Thoracic Diseases  Lung Cancer
Lung cancer is the most common form of cancer in the United States, with more than 170,000 new cases each year. It is also the leading cause of death from cancer.
Early detection can dramatically improve survival, although the disease is usually well advanced at the time of diagnosis because it has no symptoms in its early stages.
Columbia operates a robust screening program for patients at risk for lung cancer and a comprehensive, multidisciplinary treatment program for patients with advanced disease.
Non-small cell lung cancer is the most common type of lung cancer.
It often grows and spreads less rapidly than small cell lung cancer.
There are three types of non-small cell lung cancer — squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
Small cell lung cancer is less common than non-small cell lung cancer.
It grows more rapidly and is more likely to spread to other organs in the body.
Lung cancer usually begins in one lung. If left untreated, it can spread to lymph nodes or other parts of the chest, including the other lung.
Lung cancer can also spread throughout the body to the bones, brain, liver or other organs.
Lung cancer survival is related to the cancer’s stage—the size and location of the tumor, whether the cancer has spread to surrounding lymph nodes, and whether it has spread to distant sites.
When lung cancer is treated in its earliest stage, cure rate approaches 70% of patients or more.
The tumor’s size also impacts survival.
The survival rate is lower for patients whose tumors are greater than 3cm in diameter than for those with smaller tumors.
It is unknown whether detecting a tumor when it is smaller than 3cm confers an impact on survival.
Lung Cancer Treatment at Columbia University
Columbia’s thoracic surgeons work closely with practitioners from multiple Columbia Departments to provide a multidisciplinary program of comprehensive care for patients with lung cancer.
State-of-the-art imaging facilities at NewYork-Presbyterian/Columbia for lung cancer diagnosis, staging, and monitoring include outpatient high-resolution CTscanning,
MRI, PET, and PET/CT.
Decisions about each patient’s care are made in weekly meetings that combine the expertise of thoracic surgeons, pulmonologists, medical oncologists, radiation oncologists, radiation therapists, and pathologists.
Benefiting from our team approach, patients are offered individualized treatment, which may include preoperative or postoperative multimodality therapy, for example, a combination of chemotherapy and radiation therapy in conjunction with surgery.
Such an integrated effort has been shown to improve survival from lung cancer.
Non small cell lung cancer is often treated with chemotherapy. To learn about
chemotherapy treatment, or medical oncology, at Columbia Surgery, click here.
Small cell lung cancer, which grows more rapidly and is more likely to spread to other organs, frequently requires surgery followed by chemotherapy.
The type and extent of surgery recommend will depend on the patient’s specific diagnosis regarding the stage, location, and type of cancer. The larger the nodule, the more lung tissue needs to be removed.
In some cases, surgical removal may not be an option.
For those patients who are candidates for lung resection surgery, a range of approaches are available.
Whenever possible, we prefer to use minimally invasive techniques that reduce pain and aid in the patient’s recovery.
Clinical Trials
At any one time we offer multiple clinical trials evaluating novel therapies to improve the survival rate from lung cancer.
These trials are available to eligible patients.
To learn more, please click here.
Surgical Treatment of Lung Cancer
A lung resection is a surgical procedure to remove a damaged or diseased portion of a lung, or a whole lung.
Common reasons for undergoing a lung resection include cancer of the lung, emphysema, tuberculosis, or atelectasis (a collapsed lung).
At Columbia, we perform the majority of our lung resections on people who have lung cancer or other growths within the lungs.
Lung resection surgery offers the best opportunity for curing lung cancer when the disease is caught in its early stages.
Most lung cancers are identified when patients receive a chest X-ray or CAT scan for an unrelated reason. Since the possible symptoms of lung cancer include a persistent cough,
shortness of breath, recurring respiratory tract infections, or a recurring cold, many patients first see their doctor about a cold, cough, or possible pneumonia.
More advanced symptoms may include blood mixed in sputum and unrelenting chest pain.
The only accurate way to diagnose lung cancer is a biopsy of the lung nodule or growth.
Some patients can receive a needle biopsy—a needle is inserted directly into the nodule through the chest wall and cells are extracted from that nodule for examination under a microscope.
Other patients, who have nodules that are located too deep in the lung or are too small to be biopsied, may require a surgical biopsy—the biopsy is performed as part of the surgery to remove the nodule.
Surgical Procedures
The type and extent of surgery recommend will depend on the patient’s specific diagnosis regarding the stage, location, and type of cancer.
The larger the nodule, the more lung tissue needs to be removed.
In some cases, surgical removal may not be an option.
For those patients who are candidates for lung resection surgery, a range of approaches are available.
Whenever possible, we prefer to use minimally invasive techniques that reduce pain and aid in the patient’s recovery.
Lobectomy: VATS
Frequently, we examine and remove a small nodule using a video-assisted technology called VATS, or Video-Assisted Thoracoscopic Surgery.
In this technique, the surgeon makes two or three one-inch incisions between the ribs.
A camera attached to a telescope (which magnifies the field of view), is placed in one of the incisions.
The camera is used to examine the entire chest cavity, including portions of the lung.
The surgeon then excises the nodule and gives it to the pathologist to examine under a microscope.
In some cases, if the nodule is cancerous, the surgeon can proceed to remove the entire lobe where the cancer has arisen using the same technique.
A thoracoscopic lobectomy offers a significant advantage to the patient because it reduces both the recovery period and the amount of postoperative pain, lowering the need for pain medications.
Patients who undergo this procedure return to normal activities much faster than those who undergo a more extensive lobectomy performed through a thoracotomy incision.
Lobectomy: Thoracotomy
Although VATS or thoracoscopy is always the procedure of choice because it is minimally invasive, the size and location of the cancer makes this procedure impossible for some individuals.
These patients require a standard thoracotomy and lung resection.
A thoracotomy incision is made between the ribs.
It extends from the patient’s side, under the arm, and up the back.
The incision extends for about eight to nine inches.
It requires dividing some chest wall muscles and spreading the ribs.
If a thoracotomy incision is required to remove the lung cancer, our surgeons are able to perform the surgery with far less patient discomfort than was possible a decade ago.
All of our patients are given an epidural catheter through which we provide postoperative pain medication.
The pain relief from the epidural is quite effective.
Patients are able to get out of bed on the first day after surgery and walk around as required.
Pneumonectomy:
Occasionally, if the cancer is quite large or very central in the lung—close to where the major bronchus separates from the trachea—the only way to completely remove the cancer is to take out the entire lung.
This procedure is referred to as a pnuemonectomy.
When you remove the entire lung, you obviously eliminate more viable lung tissue as well.
A higher complication rate, therefore, is associated with this procedure.
We try not to remove the entire lung unless absolutely necessary to try to cure the cancer.
For more information about lung resection surgery, please register for our free online seminar, The Columbia University College of Physicians & Surgeons Guide to Surgery and select "Surgical Procedures / Lung Resection and Removal."
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