Surgery is the preferred treatment for patients with early stage non-small-cell lung cancer, or NSCLC. Unfortunately, most patients who have advanced or metastatic disease are not suitable for surgery.
People who have NSCLC that has not spread can usually tolerate surgery, provided their lungs work well enough.
Surgery is not widely used in small-cell lung cancer (SCLC). Because SCLC spreads widely and rapidly through the body, removing it all by surgery is usually impossible. Your doctor is more likely to use treatments like chemotherapy, radiation, or immunotherapy.
What Are the Types of Surgery for NSCLC?
In general, your surgeon removes some or all of your lung with cancer in it. The extent of removal depends on the size of the cancerous tumor, where it is, and how far it has spread. Your surgeon may discuss one or more of these options with you:
Lobectomy. Your lungs are made of parts called lobes. Your right lung has three lobes and your left lung has two. A lobectomy removes the lobe that has a cancerous tumor in it. Doctors like to do this type of surgery whenever possible for NSCLC.
Segmentectomy or wedge resection. These are two kinds of surgeries that remove part of a lobe. Your surgeon might choose to do either of them if they think removing an entire lobe would stop your lung from working well.
Pneumonectomy. Your surgeon removes the lung that has cancer in it. You may need this operation if your tumor is close to the center of your chest or if a lobectomy wouldn’t get rid of it.
Sleeve resection. This usually involves your surgeon removing a cancerous lobe and part of a large airway called a bronchus, which goes from your windpipe into your lung. You have two of these airways, one for each lung. The surgeon then attaches the main part of the bronchus to the part that remains in a healthy lobe. They may do this operation instead of a pneumonectomy if they think it could help you breathe easier.
Like all surgeries, lung cancer operations come with risks. Ask your doctor about the possible side effects and complications of any surgery they recommend for you.
What Happens During Surgery?
Once you’re unconscious, your surgeon typically uses one of two techniques to reach your lung:
Thoracotomy. They make a large cut (or “incision”) between your ribs in the side of your chest or your back.
Video-assisted thoracic surgery (VATS). They make one to four small cuts in your chest. Then they insert a tiny camera to see images of your lung while they operate. Some surgeons do VATS by controlling a robot, which can help them make more precise movements with their surgery tools.
VATS is a less invasive type of surgery that is used when possible for the treatment of early-stage NSCLC. Recovery from this type of surgery is usually quicker than with traditional surgery.
What Happens After Surgery?
Your medical team moves you to a recovery area and then to your hospital room. They’ll keep a close eye on you the whole time.
When you wake up, you may feel groggy. Your care team will give you medications to ease any pain. It’s common to have tubes in your chest that your surgeon put in during the operation to drain fluid and blood -- your team usually removes these after a few days. If you need to go home with a tube still in place, your doctor or nurse will give you instructions on how to take care of it.
While you’re resting in the hospital, a respiratory therapist may help you with treatments to help your lungs work better. They might use medications, a device called a spirometer that tests how well you breathe, or both. You can ask your nurses how soon you can start walking again. You can also ask them how to change your surgery bandages and care for your healing incision.
Before you leave the hospital, your doctor or nurse will give you a list of instructions on how to recover at home.
What if Surgery Isn’t Right for You?
Your doctor may talk to you about one of these procedures for NSCLC if they rule out surgery due to your overall health, age, or another reason.
Photodynamic therapy (PTD). This technique uses drugs and laser light to treat early-stage lung cancers that haven’t spread beyond the outer layers of your lung airways. It can also treat tumors that block airways, helping you breathe easier.
Your doctor first gives you a drug called porfimer sodium through a vein. Then you go home and wait a couple of days while the drug builds up in your cancer cells. On the day of the procedure, your doctor gives you medicines to numb your throat and relax you, or general anesthesia to make you “sleep.” Then they insert a thin, flexible tube with a tiny camera on it, called a bronchoscope, into your nose or mouth. They guide this down your throat to the tumor in your lung. Next, a laser light on the end of the device triggers the drug in the cancer cells and destroys them. A few days later, your doctor uses a bronchoscope to remove the dead cells.
