Lung Cancer and the Role of Surgery


June 23, 2008 — In this edition of Siteman Cancer Center’s podcast series, thoracic surgeon Bryan Meyers, MD, MPH, discusses lung cancer and the role surgery plays in treating the disease, including the rise of video-assisted thoracic surgery.

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On this edition of Cancer Connection, we’ll talk about lung cancer, who is most at risk and the role surgery plays in beating the disease.

Host: Thanks for downloading this podcast from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St Louis. I’m Jason Merrill.

While lung cancer is our leading cancer killer in men and women, it should be noted it was considered rare before the advent of cigarette smoking. Worldwide, it’s currently estimated there are 1.3 million people who die annually from lung cancer. Many patients go on to surgery to remove the disease, and to talk with us about that is Brian Myers. He is chief of thoracic surgery at Barnes-Jewish Hospital and Washington University School of Medicine. Dr. Meyers, thank you for joining us.

Meyers: You’re welcome. I’m happy to be a part of this.

Host: How big a problem is lung cancer?

Meyers: I think lung cancer is a very big medical problem in the United States. Right now, we can anticipate in the next year there will probably be nearly 200,000 new cases of lung cancer diagnosed in the United States. In addition just to the weight of all those new diagnoses, we still have a very poor track record as a country and as a medical system in curing the majority of those patients. Clearly fewer than 20 percent of the newly diagnosed lung cancer patients will actually be cured of their cancer. So not only is it a burden in terms of the number of patients who get the diagnosis but also in the very low survival rate based on the overall number of patients who are diagnosed.

Host: How is lung cancer generally diagnosed?

Meyers: Well, typically it’s diagnosed in a number of different ways, and the way that it’s diagnosed actually plays a big role in terms of the prognosis and the likelihood for a wide variety of treatment options. For instance, some patients are diagnosed when they develop symptoms. When they develop symptoms such as pain or shortness of breath or some neurologic problem, usually that’s a sign of a very advanced cancer, and that’s likely to be more challenging to cure or to treat successfully. On the other hand, there are a number of patients who have incidental cancers that are picked up probably due to some radiologic procedure that was done for some other reason. A common scenario there is where patients would be getting a chest X-ray in anticipation of some other operation or procedure, and that nodule or cancer gets detected on this chest X-ray in a patient who is totally asymptomatic. Those patients are often curable.

Host: Now you’re a surgeon. How many lung cancer patients go on to surgery?

Meyers: Well usually lung cancer is one of the diagnoses or one of the diseases in which stage is very carefully translated into treatment options. So patients who are stage IV and most patients who are stage III usually are treated with nonsurgical means. On the other hand, patients who are stage I or stage II, which could amount to as many as 25 or 30 percent of the patients, would be eligible for surgical treatment depending on their age and their general health and any other diseases or conditions they have which might be affected by the planned operation. So almost a third would be considered.

Host: Now, every patient is different obviously, but for a patient having lung cancer surgery, typically what should they know?

Meyers: Well I think that the first thing they want to know is what type of lung cancer they have. There are subtypes such as small cell or non-small cell, and that differentiation between those two will make a big difference in their treatment. The patients who most typically get treated with surgery have non-small cell lung cancer, whereas the patients with small cell are rarely treated with surgery. They also would want to know as precisely as possible what their stage is. Staging is an art, and it’s performed by surgeons, by medical oncologists, by radiation oncologists and pulmonary physicians. But the more carefully a patient is staged prior to decisions about treatment, I think the better off they’ll be. And then the other thing that they should know is the experience of the people who are taking care of them. I think there’s a general tendency to acknowledge that places that treat patients with the condition at a high volume are generally more efficient and often more effective than places or physicians who treat a disease on a sporadic basis.

Host: Now if someone is in need of surgery, you’re able to offer something called VATS, or video-assisted thoracic surgery. Talk about that procedure.

Meyers: Well in the past several years, there’s been a transition in terms of the way that surgery gets done, and that transition is taking place over all aspects of surgery. But in specific with regard to lung cancer surgery, we’ve worked to try to decrease the pain and the discomfort of the operations by making smaller incisions and utilizing technology that includes cameras that get put in between the ribs and magnify the view and optimize the lighting so that we can often do lobectomies and other complex lung cancer operations without having to make a big incision and spread the ribs apart from each other. There’s quite a bit of data in many trials from many different sources that show that using this video-assisted technique will decrease the time in the hospital, it will speed the overall recovery of the patients, and it will likely make them better candidates for any additional therapy that might be necessary after the surgery is done.

Host: We really can’t do an interview on lung cancer without talking about the dangers of cigarette smoking. What advice do you give to people who need to quit?

Meyers: Well I think that they really need to convince themselves or help their families and friends convince them that they truly need to quit. I think that the chances of being successful in quitting smoking are very poor if the patients themselves don’t believe that it’s important that they quit. We have a unique opportunity in our group of thoracic surgeons that most patients we’re meeting probably have lung cancer, and you can almost certainly attribute some part of the risk of that lung cancer to smoking. And so those patients are primed to be susceptible to any efforts to get them to quit. It’s never too late to quit. I think that’s a point to emphasize that even if they have a cancer, the treatment of their cancer and the recovery from their surgery is likely to be quicker and smoother if they’re able to quit smoking. And if they’ve already had surgery and they’re in the recovery phase, the chances of emphysema or the chances of another cancer down the line would be greatly reduced if they were able to quit smoking. So there’s really no bad time to quit, and it’s something they should always have on the list of things they can do for themselves to make their outcome better.

Host: Thank you, Dr. Meyers. Thank you for joining us.

Meyers: You’re welcome. Thanks for asking me.

Host: For more information about lung cancer, you can visit our Web site at or call 800-600-3606. Thanks for downloading. Until next time, I’m Jason Merrill.