Non-Small Cell Lung Cancer (NSCLC) is the most common form of lung cancer, accounting for approximately 85% of all diagnoses. A “resectable” tumor can be completely removed through surgery. This classification is significant because surgical removal offers the best potential for a cure.
Understanding Resectable NSCLC
Non-Small Cell Lung Cancer encompasses several common types, including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. For a tumor to be considered resectable, factors like its size, location, and absence of distant spread are crucial.
Resectable NSCLC generally refers to early-stage disease, typically Stage I, Stage II, and select cases of Stage III. Stage I tumors are smaller, up to 4 cm, and confined to the lung without lymph node involvement. Stage II involves larger tumors, between 4 cm and 7 cm, or those that have spread to nearby lymph nodes on the same side of the chest. While most Stage I and II cases are surgically removed, only carefully selected patients with Stage IIIA disease, particularly those without bulky lymph node involvement or distant spread, are considered for surgery.
Determining Resectability
Determining resectability relies on the TNM (Tumor, Node, Metastasis) staging system. This system assesses the primary tumor’s size and extent (T), lymph node involvement (N), and whether the cancer has spread to distant sites (M).
Various diagnostic tests and imaging techniques gather this information. Computed tomography (CT) scans evaluate local tumor spread. Whole-body fluorodeoxyglucose (FDG)-positron emission tomography (PET) scans assess regional lymph node involvement and distant metastasis. Magnetic resonance imaging (MRI) is also used to evaluate the local extent of disease. Tissue samples are obtained through bronchoscopy, mediastinoscopy, and biopsies for pathological confirmation.
Treatment Approaches
Surgical resection is the primary treatment for resectable NSCLC and offers the best chance for a cure. The type of surgery performed depends on the tumor’s size and location. A lobectomy, which removes an entire lung lobe, is often the preferred operation for NSCLC. If the tumor is small and lung function is limited, a segmentectomy or wedge resection, which remove only a portion of a lobe, may be considered. Pneumonectomy, the removal of an entire lung, is reserved for cases where the tumor is close to the center of the chest.
Minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS), are increasingly used for early-stage lung cancers. VATS involves small incisions through which a camera and specialized instruments are inserted, avoiding large chest incisions and rib spreading. Robotic-assisted surgery utilizes a console-controlled system with a 3D high-definition camera and miniature instruments that mimic the surgeon’s hand movements with enhanced precision. These minimally invasive approaches generally result in less pain, shorter hospital stays, and faster recovery compared to traditional open thoracotomy, which involves a larger incision and rib spreading.
Beyond surgery, other therapies are often incorporated to improve outcomes and reduce the risk of recurrence. Neoadjuvant therapy is administered before surgery, aiming to shrink the tumor and treat any microscopic spread. Adjuvant therapy is given after surgery to eliminate any remaining cancer cells. These systemic treatments include chemotherapy, radiation therapy, targeted therapy, and immunotherapy.
Platinum-based chemotherapy regimens have been shown to improve overall survival when given either before or after surgery. Immunotherapy, which activates the body’s own immune system to fight cancer, has shown promising results, with agents like nivolumab and pembrolizumab approved for use in certain resectable NSCLC cases, often in combination with chemotherapy. Targeted therapies are used for tumors with specific genetic mutations, such as EGFR or ALK alterations.
Life After Treatment
Recovering from lung cancer treatment, particularly surgery, requires time and patience. Patients can expect a hospital stay of a few days, followed by several weeks or even months of recovery at home. Pain and soreness around the incision site are common, and pain medication is prescribed to manage discomfort. Fatigue is also a frequent side effect that can persist for weeks to months post-surgery.
Full recovery of lung function may take 6 to 12 months, and gradual increases in activity are encouraged to aid the healing process. Activities like heavy lifting or strenuous exercise are typically restricted for 6 to 8 weeks. Follow-up care is a regular part of life after treatment for resectable NSCLC. This typically involves physical exams and chest CT scans every 6 months for the first 2 to 3 years, then annually. For patients with Stage I or II NSCLC who had surgery with or without chemotherapy, this schedule helps monitor for recurrence.
The prognosis for resectable NSCLC varies depending on the stage, overall health, and response to treatment. For instance, Stage I NSCLC patients can have a 5-year survival rate ranging from approximately 68% to 92%. Even after complete surgical removal, a proportion of patients may experience recurrence, with rates varying depending on the initial disease stage. Patients who achieve a pathologic complete response after neoadjuvant immunochemotherapy generally have a favorable prognosis, though continued monitoring for recurrence, both within and outside the chest, is still important.