Afterward, your airway may be swollen for a few days, which could make you feel short of breath or cough up blood or mucus. The light-sensitive drug that your doctor gave you can also bring on skin reactions, like a bad sunburn. You’ll need to avoid strong indoor or outdoor light for several weeks after you get the injection. If you go outside, wear sunscreen, shades, a hat, and sun-protective clothes.
You may need to get PTD more than once for the treatment to work best.
Laser therapy. This treatment can burn away tiny tumors in the linings of your airways or larger tumors blocking your airways. Usually your doctor gives you general anesthesia before the procedure. Once you’re unconscious, they pass a bronchoscope down your throat and place it next to your lung tumor. Then they destroy the tumor with a laser on the end of the device. You may need to get laser therapy more than once to get the best results.
Radiofrequency ablation. This treatment uses radio waves to heat cancerous tumors. It may help if your tumors are close to the outer edge of your lung.
Before the procedure, your doctor gives you a shot of numbing medication called local anesthesia. You can also ask for meds to help you relax. Then the doctor inserts a thin, needle-like device into the numb part of your body. They use an imaging test called a CT scan to see inside your body and guide the tip of the device into your tumor. Once it’s in, the device sends an electric current into the tumor, heating it and destroying cancer cells.
You may have pain where the needle went in for a few days afterward.
Cryosurgery. A technique called cryosurgery is sometimes used for NSCLC. Your doctor may also call it cryotherapy or cryoablation. In cryosurgery, the tumor is frozen, which destroys it. This treatment is mainly reserved for patients who can’t tolerate traditional surgery.
Before the procedure, your medical team either gives you medicines to numb your throat and relax you, or general anesthesia to make you “sleep.” Your doctor then inserts a thin device called a cryoprobe into your nose or mouth and guides it down to your lung. They use imaging tests -- like ultrasound, CT, or MRI -- to see inside your body while they do this. The cryoprobe contains extremely cold gas or fluid that destroys cancer cells when it touches the tumor. Afterward, you may need to stay in the hospital overnight.
Experts are still looking into whether cryosurgery helps over the long term. If you and your doctor decide it’s right for you, make sure your health insurance plan covers it.
How Do You Prepare for Surgery or Another Procedure?
These general tips can help you get ready and set you up for a smoother recovery. Your doctor will give you specific instructions.
Weeks before your procedure:
- If you smoke, ask your doctor to help you quit.
- Get any tests your doctor recommends.
- If you have health insurance, find out how much you may need to pay out of pocket.
- Arrange for someone to drive you to and from the hospital or doctor’s office.
- Have a loved one or friend on standby to help you with chores and errands.
- If you work, request time off. (Your doctor can tell you how much you’ll need.)
Days before your procedure:
- Ask your doctor or nurse what to eat or drink in the 24 hours before your treatment.
- Also ask what medications you need to take.
The day of your procedure:
- Dress in loose, comfy clothes.
- Leave any jewelry, other valuables, and contact lenses at home.
- Follow any other instructions your doctor gave you.
What Should You Ask Your Doctor?
Before your procedure, ask questions about your recovery, like:
- What activities should I do or avoid while I’m recovering at home?
- What side effects should I be aware of, and how do I manage them?
- How long might I have shortness of breath?
- What follow-up appointments will I need?
- Could physical therapy help me recover? If so, when should I start?
What’s Recovery Like?
It depends on the type of procedure you had and your overall health.
An operation for lung cancer is major surgery. Many people feel pain, weakness, fatigue, and shortness of breath after surgery. Most have problems moving around, coughing, and breathing deeply. The recovery period can be several weeks or even months. You can ask your doctor for treatments to ease your pain or side effects at any time.
The other procedures -- radiofrequency ablation, cryosurgery, laser therapy, and photodynamic therapy -- generally have quicker, easier recoveries than surgery.
In general, call your doctor if you have:
- Discomfort while moving, coughing, or breathing deeply
- Emotional distress
- Any other concerning symptoms or drug side effects
While you’re getting better, tell your loved ones how they can help you, and reach out to your doctor with any questions you have.