Our Summary

This research paper is about improving the diagnosis process for a specific stage of non-small cell lung cancer (NSCLC), a common type of lung cancer. The study focuses on patients with “stage IIIA-N2” disease, meaning the cancer has spread to certain lymph nodes. Identifying these patients early is important because they typically do not benefit from immediate surgery.

Using data from the Dutch Lung Surgery Audit, researchers looked at patients who underwent surgery for NSCLC between 2013 and 2015. Of the 3585 patients, they found that 527 had stage IIIA NSCLC. Interestingly, 254 of these patients were initially diagnosed with a less advanced disease (N0 or N1), but were later found to have more advanced N2 disease after surgery - this was 7.1% of the patients.

The paper suggests that to decrease this percentage, improvements need to be made to the standard pre-surgery checks. These checks, which include different types of scans and ultrasounds, are used to determine the stage of the lung cancer. Improving these processes could help more accurately diagnose the stage of NSCLC before surgery, which would help doctors provide the most appropriate treatment.

FAQs

  1. What is the focus of this research study on non-small cell lung cancer (NSCLC)?
  2. What is the issue with diagnosing patients with stage IIIA-N2 disease of NSCLC as discovered in the Dutch Lung Surgery Audit?
  3. How could improvements in pre-surgery checks benefit the treatment of NSCLC?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lung surgery is to follow all pre-surgery instructions carefully, including any necessary tests or scans. This will help ensure that the stage of the lung cancer is accurately diagnosed before surgery, leading to the most effective treatment plan. Additionally, it is important to communicate openly with your healthcare team about any concerns or questions you may have before undergoing lung surgery.

Suitable For

Patients who are typically recommended for lung surgery include those with early-stage lung cancer (stage I or II) or select patients with more advanced disease (stage III or IV) who may benefit from surgery as part of a multimodal treatment approach. In the case of NSCLC, patients with stage IIIA-N2 disease may be recommended for surgery if they are deemed appropriate candidates based on factors such as overall health, tumor size and location, and extent of lymph node involvement.

It is important to note that not all patients with stage IIIA-N2 NSCLC will be recommended for surgery, as other treatment options such as chemotherapy, radiation therapy, or targeted therapy may be more appropriate in certain cases. Additionally, patients with advanced age, significant comorbidities, or poor overall health may not be suitable candidates for surgery.

Ultimately, the decision to recommend lung surgery for a patient with NSCLC is made on a case-by-case basis by a multidisciplinary team of healthcare providers, including thoracic surgeons, medical oncologists, radiation oncologists, and pulmonologists. The goal is to provide each patient with the most effective and personalized treatment plan based on their individual circumstances and disease characteristics.

Timeline

Before lung surgery:

  • Patient experiences symptoms of lung cancer such as persistent cough, chest pain, shortness of breath, and coughing up blood.
  • Patient undergoes diagnostic tests such as chest X-rays, CT scans, PET scans, and biopsies to determine the stage and extent of the cancer.
  • Based on the results of these tests, the patient is diagnosed with stage IIIA-N2 non-small cell lung cancer.
  • Patient consults with a multidisciplinary team of doctors to discuss treatment options, which may include surgery, chemotherapy, radiation therapy, or a combination of these.

After lung surgery:

  • Patient undergoes surgery to remove the cancerous tumor and affected lymph nodes.
  • Patient may experience pain, fatigue, and difficulty breathing in the immediate post-operative period.
  • Patient is monitored closely for complications such as infection, bleeding, and pneumonia.
  • Patient undergoes follow-up tests such as CT scans and blood tests to monitor for recurrence of the cancer.
  • Depending on the results of these tests, the patient may require additional treatment such as chemotherapy or radiation therapy.

What to Ask Your Doctor

  1. What specific tests will be done to determine the stage of my lung cancer before surgery?
  2. How accurate are these tests in detecting the spread of cancer to lymph nodes?
  3. What are the potential risks and benefits of undergoing surgery for stage IIIA-N2 NSCLC?
  4. Are there alternative treatment options available for my stage of lung cancer?
  5. What is the success rate of surgery for stage IIIA-N2 NSCLC, and what factors may affect the outcome?
  6. How experienced is the surgical team in performing lung cancer surgeries, particularly for stage IIIA-N2 disease?
  7. What is the typical recovery process after lung surgery, and what can I expect in terms of pain management and rehabilitation?
  8. Are there any potential long-term side effects or complications associated with lung surgery for NSCLC?
  9. How will my treatment plan be personalized to meet my specific needs and medical history?
  10. Are there any clinical trials or new advancements in lung cancer treatment that I should be aware of?

Reference

Authors: Heineman DJ, Beck N, Wouters MW, van Brakel TJ, Daniels JM, Schreurs WH, Dickhoff C. Journal: Eur J Surg Oncol. 2018 Jun;44(6):830-834. doi: 10.1016/j.ejso.2017.12.002. Epub 2018 Jan 9. PMID: 29396329