- My grandfather, who died from lung cancer, was one of the most important reasons I went into thoracic surgery.
- While lung cancer survival rates continue to rise, low screening rates are leaving people at risk.
- As we see the criteria for getting screened for lung cancer open, we also want to see more people being saved by having minimally invasive surgery to remove their screen-detected lung cancers.
I decided to go into thoracic surgery for many different reasons. One of the most important reasons was that my grandfather died from lung cancer when I was training to be a surgeon.
I remember that helpless feeling when the CT scan came back and metastases in the liver were discovered. Like far too many patients, he was too far along for any surgical intervention to make a difference. More than 20 years later, advances and novel therapeutics have enabled us to now address patients with what we call oligometastatic disease, or tumors in more than one location.
We now have lung cancer screenings that allow us to pick up the disease at an earlier stage where it might be even more curable. I cannot help but wish I could go back in time and implement these advances to buy more time with him.
As lung cancer surgeons, we all have a list of patients who are no longer with us that we wish could have just lived a little bit longer to see the advances of technology applied to their case. However, there are far too many people who now qualify for a screening CT scan but don't get referred by their doctor. Or worse, they fail to go.
As we see the criteria for getting screened for lung cancer open, we also want to see more people being saved by having minimally invasive surgery to remove their screen-detected lung cancers.
The American Cancer Society recommends annual screenings for lung cancer with low-dose CT scans in asymptomatic individuals aged 50 to 80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history.
Working with Lung Cancer Patients
Today, one of my favorite groups of patients I get to care for are those with multifocal lung cancer. These patients become a little closer to their surgeons because they usually don’t just present to us once or twice. Instead, they come to us for lung-sparing minimally invasive resections over and over during their life.
These patients often present with what we call GGOs (ground glass opacities) or a genetic predisposition (fusions, alterations or deletions) enhancing their chances of developing lung cancer. The tiny lesions pop up and slowly advance in multiple areas in their lungs. As we watch these areas evolve, we often can identify the cancer before it invades into the lymph nodes, timing our surgery for removal at just the right moment when we are convinced it has developed into a cancer, but not advanced so much that it has spread.
As our surgeries become less invasive and more organ-sparing, our patients benefit. We, as surgeons, offer segmentectomies to get all of the lymph nodes as well as a good margin around the tumor, like an expert pruning a tree. It’s important to remind people that not all lung cancer develops from smoking.
As I walk over to see my next clinic patient, I look at the name outside the door to see who is next. This time, it is one of my favorite and familiar regulars back again for another "pruning." Close follow-up, careful minimally invasive surgery, genetic testing, and referral for additional treatment, when indicated, are critical.