Inoperable Lung Cancer

Medically Reviewed by Sabrina Felson, MD on August 22, 2022
6 min read

Inoperable lung cancer is a tumor that surgery can’t treat. This might be because the cancer is in a hard-to-reach spot or for other reasons, like if it’s spread outside your lungs. It’s also called unresectable lung cancer.

Just because you can't have surgery doesn't mean you can't do anything about the cancer. Treatments like radiation, chemotherapy, targeted therapy, and immunotherapy can fight it, even when an operation isn't an option.

There are two main types of lung cancer, based on the size of the affected cells:

  • Non-small-cell lung cancer (NSCLC). Up to 85% of lung cancer cases are this kind. It has three subtypes:
    • Adenocarcinoma. This starts in cells that make things like mucus. It’s often found in the outer parts of your lung, many times before it has spread.
    • Squamous cell carcinoma. This begins in the flat cells that line the inside of your airways. It’s usually found in the center of your lungs.
    • Large-cell (undifferentiated) carcinoma. This can happen in any part of the organ. It tends to grow and spread quickly, so it can be harder to treat than the other types.
  • Small-cell lung cancer (SCLC). This kind is almost always tied to cigarette smoking.About 70% of cases are diagnosed after the cancer has spread. It tends to grow faster than NSCLC. This means it may respond well to chemotherapy and radiation therapy.

Some reasons why surgery might not be right for you:

Your cancer has spread. The goal of lung cancer surgery is to take out the whole tumor. Doctors can't do that if it's spread outside your lung.

Removing the main tumor in the lungs won't stop cancer in other organs or distant lymph nodes. Treatments like radiation, chemotherapy, or immunotherapy work better than surgery.

You have small-cell lung cancer. Surgery is one of the main treatments for early NSCLC. Doctors rarely treat SCLC with surgery because the cancer has often spread by the time it's diagnosed.

The cancer is in a tricky spot. A tumor that is very close to other organs or to blood vessels may be hard to remove without causing a lot of damage. This can make the surgery too risky.

Your lungs aren't healthy enough. Lung cancer surgery removes part or all of the diseased lung. You need enough healthy tissue left behind to be able to breathe well after the surgery.

You'll get lung function tests like spirometry before your procedure. These tests measure the force of your breath to make sure your lungs are in good enough shape for surgery.

You have heart disease. In that case, there's a small chance your lung surgery could cause complications like a heart attack or another serious heart problem. Your doctor will do tests to check your ticker's health before surgery.

You have other serious health conditions.Lung surgery and the anesthesia used to put you to sleep can cause complications. The operation may be too risky for you if you're in poor health.

Symptoms like a nagging cough, chest pain, and shortness of breath often don't start until lung cancer has spread. The lack of early symptoms is why many people aren't diagnosed until their cancer is inoperable.

Lung cancer is usually first suspected on imaging, an xray or lung ct. To make a certain diagnosis your doctor will need small sample of the mass. Depending on where in the lung it is located it may be collected by bronchoscopy or Video-assisted thoracoscopic surgery (VATS) if it is located closer to the chest wall rather than inside or close to a large airway which is more accessible by bronchoscopy. 

A bronchoscopy involves using a thin tube with a light on the end that lets your doctor see inside your lungs and remove a small piece of tissue. A lab then examines the tissue sample to see if it's cancer.

Other tests can show where in your body the cancer has spread and help your doctor decide whether surgery is an option for you:

  • X-ray. It uses radiation in low doses to make pictures of your lungs and other organs.
  • CT. It's a powerful X-ray that makes detailed pictures of your lungs, lymph nodes, and other organs.
  • MRI. It uses powerful magnets and radio waves to create images of structures inside your body. It can find lung cancer that has spread to your brain or spinal cord.
  • Ultrasound. Your doctor uses sound waves to make pictures of the inside of your body.
  • PET (positron emission tomography). It uses a radioactive sugar that cancer cells absorb. Then, a special camera gets a close-up look at areas that have absorbed the sugar. PET is often combined with a CT scan.
  • Bone scan. It uses a radioactive material and special camera to show whether cancer has spread to your bones.
  • Thoracoscopy. This procedure uses a lighted tube with a video camera on the end to see if the cancer has spread outside of your lungs.
  • Mediastinoscopy. Your doctor uses a thin, lighted tube to see inside your lungs and remove tissue to check for cancer.

The tests will tell your doctor where the cancer is, whether it’s spread, and whether it’s affecting other parts of your body. The doctor will use this information to assign a stage.

The stages of non-small-cell lung cancer are:

  • Stage 0 or in situ. The cancer hasn’t spread into nearby tissues.
  • Stage I. This is a small tumor that hasn’t spread to any lymph nodes, so a surgeon can remove it all.
  • Stage II. Surgery is sometimes an option at this stage.
    • Stage IIA. This tumor is between 4 and 5 centimeters (cm). It hasn’t spread to nearby lymph nodes.
    • Stage IIB. The tumor is 5 cm or smaller and has spread to the lymph nodes, or it’s bigger than 5 cm and hasn’t spread to the lymph nodes.
  • Stage III. This stage is further divided into IIIA, IIIB, and IIIC, depending on the size of the tumor and which lymph nodes are involved. It may be very hard to remove IIIA and IIIB tumors with surgery. IIIC cancer can’t be treated with surgery.
  • Stage IV. This cancer has spread to more than one area in the other lung, the fluid around the lungs or heart, or distant parts of your body. Surgery generally isn’t an option at this stage.

The stages of small-cell lung cancer are:

  • Limited. Cancer is in only one part of your chest.
  • Extensive. The cancer has spread to other parts of your body, such as your other lung, brain, bones, or bone marrow.

Your doctor may consider surgery for SCLC if you’re diagnosed at a very early stage.

A lung cancer diagnosis can be stressful and scary. But it’s important to remember that “inoperable” doesn’t always mean there’s nothing to be done. If you can't have surgery, your doctor will help you choose another treatment, based on your stage and overall health.

  • Radiation therapy. Your doctor uses high-energy X-rays or other radiation to kill cancer cells or keep them from growing. If you have NSCLC, they may direct the energy at a certain part of your body from the outside with a machine (called external) or implant a radioactive seed, wire, or needle in your body near the cancer (called internal). External radiation therapy is used for SCLC.
  • Chemotherapy. Certain drugs can kill cancer cells or keep them from dividing. You may get pills to swallow or have injections.
  • Targeted therapy. This treatment uses drugs or antibodies that attack specific cancer cells, often with less harm to healthy cells than either radiation or chemo. It’s used for non-small-cell lung cancer.
  • Immunotherapy. This is also called biologic therapy. It helps boost your immune system, direct it, or restore it to fight cancer.
  • Clinical trials. You may also join a clinical trial. It's a type of study that tests new treatments for lung cancer before they're available to everyone. Your doctor can tell you if one of these trials might be a good fit for you.


Your outlook will depend on several things, including the cancer type and the stage at diagnosis. About 20.5% of people who have any kind of lung cancer live at least 5 years after diagnosis. This 5-year survival rate is 24% overall for non-small-cell lung cancer and 6% overall for small-cell lung cancer.

Five-year survival rates for people who have NSCLC are:

  • 61% if the cancer hasn’t spread outside the lung
  • 35% if it’s spread to nearby areas
  • 6% if it’s spread to distant parts of your body

Five-year survival rates for people who have SCLC are:

  • 27% if it hasn’t spread outside your lung
  • 16% if it’s spread to nearby areas
  • 3% if it’s spread to distant parts of your body