Expert Explains Recent Advances in Early Stage Lung Cancer Surgery

Advances in surgery and a clearer understanding of early stage lung cancer are improving outcomes for many patients. Dr. Nabil Rizk, chief of thoracic surgery at Hackensack University Medical Center in New Jersey, discussed how treatment has changed and what patients should know.

He said minimally invasive procedures, including video-assisted and robotic surgery, allow doctors to remove smaller areas of the lung with faster recovery. A recent study also showed that removing part of a lung lobe works as well as removing the whole lobe, so most patients now have less-extensive surgery.

CURE: Why is Lung Cancer Awareness Month an important opportunity to educate the public?

It's very important, in general, for most cancers to be able to detect them at an early stage, and in particular lung cancer, which is a pretty deadly cancer when not caught at an early stage. I think if we can use Lung Cancer Awareness Month to increase utilization of screening for appropriate patients, we will do a lot of good for patients.

What symptoms should people recognize earlier, and who should be screened for lung cancer?

Symptoms are not a good thing for lung cancer. In fact, screening for lung cancer is not done in patients who have symptoms. Symptoms like cough or a seizure or something that's representative of more advanced stage disease typically are a poor prognostic sign. People who should, however, be screened for lung cancer are patients who are at high risk to develop lung cancer, so they have no clinical evidence of it. The guidelines currently are anyone over the age of 50 who smoked more than 20 pack years — pack years of a pack a day for 20 years. People meeting those criteria should get screened, and the screening means a yearly CT scan, typically, unless there's an abnormality and further scanning is done.

How has treatment improved in recent years, especially for earlier-stage disease?

There have been a lot of improvements in the treatment of lung cancer. Particularly with regards to early-stage disease, our ability to do less-invasive surgeries using either video-assisted or robotic surgery, and our ability to find very small nodules using robotic bronchoscopy technologies, have made a big difference in minimizing the amount of surgery that's necessary to treat these lung cancers.

Is there any recent study or recent finding that has specifically caught your eye that makes you more hopeful for the future?

Yeah, so the most recent study I think that's been the most impactful for early-stage disease is the question that's always existed as to what's the best surgical treatment for lung cancer. Historically, it was to remove the lobe of the lung that contained the cancer, right? You have three lobes on the right, two lobes on the left. We would confirm cancer and then take out the lobe.

This clinical trial that was published maybe two and a half years ago showed that there's actually not much difference in outcome. There is no difference in outcome between taking out the whole lobe or taking out less than a lobe. So nowadays, most people undergo less than a lobe resection for lung cancer, which makes a big difference as far as how involved the surgery is and how quickly patients recover.

What role does surgery play in lung cancer today, and how is that evolving?

For early-stage lung cancer, surgery is the primary therapy. If you can't operate, radiation is backup, also with the intent to cure. But surgery is still the primary treatment if it's possible.

So where do you see the biggest gaps in screening and access to care?

In the state of New Jersey, where Hackensack is, only about 22% of patients get screened who should be screened. This is in comparison to things like colonoscopy and mammography, which are in the 70s and 80%. I think it's primarily awareness of the need to be screened. The guidelines have been evolving and expanding over time, so that could partly be a reason why adherence is not as high. But it's still a bit surprising, because the guidelines for screening have been out for almost 15 years, yet adoption is still pretty low. We should use things like Lung Cancer Awareness Month as an opportunity to try to educate patients and even physicians.

What resources would you give to patients, and what's the easiest way for them to get this information for themselves so they can make the right treatment decisions?

I mean, it's all online. It's difficult to understand why adoption is not as high. I think part of the problem for lung cancer is that, historically, the treatments for lung cancer have been pretty aggressive and fairly morbid. People were rightfully concerned about what would happen if you detected something that needed to be taken care of surgically. That has really changed. It's night and day between what it used to be and what it is now. A lot of these patients go home the same day as we treat their lung cancer. Treatments have evolved quite a bit, to the point where it is a major operation, but a much better tolerated operation than it used to be.

What message do you share with someone newly diagnosed with lung cancer and their loved ones?

The most important message, I think, to patients regarding lung cancer is that stage means everything. Early-stage lung cancer — we can cure the vast majority of those patients. I follow many, many patients on whom I have done an operation for early stage disease, and they're effectively cured. Detect it early and you'll be cured.

Transcript has been edited for clarity and conciseness.

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