CANCER

                  Surgery for lung cancer

 

Surgery is mostly used to treat non small cell lung cancer. But it may be better for you to have other cancer treatment such as radiotherapy, chemotherapy or possibly both if your cancer is very near any of the following structures

• Heart
• Windpipe
• Food pipe (oesophagus)
• Major blood vessels

Surgery is not normally used to treat small cell lung cancer, except if it is at a very early stage. This is because small cell lung cancer has usually spread beyond the lung when it is diagnosed and so it is not then possible to remove it all with surgery. Chemotherapy and radiotherapy are more often used than surgery for small cell lung cancer.
The type of surgery you have will depend on the size of the cancer and its position within the lung.

 

Removing lobes of the lung

Lobectomy is the removal of one lobe of the lung. Your surgeon will recommend this type of operation if they think the cancer is just in one part of one lung. It is the most common type of operation for lung cancer. Bilobectomy is the removal of two lobes of the lung.


A small number of people with lung cancer have an operation called a sleeve resection. Your surgeon may do this to avoid removing your whole lung if the cancer is in the central area of the lung and is growing into one of your main airways (bronchi). In this situation a simple lobectomy can't be done. Sleeve resection involves removing the affected section of the bronchus, and any surrounding cancer in the lobe.

Removing the whole lung

Removing the whole lung is called pneumonectomy. Your specialist will recommend this operation if the tumour is in the central area of the lung and involves either the 2 lobes on the left or the 3 lobes on the right.

Many people worry that they won't be able to breathe properly with only one lung but you can breathe normally with only one lung. If you had breathing problems before the operation, you will probably still be breathless afterwards. Your doctor will arrange for you to have breathing tests before the surgery to help decide if this operation is right for you.

 

Removing a section of lung

Some operations remove particular areas of the lung. A wedge resection removes an area of the lung that includes part of one or more lobes. A segmentectomy removes areas of the lung along with their veins, arteries and airways. These types of operation are used when the specialist thinks the cancer has been diagnosed early and is only in one very small area. If the specialist thinks the cancer cells could be anywhere else in the lung they will not recommend this type of operation.

 

Removing lymph nodes

During your operation your surgeon will remove some of the lymph nodes from around the lung. This is because the lymph nodes may contain cancer cells that have broken away from the main cancer. The surgeon sends the lymph nodes to the laboratory where they are examined under a microscope. If the nodes contain cancer cells this may affect the treatment that you need after the surgery.

 

If your cancer has spread

If your cancer has spread to anywhere else in your body, then a major operation to remove your cancer is usually not the right treatment for you. If there are cancer cells anywhere else, the operation will not remove them and your doctor will probably suggest another type of cancer treatment such as chemotherapy and radiotherapy instead.

 

Your general health

If you have other health problems such as a severe heart condition or other lung disease, you may not be fit enough to have major lung surgery. Your surgeon will examine you thoroughly and do quite a few tests before you decide together whether an operation is right for you and which type of operation.
Your doctor may recommend radiotherapy instead of surgery and you can find information about this in our section about radiotherapy for non small cell lung cancer.

Before surgery for lung cancer

 

Information and explanation

Before your operation you will see your surgeon, and anaesthetist, and usually a specialist nurse. They will explain what the operation involves and what to expect when you come round from the anaesthetic. This may include information about what to eat and drink and when you will be able to move around. 

Your surgical team may meet you in the outpatient pre assessment clinic before you go into hospital. Or you may meet them when you arrive at the hospital for your operation. They will ask if you have any questions. When your questions have been answered your doctor will ask you to sign a form saying that you agree to have the operation. Remember that no operation can be done without your consent.

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Testing your general health

Before your operation you will have tests to make sure that you are fit enough for the surgery. You may have these test at a pre admission clinic in the outpatient department. Or you may have them in the hospital a few days before your operation.
You will have some blood tests to check your general health and make sure you are not anaemic. You will probably also have an ECG (electrocardiogram). This tests how well your heart is working. It is painless and doesn't take long. A nurse or technician will attach some wires to your chest with suction cups or tape. They attach the wires to a machine that takes a recording of your heart beating. If you have heart problems your doctor may ask you to have some extra tests.

