Galen Ohnmacht, MD answers frequently asked questions about lung cancer treatment.
Dr. Ohnmacht is a thoracic surgeon and chair of thoracic surgery at UM BWMC and a clinical associate professor of surgery at the University of Maryland School of Medicine.
What are the risk factors for lung cancer?
Lung cancer is an abnormal growth of cells that originates in the lung and can spread and grow to other parts of the body without any kind of normal regulation by the body or its normal immune system. Risk factors for lung cancer include tobacco smoke, which is one that everyone knows, but also other substances such as asbestos, certain types of chemicals, and radon exposure. The substances that act on the lung, primarily tobacco smoke, are full of things called carcinogens, which act on the cells in the lung to cause them to grow abnormally and cause them to become cancerous.
How do you screen for lung cancer?
Ways that have been tried in the past include screening chest x-rays, however, studies in the '70s and '80s show that screening chest x-rays weren't even a benefit to patients in terms of screening for lung cancer or catching it at an early stage, which is one of the goals of a lung screening program.
Other ways of screening include what's called sputum cytology, where people cough or expectorate into a cup and we analyze that sputum for abnormal cells. There's a lot of hope that this would yield a screening tool for lung cancer, but unfortunately, many studies also show that that was not really effective at catching lung cancer at an early enough stage to make any difference in people's survival and outcomes.
One area of study now is CT scanning of the chest for lung cancer. There's many proponents and many opponents of this particular screening method, but the proponents say that lung cancers can be caught earlier and that people can be caught at a stage in their disease where it's much more easily treatable by such things as surgery, chemotherapy and radiation therapy. Others point to the fact that we screen a lot of people who don't have lung cancer, exposing them to the radiation of CT scans, without any proven benefit to their overall survival or outcomes.
What are the signs and symptoms of lung cancer?
One of the biggest problems with people who have lung cancers in their bodies is that there are very few signs that you could be having a problem in your lungs, in terms of a lung cancer that's growing. Unfortunately, there's not any one single thing to look for. By the time that lung cancer causes symptoms for people to look for, often times it's very advanced and it's among the most poorly treatable types of lung cancers.
Types of symptoms that people do have include chest pain, coughing up of blood, a non-productive cough that never stops, chest wall pain or pressure, or just a funny feeling in the chest that persists and doesn't go away.
How is lung cancer treated?
The primary treatments for lung cancer include surgery, chemotherapy and radiation therapy, and of course novel therapies. For patients with early stage lung cancer, primarily the treatment is surgery. For people who have a little bit more advanced cases, sometimes chemotherapy and radiation can play a role. In especially advanced lung cancers, often times radiation and nearly always chemotherapy plays a role.
In terms of new advances in surgery, which I'm concerned with, surgery and removing the portion of the lung affected by lung cancer is the treatment we most often choose. In terms of technological advances, one of the things that we're able to do at UM BWMC in selected patients with early stage cancers is, we can offer them a video lobectomy, which is using video technology to help visualize and help along the operation in a minimally invasive manner. We can avoid larger and sometimes more painful incisions. The advantages of a video lobectomy as opposed to traditional, open lobectomy with a thoracotomy, a bigger incision, is that we are usually able to offer our patient a shorter length of stay, less pain, and hopefully a quicker recovery. Certainly, many studies have shown that for selected early-stage patients, the complication rates can be as low or lower than traditional open thoracotomies.
What are the surgical options for treating lung cancer?
The usual, traditional approach for operations for lung cancer is to approach it through a larger incision, up to 6-8 inches long. That allows us to look inside the chest, and it usually involves spreading the ribs apart far enough that we can peer into the chest and see the anatomy of the lungs and the tumor's relationship to the lungs and the major structures within the chest. We're able to see and access everything in the chest from the incision that we make. No other incisions are made except to place drains, and occasionally special implements.
A video lobectomy, on the other hand, the visualization is provided by a video camera that's on a slender tube that's inserted into the chest. This allows us to see within the chest and then we only have to make other incisions, usually less than an inch long that we can insert our instruments through, and work under the direction for the video camera. Both approaches are effective, and we can do the operation through either approach.
What are the advantages to a video lobectomy?
Many state that they feel that the advantages of a video lobectomy over a traditional open thoracotomy with a longer incision and rib spreading is that there is generally a shorter hospital stay in may cases, and that there is an early time to going home. There's less drainage from the chest, and it stops earlier. People have less pain because there's no rib spreading involve, except to actually remove the diseased portion of the lung. The recovery time is felt by many to be shorter as well.
Are there risks to this type of surgery?
One common misconception we hear frequently is that if you have an operation for lung cancer, when you open the chest for any reason and expose the tumor to air, that it's going to grow or spread faster. That's not the case--there's no evidence to indicate that the cancer will grow or spread faster with an operation. If that were the case, thoracic surgeons wouldn't be able to operate for lung cancer.
Is surgery the right option for me?
Patients who undergo operations for lung cancer are carefully screened beforehand to make sure they have the capacity to recover afterwards, in terms of their lung function and their overall reserve of how well they're able to breathe. We perform pulmonary function testing in order to assess their lung volume and pulmonary reserve. Though these tests aren't foolproof and we're careful, most people can tolerate operations if they're properly selected.
In terms of the recovery time, most patients are in the hospital for a little bit less than a week, usually 4-6 days after a standard thoracotomy. They're able to go back to work within 3-4 weeks after surgery. After any operation, people may have pain, and we treat the pain with oral pain medication, weaned off over a week or two after the operation.