribs to reach the lung. Therefore, there may be pain at the incision site for some time.
For information on other types of treatments, please see our section on treatments in oncological surgery.
