Thoracic Surgery & Oncology: A Guide to Lung Cancer Care
Introduction
Thoracic oncology focuses on diagnosing and treating intrathoracic cancers or cancers of the chest area. This includes small and non-small cell lung cancer, oesophagal cancer, and mesothelioma. A thoracic oncologist is a primary healthcare provider of a patient undergoing cancer treatment, ensuring an individualised and tailored therapy for intrathoracic cancers, including surgery and other medical interventions.
What is Thoracic Surgery
Thoracic surgery, meaning, in simple terms, is chest surgery involving the lungs, heart, or oesophagus. This speciality may involve diagnosing and treating lung cancers, including removing nodules, tumours, and lymph nodes to treat the disease. A thoracic surgery doctor specialising in thoracic oncology is equipped to treat lung cancers with multi-modal therapy, including surgery, chemotherapy, and radiation.
Types of Lung Cancer
- Small Cell Lung Cancer (SCLC) typically affects individuals with a long history of tobacco use. It is a rare, fast-growing lung cancer that starts in the bronchi (breathing tubes) and spreads to lymph nodes, bones, and the brain.
- Non-small Cell Lung Cancer (NSCLC) is any type other than SCLC. The most common are squamous cell carcinoma, large cell carcinoma, and adenocarcinoma. These NSCLCs may be associated with smoking. However, specialists may find these cancers in individuals who never smoked.
Causes and Risk Factors
The primary cause of lung cancer is cigarette smoking. It damages the cellular lining of the lungs due to cancer-causing substances, leading to abnormal cell growth.
Other Risk Factors
- Exposure to secondhand smoke and radon gas
- Exposure to cancer-causing agents in the workplace, e.g. diesel exhaust, coal products, and silica
- Previous radiation therapy
- Air pollution
- Family History
Symptoms and Diagnosis
Early-stage lung cancer has no apparent signs or symptoms. It commonly occurs when the tumour is at more advanced stages.
A lung cancer diagnosis starts with a thorough physical examination and an understanding of medical history and symptoms.
To confirm the diagnosis and aid in planning specific and appropriate treatment, your specialist may use the following tests:
- Imaging Tests
- Chest X-ray to spot large lesions.
- Computerised Tomography (CT) Scan to confirm X-ray findings and detect smaller growths.
- Magnetic Resonance Imaging (MRI) Scan to identify tumour depth across planes
- Positron Emission Tomography (PET) CT Scan for cancer staging.
- Imaging Tests uses a microscope to identify abnormal cells from sputum samples.
- Biopsy for lung cancer involves a bronchoscopy procedure. This requires a tube with a light and camera system to remove lung tissue for inspection.
Treatment Options
Thoracic surgery procedures and other medical interventions to treat lung cancer depend on the type and severity. A multidisciplinary approach with different specialists, such as a thoracic surgeon, oncologist, pulmonologist, and other healthcare providers, develops a treatment plan necessary for the patient’s needs and may include one or a combination of the following:
1. General Thoracic Surgery For Lung Cancer
One question that comes to mind for lung cancer patients is, “Is thoracic surgery dangerous”. Similar to other surgical procedures, thoracic surgery in Singapore comes with risks. It includes infection, bleeding, and blood clots. However, the advantages of the surgery outweigh the risks.
- Most common thoracic surgery procedures for precancerous or early-stage lung cancers with tumours less than two inches:
- Wedge Resection remove the cancerous tumour and the surrounding tissue. It may require the removal of small, triangle-shaped lung tissue.
- Segmental Resection is a thoracic surgery that removes a larger lung tissue than wedge resection.
- Wedge Resection remove the cancerous tumour and the surrounding tissue. It may require the removal of small, triangle-shaped lung tissue.
- Lobectomy involves the removal of the affected lobe when the cancer is localised and has a lower chance of spreading to other parts.
- Pneumonectomy removes the right or left entire lung due to an advanced cancer stage located in the main stem bronchus or extends across a major fissure.
2. Radiation Therapy uses X-rays and protons to generate intense energy beams to kill cancer cells. This is a neoadjuvant therapy to shrink the tumour before thoracic surgery, making removal easier.
3. Chemotherapy uses potent drugs to stop or slow cancer growth. This can also be a neoadjuvant or combination therapy with radiation.
4. Targeted Drug Therapy shrinks tumours with specific gene changes for advanced lung cancers.
5. Immunotherapy activates the patient’s immune system to recognise and destroy late-stage lung cancer cells.
Consult a thoracic surgeon with oncology specialisation for an accurate diagnosis and a suitable personalised and specific treatment plan to increase your survival rate and improve your quality of life after cancer.
Additionally, early screening detects the disease when it is more treatable. In Singapore, individuals aged 55 to 74 years who are current or former smokers with a smoking history for at least 30 or more pack-years may undergo a low-dose CT scan to screen for lung cancer.
(Pack years are calculated by multiplying the number of packs smoked per day by the number of years smoked.)
Conclusion
In Singapore, lung cancer is the second and third most common cancer diagnosis in men and women, respectively. As a result, understanding risk factors, symptoms, and the importance of screening is crucial to detect the disease early, especially for individuals with a smoking history. It leads to better outcomes and effective symptom management, allowing patients to live an improved quality of life even after thoracic surgery.
If you’re experiencing lung cancer symptoms, consult a thoracic surgeon specialising in thoracic oncology for early diagnosis, individualised symptom management and treatment, and better recovery before it develops into an advanced cancer stage.
