Lung Cancer (Small Cell)

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Treating Lung Cancer - Small Cell TOPICS

Surgery for small cell lung cancer

Surgery is rarely used as the main treatment in small cell lung cancer (SCLC). Occasionally (in fewer than 1 out of 20 patients), the cancer is found as only a single lung tumor, with no spread to lymph nodes or other organs. Surgery may be an option for these early stage cancers, usually followed by additional treatment (chemotherapy, often with radiation therapy).

If your doctor thinks the lung cancer can be treated with surgery, pulmonary function tests will be done first to see if you would still have enough healthy lung tissue remaining after surgery. Other tests will check the function of your heart and other organs to be sure you’re healthy enough for surgery.

Because more advanced stage lung cancers are not helped by surgery, your doctor will also want to make sure the cancer hasn’t already spread to the lymph nodes between the lungs. This can be done before surgery with mediastinoscopy or with some of the other techniques described in the section “How is small cell lung cancer diagnosed?

Types of lung surgery

When surgery is being considered for SCLC, the first step often involves making sure that the cancer hasn’t spread to the lymph nodes in the middle of the chest. The surgeon will do biopsies under bronchoscopy or mediastinoscopy (these were discussed in the section “How is small cell lung cancer diagnosed?”). If the lymph nodes contain cancer, then surgery is not a good treatment for SCLC.

Different operations can be used to treat lung cancers. These operations require general anesthesia (where you are in a deep sleep) and are usually done through a surgical incision between the ribs in the side of the chest (called a thoracotomy).

  • Pneumonectomy: an entire lung is removed.
  • Lobectomy: an entire section (lobe) of a lung is removed.
  • Segmentectomy or wedge resection: part of a lobe is removed.
  • Sleeve resection: a section of a large airway is removed and the lung is reattached.

In general, lobectomy is the preferred operation for SCLC if it can be done, because it offers a better chance of removing all of the cancer than segmentectomy or wedge resection.

With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer.

When you wake up from surgery, you will have a tube (or tubes) coming out of your chest and attached to a special canister to allow excess fluid and air to drain out. The tube(s) will be removed once the fluid drainage and air leak subside. Most people will spend about a week in the hospital after the surgery.

Video-assisted thoracic surgery: Some doctors now treat some early stage lung cancers near the outside of the lung with a procedure called video-assisted thoracic surgery (VATS), which requires smaller incisions than a thoracotomy.

During this operation, a thin, hollow tube with a tiny video camera on the end is placed through a small cut in the side of the chest to help the surgeon see inside the chest on a TV monitor. One or two other small cuts are created in the skin, and long instruments are passed though these holes to cut away the tumor. One of the incisions may need to be enlarged to remove the lung specimen. Because smaller incisions are needed, there is less pain after the surgery and a shorter hospital stay, usually around 4 to 5 days.

Most experts recommend that only early stage tumors near the outside of the lung be removed this way. The cure rate after this surgery seems to be the same as with surgery done with a larger incision. But it is important that the surgeon be experienced with this procedure because it requires a great deal of technical skill.

Possible risks and side effects of lung surgery

Possible complications during and soon after surgery depend on the extent of the surgery and a person’s health beforehand. Serious complications can include excess bleeding, wound infections, and pneumonia. While it is rare, in some cases people may not survive the surgery, so it is important to talk with your doctors to be sure you are a good candidate for surgery.

Surgery for lung cancer is a major operation, and recovering from the operation typically takes weeks to months. When the surgery is done through a thoracotomy, the surgeon must spread ribs to get to the lung, so the area near the incision will hurt for some time after surgery. Your activity will be limited for at least a month.

If your lungs are in good condition (other than the presence of the cancer) you can usually return to normal activities after some time if a lobe or even an entire lung has been removed. If you also have non-cancerous lung diseases such as emphysema or chronic bronchitis (which are common among heavy smokers), you may become short of breath with activity after surgery.

Last Medical Review: 09/12/2014
Last Revised: 03/09/2015