Lung Cancer

What is Lung Cancer?

Lungs are double sponge-like organs of our respiratory system. The right lung is composed of 3 parts (lobes) and is slightly larger than the left lung (2 lobes). Lung cancers are divided into two main pathologic categories: small cell and non-small cell lung cancers. Both lung cancer types develop, spread and are treated differently. Non-small cell lung cancers are more frequent, and develop and spread more slowly. Non-small cell lung cancer has 3 main types. They are named according to the type of tissue from which the cancer emerges (squamous cell carcinoma, adenocarcinoma and large cell carcinoma). Small cell cancer, sometimes called oat cell cancer, is less common than non-small cell cancer. This type of lung cancer grows faster and tends to spread to other parts of the body.

How is lung cancer diagnosed?

If you have the symptoms listed above, your doctor will investigate your medical history, smoking history, exposure to environmental toxic substances and your family history. Your doctor will also order a chest x-ray and other diagnostic tests. Various procedures such as sputum cytology, bronchoscopy, needle biopsy, thoracentesis or thoracotomy may be performed.

What is staging?

If you are diagnosed with cancer, your doctor must know the stage of your disease. Staging allows identifying the spread of cancer in your body. Once the cancer is staged, your doctor may organize your treatment. Computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), bone scintigraphy and/or mediastinoscopy/ ediastinotomy can be used for this.

How is cancer treated?

Cancer treatment may vary depending on many factors: cancer stage (spread), size, location and general condition of the patient. Various treatments and treatment combinations may be used to control lung cancer or to improve quality of life by reducing symptoms. Lung cancer treatment includes surgery, radiation therapy, and chemotherapy.

Lung Cancer Surgery

Surgery is the oldest and most effective form of cancer treatment. Approximately 15-20 percent of cancer patients are treated with direct surgery. Surgery can be applied in combination with other treatment methods. Curative surgery involves the removal of the tumor tissue and if necessary, all accompanying lymph nodes with the surrounding tissues. Many studies have demonstrated superiority of surgery over other treatment modalities in cases without distant metastasis (except brain metastasis). It has been accepted as the best treatment modality in lung cancer especially in the early stages of the disease. Surgery may be supported by radiation therapy and/or chemotherapy as necessary.

Types of curative surgery

  • Videothoracoscopic (closed) surgery
  • Robotic surgery
  • Open surgery with thoracotomy
  • Diagnostic surgery (biopsy): This is a method used both in the diagnosis and treatment of masses located in the peripheral regions of the lungs. Furthermore, it is usually used as a final option for masses that cannot be diagnosed by other methods.
  • Staging Surgery: It is applied to determine the distant or regional spread of cancer. Mediastinoscopy or mediastinotomy identifies the spread of the disease in the regional lymph nodes and provides effective treatment before surgery.
  • Supportive surgery: It can be applied to support other cancer treatments. For example, some chemotherapy devices need ports placed under the skin.
  • Palliative surgery: It is used only to reduce pain and complications from the progression of cancer. Palliative surgery is performed to improve the quality of life; it is not a cure or anti-cancer treatment.

Minimally Invasive Surgery

Minimally invasive or endoscopic surgery provides the advantages of performing effective cancer surgery thanks to advances in computer imaging and robotic field.
Advantages of Minimally Invasive Surgery
  • Less blood loss
  • Reduced blood transfusion requirement
  • Short hospital stay
  • Reduced pain and postoperative medication requirement
  • Faster return to normal diet
  • Quick recovery and return to normal activities
  • Less scarring and better cosmetic appearance

Video-Assisted Thoracoscopic Surgery (VATS / VYTC)

Video-assisted thoracoscopic surgery or VATS can be used to diagnose and/or treat lung and esophageal cancers. It can be performed through a 1.5 cm incision for diagnostic purposes, as well as a few small incisions and a 5 cm additional incision to remove a part or all of the lung for treatment. It is a very good diagnostic method for sampling pleural membrane, lung nodules, mediastinal masses and pleural fluid. It can be used in combination with pleurodesis (powder use) to prevent re-accumulation of fluid, especially in the presence of recurrent fluid due to cancers.

Robotic Surgery (Da Vinci)

The "Da Vinci" Robotic System used at Liv Cancer Center has changed patients' experience of thoracic and lung cancer. Traditional surgery involves painful and large incisions, as well as major complications and long recovery times.

The Da Vinci robot makes it easy to reach the thoracic cavity, without requiring a large incision and separation of the ribs. Da Vinci's equipment allows the removal of part or all of the lung with minimal damage to surrounding tissues within the thoracic cavity. The ability to provide 3D (three dimensional) images and 360° movement allows the surgeon and the patient a very safe surgery.

3D Brachytherapy in Lung (Bronchial) Cancers

Suitable patients for whom external irradiation methods cannot be used in lung cancer radiotherapy, the chest diseases team can perform brachytherapy through tubes inserted in the main airways.

Additional Treatment and Follow-up

After lung cancer surgery, chemotherapy and/or radiotherapy may be required depending on the pathology report and the surgeon's findings during operation. Depending on the stage of the disease, the probability of recurrence, which is at 20% at the earliest stage, increases to 60-70% in the final stage in which the operation is performed (Stage III A).

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