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Early lung cancer and surgical treatment

Lung cancer is the second most common cancer in males and third most common cancer in females in Singapore.

As with most cancers, lung cancer is divided into four stages: 1 to 4.

Stages 1 and 2 are considered as early stage lung cancer whilst stage 3 and 4 are late stages.

Unfortunately, majority of lung cancers present at a very late stage (stages 3 and 4) and treatment will be non-curative. New therapies such as targeted therapy and immunotherapy as well as chemotherapy regimes are emerging with excellent long-term results.

Detection of early disease is therefore crucial. Screening is recommended for those who are at risk of developing lung cancers. Those with smoking history or family history of cancers and those who previously have cancers are at risk. There is also an increase in incidence of non smoking women developing lung cancers.

Low dose CT scan of the lungs is the preferred method for screening.  CT scan lungs may discover a mass or nodule in the lungs for which a biopsy may be required to confirm the presence of cancer.

PET scan is then done to rule out any spread to other organs (stage 3 or 4).

Early stages of lung cancer can be managed surgically. The most common operation for lung cancer is a lobectomy (removal of a sub section), and mediastinal lymph node dissection.

The lungs are paired organs which are divided into lobes (sub sections). Three on the right side and two on the left side. If the tumour is located in a particular lobe, lobectomy and mediastinal lymph node dissection constitute curative surgery for early cancer. Conventional lung surgery is done via a thoracotomy approach, a large incision with morbidity of pain and longer hospital stay.

Minimally invasive surgery for early lung cancers is now the preferred approach. With use of video assisted equipment, surgery can be in a less invasive manner with key hole access into the chest. Subsections of lung (lobes) can be removed safely with endostaplers and specimen delivered with endo bag which prevents contamination. At the end of surgery, a small tube for drainage will be left in the chest for 2 days.

Incisions are kept to sizes less then 3 cm and surgery is done without rib spreading. Recovery is faster with shorter hospital stay (about 3-4 days). Risk of lobectomy with this approach is about 1% mortality.