Lung resections for lung cancer
Tumors in the lung usually appear as something unexpected, since they have few symptoms. Even though it is a complex situation, thanks to the progress of science and medicine, there are treatments and solutions that allow treating the disease; such as surgery, which is undoubtedly the best option. At present, lung cancer is among the top five cancer diagnoses in our country, and in the world it is one of the main causes of death.
Tumors in the lung can be caused by other tumors located in other organs or, failing that, they originate in the lung itself. In this case they are called primary tumors and can be benign or malignant, if cancer is present. If, on the other hand, the tumor is the product of other tumors, it is called metastasis. Thoracic surgery may or may not be decisive, depending on the situation at the time of diagnosis.
It is a difficult tumor to diagnose early because it is “silent” and its symptoms are scarce. Once symptoms begin to appear, the tumor is already in an advanced condition. The diagnosis and treatment of the patient with lung cancer requires multidisciplinary care by various specialists.
Lung cancer treatments
Surgical treatment of lung cancer usually requires the performance of a lung lobectomy or pneumonectomy, followed by complete removal of all the lymph nodes around the lung (lymphadenectomy). In most cases, these procedures are performed by minimally invasive surgery (VATS), without opening the chest.
There are some treatments that can be performed after surgery, or when there is no longer an option for surgery. Among the treatments are chemotherapy and radiotherapy, these are ideal to fight lung cancer, depending on when the tumor is detected.
Chemotherapy, in some cases, is recommended before surgery in order to reduce the size of the lesion, or to complement the treatment of surgery. On the other hand, radiotherapy is resorted to when surgery is no longer an option; it is usually associated with chemotherapy in advanced stages, if the patient’s condition allows it.
Malignant Pleural Mesothelioma
Malignant mesothelioma is a disease in which malignant (cancerous) cells are found in the pleura (the thin layer of tissue that lines the chest cavity and covers the lungs). Many people affected with malignant mesothelioma have worked or lived in places where they inhaled asbestos.
Possible signs of malignant mesothelioma include shortness of breath and chest pain.
Differences between lung cancer and malignant mesothelioma:
In order to differentiate malignant mesothelioma from lung cancer, the following tests and procedures may be used.
- Radiologic studies (CT of the chest): a procedure in which a series of detailed pictures of the chest and abdomen are taken from different angles (using x-rays). A contrast dye is injected into a vein to help the organs or tissues show up more clearly.
- Biopsy: The removal of cells or tissues from the pleura for examination under a microscope to check for signs of cancer. The following procedures are used to obtain cells or tissues:
- Fine needle aspiration biopsy (FNA): removal of tissue or fluid with a fine needle. It is performed under radiological control to locate the abnormal tissue or fluid. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid and a sample is removed.
- Thoracoscopy: An incision (cut) between two ribs and introduction of a thoracoscope.
- Thoracotomy: An incision made between two ribs to examine the inside of the chest for signs of disease.
- Open biopsy: a procedure in which an incision is made in the skin to expose and remove tissues for examination for signs of disease.
- Cytologic examination: Examination of cells under a microscope to check for anything abnormal. In the case of mesothelioma, fluid from around the lungs and samples of pleural tissue are removed.
- The prognosis of the disease and treatment options depend on the following: the stage of the cancer, the size of the tumor, whether the tumor can be completely removed by surgery, the amount of fluid in the chest or abdomen, the patient’s age and general health, and the type of mesothelioma cancer cells.
Treatment options for malignant mesothelioma:
Localized malignant mesothelioma (stage I).
If the malignant mesothelioma is located in one part of the pleura, surgery is the best treatment option. Surgical treatment may consist of:
- Pleurectomy and decortication, with or without chemo-radiotherapy, as therapy to reduce symptoms and improve quality of life.
- Extrapleural pneumonectomy, with or without chemo-radiotherapy.
- Radiotherapy, as palliative therapy to alleviate symptoms and improve quality of life.
- A clinical trial of anticancer drugs applied directly to the chest (intraoperative chemotherapy) after surgery to remove the tumor.
- A clinical trial of combinations of surgery, radiotherapy and chemotherapy.
- Participation in a clinical trial of an innovative treatment.
Advanced malignant mesothelioma (stage II, III and IV).
Treatment of advanced malignant mesothelioma may include:
- Surgery, to drain fluid that has accumulated in the chest, to reduce discomfort.
- Pleurodesis, to prevent more fluid from accumulating in the chest.
- Pleurectomy and decortication, as therapy to relieve symptoms and improve quality of life.
- Radiation therapy, as palliative therapy to relieve pain.
- Chemotherapy with an anticancer drug.
- Participation in a clinical trial of combination chemotherapy.
- A clinical trial of combinations of surgery, radiotherapy and chemotherapy.
- A clinical trial of intrapleural chemotherapy to shrink tumors and prevent fluid accumulation.