Is Surgery an Option for Unresectable Lung Cancer?

It might seem a curious question: Can you ever get surgery for unresectable lung cancer? After all, "unresectable" means you have a tumor that surgeons can't remove completely. But the truth is that sometimes, an operation may be a good idea.

Surgery could be an option if chemotherapy or radiation therapy shrinks your tumor so that it's small enough to take out. Your doctor may also think an operation is a good way to ease your cancer symptoms and help you feel better.

Surgery for Late-Stage Lung Cancer

Once, surgery wasn't possible for people with lung cancer that had spread. Doctors didn't want to put them through the pain and risks of surgery for a cancer that you can't cure.

But as treatments improve, tumors that doctors once considered unresectable can sometimes qualify for surgery today.

One option is to first shrink these tumors with chemotherapy or a combination of chemotherapy and radiation, called chemoradiotherapy. If your tumor gets down to a small enough size, your doctor may be able to remove all of it with surgery.

Researchers are also checking to see if surgery may be possible for late-stage lung cancer that has spread to other organs. It's based on the notion of "oligometastases" -- a new concept about the way cancer spreads.

"Oligo" means "a few." The term describes cancers that have spread to only a few places in your body. Lung cancer often travels first to organs like the brain, liver, or adrenal glands.

Surgery to remove cancer that has spread to these organs might help people live longer. Doctors are still testing this treatment approach, but it's promising.

Palliative Surgery

Palliative surgery won't stop your cancer from growing, but it can help ease symptoms like shortness of breath and a cough.

A few types of surgery are part of palliative care for lung cancer:

Bronchoscopy. A tumor in the lung can grow large enough to block your airway. In bronchoscopy, your doctor uses tools that he places down a thin scope into your lungs to open up the blockage and help you breathe more easily. He can also use the bronchoscope to burn off cancer cells with a laser.

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Stent. Your surgeon places a small plastic or metal tube inside your airway to hold it open. This tube is called a stent.

Photodynamic therapy. This procedure shrinks tumors that are blocking your airways. It uses a special medicine that kills cancer cells with light.

First, you get a medicine called porfimer sodium (Photofrin) that your doctor injects into a vein. The drug collects in lung cancer cells.

Then your doctor places a bronchoscope into your lung. It has a laser light on the end. The laser light activates the drug, which kills the cancer cells.

Thoracentesis. Lung cancer can cause fluid to build up in the space around your lungs. You'll hear your doctor call this pleural effusion.

The fluid can put pressure on your lungs and prevent them from filling all the way with air. This pressure makes it hard to breathe.

Thoracentesis places a needle or tube into the space between the lungs and chest wall. The fluid then drains out through the needle or tube.

Pleurodesis. This procedure treats pleural effusion -- a buildup of fluid around the lung -- and stops it from happening again.

Your doctor makes a small cut in your chest and places a tube between your lungs and chest wall. Fluid drains out through the tube.

Then your doctor injects medicine into the space to prevent fluid from collecting outside your lungs again.

Pericardiocentesis. Fluid can also build up in the sac around your heart. This can put pressure on your heart and prevent it from beating strongly enough.

During this procedure, your doctor inserts a needle into the area around your heart. Then he puts in a tube called a catheter to drain out the fluid.

The Decision to Have Surgery

Your doctor will talk you through all your treatment options, which might include surgery. Find out how a procedure might help you. Also ask what risks it can have.

Before you have any procedure, your doctor will do tests to check that you're healthy enough to go through surgery. Your medical team will also make sure that the surgery you have will help you more than harm you.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on July 28, 2018

Sources

SOURCES:

American Cancer Society: "Palliative Procedures for Non-Small Cell Lung Cancer," "Surgery for Non-Small Cell Lung Cancer."

Canadian Cancer Society: "Surgery for non-small cell lung cancer."

Cancer.net: "Lung cancer -- non-small cell: Stages," "Lung cancer -- non-small cell: Treatment options."

Johns Hopkins Medicine: "Pericardiocentesis."

Journal of Thoracic Disease: "Oligometastatic non-small cell lung cancer: is there a role for locoregional therapy?"

Lung Cancer: Targets and Therapy: "Oligometastatic non-small-cell lung cancer: current treatment strategies."

National Cancer Institute: "Unresectable."

UpToDate: "Management of stage III non-small cell lung cancer."

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