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Testing your breathing

If you are going to have part, or all, of a lung removed, it is important that the doctor is sure you will be able to breathe comfortably afterwards. They may want you to have some lung function tests. These tests measure how much air you can breathe in and out. They don't hurt, but can be a bit tiring.

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When you go into hospital

Before your operation you will see a physiotherapist and a doctor. The physiotherapist will teach you breathing exercises and leg exercises to do after your operation.
When you are in bed and not moving around very much, you are more likely to develop chest infections and blood clots. The breathing exercises will help you to avoid getting chest infections after the surgery.
To stop blood clots forming, you may be given medicines called heparin, tinzaparin, or dalteparin before the surgery and for a couple of weeks afterwards. You usually have them as a small injection under the skin. You may need to have regular blood tests to make sure you are getting the right amount of this medicine. Your nurse may also give you elasticated stockings to wear.
The video below is a guide to breathing and circulation exercises after surgery when the wound is on your side. Click on the arrow to watch it. If you have trouble playing the video, you can view it on Cancer Research UK's YouTube channel.

After surgery for lung cancer

 

After your operation

After lung surgery you may wake up in intensive care (ICU) or a high dependency recovery unit (HDU). This is routine after a big operation and as soon as your doctors are sure you are recovering well, you will be moved back to the ward. This is usually within a day or so of a lobectomy and 1 or 2 days after lung removal.
In ICU you have one to one nursing care, and are checked very regularly. This is normal and doesn't mean there is something wrong. Your surgeon and anaesthetist will keep a close eye on your progress. ICUs are very busy places and can be noisy. You may feel very drowsy. Some people find the experience of being in ICU a bit strange and disorientating.

 

Drips and drains

To start with, you are likely to have some tubes in place including

• A drip (or intravenous infusion) into your arm
• Drainage tubes from your wound, connected to a bottle, and possibly a suction machine

Your nurse will take the drip out as soon as you are able to eat and drink normally. This is usually within a couple of days.
Your nurses will take out the drainage tubes when fluid from the wound has stopped draining out. This can be up to a week later.

 

Moving around

The nurses and physiotherapists will get you moving about as soon as possible after you have your operation. Until you can get out of bed, they will help you to do some breathing and leg exercises to help stop complications such as blood clots in the legs or chest infections.
You will have regular chest X-rays to make sure you can breathe well. To start with these will probably be done on the ward with a portable X-ray machine.

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Painkillers

You will have some pain for the first few days after your operation. There are different types of painkilling drugs you can have and different ways of giving them. If you are in pain, it is important to tell your nurse or doctor as soon as possible. With your help, they will be able to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly. It is important that you are as comfortable as possible so that you can breathe properly and move around to lower your risk of chest infection.
Rarely, some people find they have pain that starts a few weeks or months after their operation. This is usually because nerve endings that were damaged during the operation have started to grow back. This pain will go when the nerve endings have recovered, but it can take some time to get better. If you have any pain after your operation, do go and see your surgeon to find out what could be causing it. If it can't be sorted out straight away, your doctor can refer you to a specialist pain clinic.

 

Going home

You will probably be ready to go home about 10 days after lung removal and 5 to 7 days after lobectomy.
If you live alone, or might have difficulty managing, let the nurses know when you first go into hospital so that they can make plans to help you when you go home.
When you get home, it is important to gently exercise to get yourself fit again. Check with your doctor or physiotherapist about exercise before you leave the hospital. It is important to start slowly and not overdo it. Once you are getting back on your feet you could try brisk walking or swimming.
You will be given an outpatient appointment before you leave the ward. This is usually about 6 weeks after your operation.
Remember that if you have any worries or symptoms before your outpatient appointment, contact your doctor or the hospital ward. You don't have to wait until your appointment.

 

Driving

After surgery to your chest you should not drive until the effects of the anaesthetic and painkillers have worn off and your wounds have healed well. At first the seat belt may press on your wound and make it sore.
Your doctor will tell you when you can start driving again but it is usually about 4 to 6 weeks after surgery. Some insurance companies also specify that you should not drive for a certain amount of time after chest surgery so it is worth checking with your car insurance company.