What is Lung Cancer?

Lungs are the double sponge structured organs of our respiratory system. Right lung consists of 3 parts (called lobes) and is a little bigger than the left lung (consists of 2 lobes). Lung cancers are divided into two main types pathologically as small cell and non-small cell lung cancers. All lung cancer types grow, spread and are treated differently. Non-small cell lung cancer is seen more and generally grows and spreads slower. There are 3 main types of non-small cell lung cancer. They are named depending on the tissue the cancer emerged on (squamous cell cancer, adenocarcinoma and large cell carcinoma). Small cell cancer, sometimes also called oafrcell cancer, seen rarer compared to non-small cell cancer. This type of lung cancer grows faster and tends more to spread to the other parts of the body.

How is Lung Cancer diagnosed?

In case the abovementioned findings are existent, your doctor will investigate your medical history, smoking history, if and how much you were exposed to environmental poisonous materials and your family history. Your doctor will also ask for a breast roentgenogram and other diagnostic tests. Different procedures such as phlegm cytology, bronchoscopy, needle biopsy, thoracentesis or thoracotomy can be implemented.

What is staging?

If you are diagnosed with cancer, your doctor needs to know at what stage of the disease you are. Staging is finding how much the cancer have spread around your body. Once the cancer is staged, your doctor can prepare your treatment. For this, computed tomography (CT), Positron Emission tomography (PET), magnetic resonance imaging (MRI), bone scintigraphy and / or mediastinoscopy / mediastinotomy can be used.

How is cancer treated?

Cancer treatment may vary depending on many factors: such as cancer stage (spreading), size, location and general condition of the patient. Different treatments and treatment combinations may be used to control the lung cancer or to reduce the symptoms to increase the life quality. Lung cancer treatment includes surgical, radiation (radiotherapy) therapy and chemotherapy treatment.

Lung Cancer Surgery

Surgery is the oldest and most effective form of the cancer treatment. In 15-20% of the cancer patients, the treatment option is direct surgery. Surgery can be performed combined with other treatment methods.

Different methods with same goal can be used in surgery.

Curative surgery involves removing the tumour tissue and all adenoids with it, with the surrounding tissues if required. In the cases where far organ spreading (metastasis) is not seen (except from single brain metastasis, the superiority of surgery to other treatment methods were demonstrated in various studies and it was accepted as the best treatment method in the entire world in lung cancer, especially in early stage. Surgical treatment can be supported with radiotherapy and / or chemotherapy where required.

Curative Surgery Types:

• Videothoracoscopic (closed) surgery
• Robotic surgery
• Open surgery with thoracotomy

Diagnostic surgery (biopsy): this is a method that is used both in diagnosis and treatment of the masses located especially in the peripheral parts of the lungs. It is also a method that is generally applied with a closed approach as the last option in the masses that could not be diagnosed with other methods.

Staging surgery: this is used to determine the far or areal extensity of the cancer. The extensity of the disease in areal adenoids are shown with mediastinoscopy or mediastinotomy and patients are provided with pre-surgery effective treatment.

Supportive surgery can be implemented to support other cancer treatments. For instance, some chemotherapy devices require ports placed under the skin.

Palliative surgery is used only to reduce the pain and the complications emerging due to the development of the cancer. Palliative surgery is implemented to increase the life quality, it is not a healing or anti-cancer treatment.

Minimal Invasive Surgery

Minimal invasive or endoscopic surgery provides the advantage of implementing and effective cancer surgery using computer imaging and developments in robotics.

The advantages of minimal invasive surgery:

• Less blood loss
• Reduced need of blood transfusion
• Short inpatient duration
• Reduced pain and need of post-surgical medication
• Quicker return to normal diet
• Quick recovery and return to normal activities
• Less scars and better cosmetic appearance

Video-Assisted Thorascopic Surgery (VATS / VYTC)

Video-assisted thorascopic surgery or VATS can be used in diagnosing and / or treatment of lung and oesophagus cancers. As it can be performed via a diagnosis-oriented 1.5 cm cut, it can also be performed using a few treatment-oriented cuts and an additional cut of approximately 5 cm and removing the lung partially or completely. It is a very useful diagnostic method for the sampling of membrane covering inside of the thoracic wall (pleura), lung nodules, mediastinal bulks and pleural fluid. Especially in the case of repetitive fluid existence due to cancers, it can be used together with pleurodesis (powder use) procedure to prevent the fluid from gathering again.

RoboticSurgery (DaVinci)

“Da Vinci” Robotic System used in Liv Cancer Centre has changed the thoracic and lung cancer experiences of the patients. In general surgery, along with painful and large cuts of the patients, there are major complication risks and long recovery times.

Da Vinci robot has eased reaching at thoracic cavity without requiring a large cut and splitting the ribs. Da Vinci equipment allows removing the lung partially or entirely giving the least damage to surrounding tissue within the thoracic cavity. Its 3D (3 dimensional) imaging and 360^o movement capability offers a very safe surgery to the surgeon and the patients.

Additional Treatment and Follow-Up

Chemotherapy and / or radiotherapy treatment may be required according to the pathology report and operation findings of the surgeon after the lung cancer surgery. Depending on the stage of the disease, the relapse (repeating) potential of the disease which is at 20% at the earliest stage may rise up to 60-70% at the latest stage (Stage III A).

Thoracic Wall (Pectus)Deformities

It is described as cartilage and bony tissue developing more than normal in thoracic cage. There are two main deformity types called as pectus excavatum (downing through inside) and pigeon breast (protrusiveness). It is estimated that there are 200-250 thousand patients who has such problems in our country. Pectus excavatum and pigeon breast is seen more often in males at the rates of 1:3 and 1:6, respectively. The individual avoids sharing this problems because of its psychological effect. The individual may be avoiding swimming, wearing tight t-shirts and seeing a doctor for this. There are even many patients who does not notice having such a problem. They do not go and see doctors as this does not affect their lives physically. However, as the individual gets older, the deformity may become more obvious. With closed method (minimal invasive intervention) its surgical treatment became the standard method.

Hand and Armpit Sweating

Surgical treatment may create a lot better reasons compared to other treatment methods for the patients whose life quality has decreased due to areal excessive sweating (hyperhidrosis). With Endoscopic Thoracic Sympathectomy (ETS) sympathetic nerves that control the sweating activity of hands and armpits are separated surgically or their activity is blocked by clipping method. The most important complication that should be known in the patients whose hand and armpit sweating is treated with closed method (videothoracoscopic) with 1-2% compliation rates, is compensatory sweating. In the patients who were applied single level (T3 or T4) operation, it is seen at 10-30% and the person may need to change day long. In the patients treated with clipping method, as 40-50% return potential is existent, clips may be removed. With the same method, flushing and face sweating may also be treated.