Lung Cancer (Small Cell)

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Treating Lung Cancer - Small Cell TOPICS

Small cell lung cancer surgery

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

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.

Surgery and other techniques to relieve symptoms of SCLC

In some cases, surgery (or other localized techniques) may be used to help treat the symptoms of the cancer (as opposed to trying to remove all of the cancer).

Treating airway blockage

Tumors can sometimes grow into the lung airways, blocking them and causing problems such as pneumonia or shortness of breath. Treatments such as laser surgery can be used to relieve the blockage in the airway. This is done using a special type of laser on the end of a bronchoscope to destroy the tumor cells. A bronchoscope may also be used to place a metal or silicone tube (called a stent) in the airway after treatment to help keep it open. Other techniques like radiation therapy (described in the “Radiation therapy for small cell lung cancer” section) may also be used.

Treating fluid buildup

Sometimes fluid can build up in the chest outside of the lungs. It can press on the lungs and cause trouble breathing.

Pleurodesis: To remove the fluid and keep it from coming back, doctors sometimes perform a procedure called pleurodesis. A small cut is made in the skin of chest wall, and a hollow tube is placed into the chest to remove the fluid. Either talc or a drug such as doxycycline or a chemotherapy drug is then instilled into the chest cavity. This causes the linings of the lung (visceral pleura) and chest wall (parietal pleural) to stick together, sealing the space and limiting further fluid buildup. The tube is often left in for a couple of days to drain any new fluid that might collect.

Catheter placement: This is another way to control the buildup of fluid. One end of the catheter (a thin, flexible tube) is placed in the chest through a small cut in the skin, and the other end is left outside the body. This is done in a doctor’s office or hospital. Once in place, the catheter can be attached to a special bottle or other device to allow the fluid to drain out on a regular basis.

Last Medical Review: 06/06/2013
Last Revised: 02/11/2014