Surgery is the main treatment for lung carcinoid tumors whenever possible. Most lung carcinoid tumors are cured by surgery alone. The type of surgery will depend on a number of factors, including the size and location of the tumor and whether you have any other lung problems or serious diseases. Thoracic and cardiothoracic surgeons are likely to have the most experience with these operations.

Several types of surgery are used to treat people with lung carcinoid tumors. Surgeons usually have to remove some normal lung tissue along with the tumor, but they try not to remove any more normal tissue than they need to.

These operations require general anesthesia (where you are in a deep sleep) and a surgical incision between the ribs in the chest (thoracotomy). You will generally need to spend 5 to 7 days in the hospital after the surgery.

Sleeve resection: To treat central carcinoids of a large airway, the surgeon may do a sleeve resection. If you think of the large airway with a tumor as similar to the sleeve of a shirt with a stain an inch or 2 above the wrist, the sleeve resection would be like cutting across the sleeve above and below the stain and sewing the cuff back onto the shortened sleeve.

Wedge resection: For small carcinoids found at the edges of the lungs away from the large airways, the surgeon may remove a wedge-shaped piece of the lung in an operation called a wedge resection or segmental resection.

Lobectomy: If it is not possible to do a sleeve or wedge resection because of the size or location of the tumor, the surgeon will usually do a lobectomy, in which an entire lobe of the lung is removed. In some cases 2 lobes may be removed (bilobectomy).

Pneumonectomy: In rare cases where the cancer is in many spots or is in a place that makes it hard to remove, it may be necessary to remove the entire left or right lung in an operation called a pneumonectomy.

With any of these operations, lymph nodes near the lungs are usually removed to look for possible spread of the cancer. This is important because about 10% of typical carcinoids and 30% to 50% of atypical carcinoids will have spread to lymph nodes by the time they are diagnosed. Not removing these nodes might increase the risk of the carcinoid tumor spreading even farther, to other organs. If this happens, you may no longer be able to be cured by surgery. Removing the lymph nodes also provides some indication of your risk of having the cancer come back.

Video-assisted thoracic surgery (VATS): Recently, some doctors have begun to use this less invasive procedure for treating some cancers in the lungs. During this operation, a thin telescopic tube with a tiny video camera on the end is placed through a small hole in the chest to help the surgeon see the chest cavity. One or two other small holes are created in the skin, and long instruments passed though these holes are used to remove the tumor. Because only small incisions are needed, there is a little less pain after the surgery. Another advantage of this surgery is a shorter hospital stay – usually around 4 to 5 days.

Most experts recommend that only tumors smaller than 4 to 5 cm (about 2 inches) across be treated with this method. This would apply to most carcinoids. The cure rate after this surgery seems to be the same as with older techniques. It is important, though, that the surgeon performing this procedure be experienced since it requires a great deal of technical skill.

Possible side effects of surgery

Possible complications depend on the extent of the surgery and the person's health beforehand. Serious complications can include excessive bleeding, wound infections, and pneumonia.

Because the surgeon must spread ribs to get to the lung in patients undergoing a thoracotomy, the incision will hurt for some time after surgery. Your activity will be limited for at least a month or two.

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

Surgery to relieve symptoms from lung carcinoid tumors

If you can't have major surgery because of reduced lung function or other serious medical problems, or if the cancer is widespread, other types of surgery may be used to relieve some symptoms.

For example, if the tumor is causing blockage of airways that may lead to pneumonia or shortness of breath, removing most of the tumor through a bronchoscope or vaporizing most of it with a laser can be helpful. These treatments, called palliative procedures, can relieve symptoms, but they cannot cure the cancer and are recommended only if you cannot have surgery to completely remove the tumor. If you are treated with these procedures you may also get radiation therapy (see the section on radiation therapy).

Sometimes fluid can build up in the chest cavity (outside of the lungs) and interfere with breathing. 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 the 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 preventing further fluid buildup. The tube is generally left in for a day or two to drain any new fluid that might accumulate.

For more general information about surgery, please see the separate American Cancer Society document, Surgery.

Last Medical Review: 03/09/2009
Last Revised: 03/09/2009