Mar 1, 2016


Dr. Miller: When do you need surgery for lung cancer? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. "The Specialists," with Dr. Tom Miller, is on The Scope.

Dr. Miller: Hi, I'm Dr. Thomas Miller, and I'm here with Dr. Thomas Varghese, and he is a thoracic surgeon in the Department of Surgery here at the University of Utah. Thomas, tell us a little bit about when patients might be ready for lung surgery if they have lung cancer.

Dr. Varghese: Lung cancer, you hear about, it can be divided into clinical stages. Really where it comes down to is localized lung cancer, where it's spread outside the lungs to nearby organs, and where it's spread distant away from the lung.

Dr. Miller: In those cases, I think surgery would probably not help.

Dr. Varghese: That is correct. Where surgery helps is where we call localized lung cancer, that is the cancer's within the lung and may involve a lymph node that is nearby the lung. But once it extends beyond that area, surgery really doesn't serve a role for that particular disease.

Dr. Miller: But, Thomas, is lung cancer curable if it is caught early?

Dr. Varghese: It is. The sad truth, though, is that the vast majority of lung cancer is caught late. In the early stages, lung cancer really doesn't cause any symptoms so most patients pick up on lung cancer incidentally. For example, they get worked up for another different cause altogether. Like they were involved in a motor vehicle accident and got an X-ray or a CAT scan, and all of a sudden they find a lesion, and that subsequently leads to the workup for lung cancer.

Dr. Miller: Lung cancer in this early stage, is curative potential with surgery true for all types of lung cancer?

Dr. Varghese: Great question. No, there are two major categories for lung cancer. There are small-cell lung cancer and non-small-cell lung cancer.

Dr. Miller: Which of those is most common?

Dr. Varghese: The most common is non-small-cell lung cancer. It comprises about 85% of the total number of cases, the majority. That's the area, the non-small-cell lung cancer, where surgical intervention plays a role. The small-cell lung cancer, unfortunately, is a very aggressive cancer, and as a result, surgery really doesn't play a role for that particular type.

Dr. Miller: But for the 85% of the other type of cancer, there is potential to cure it, obviously.

Dr. Varghese: Absolutely, if caught early.

Dr. Miller: In the past, screening has not proven to be beneficial. There were a number of studies that were done by just patients just taking plain film X-rays. More recently, do you think that screening has advanced and that it's useful?

Dr. Varghese: It has. We have better technology. There are these low-dose CAT scans, which use less radiation than before but are very sensitive at picking up small lesions. Recently, the National Lung Cancer Screening Trial actually proved that for heavy smokers, the particular subset that is at particularly high risk for developing lung cancer, in those patients, using screening CAT scans, you could pick up lesions at an early stage.

Dr. Miller: Now, let's say a patient comes to you with an early stage lesion, and potentially that's curable, what can that patient expect after the surgery? I mean, obviously, you're taking out a piece of the lung. Are they able to carry on with their life in a normal way?

Dr. Varghese: It's a great question. Yes, they are. Now, our philosophy is that the surgery only plays one aspect in terms of the intervention for their care. We have to make sure that, before we offer any type of treatments, that we deliver that care, but get them back into the quality of life that they're used to. As a result, we take a pause and we make sure that we optimize their health prior to the elective surgical intervention. We take steps to make sure they're in the best health coming into the surgery . . .

Dr. Miller: And that might mean stopping, quitting smoking?

Dr. Varghese: That is correct. That's one of the key, essential things. It's not just quitting smoking, but making sure you're off of cigarettes for at least two to three weeks. Most of the clinical trials have shown that you need at least that period of time to make sure all the toxic effects of the cigarette smoke is out of your system. It includes interventions such as increasing the amount of aerobic exercise that you do, a walking program.

We give patients a breathing toy, called an incentive spirometer, which helps to exercise their lungs prior to the surgery. As a result, we also take a look at their entire medical history and their overall health, make sure if there are any health conditions that be potentially improved or reversed, we do those steps before the surgery.

Dr. Miller: By following those steps, the outcomes can be even better.

Dr. Varghese: Absolutely. As a result of a lot of the work that we did prior to my coming to the University of Utah, while I was at the University of Washington, we had developed a program called Strong for Surgery. The Strong for Surgery platform was exactly this, taking these simple steps to improve the health prior to elective surgery. Strong for Surgery now has been endorsed and adopted by the American College of Surgeons and it's an initiative that's going to be nationwide in the years ahead.

Dr. Miller: Once you operate on a patient with small-sized lung cancer, and effectively cure that, how do you follow those patients up? Are they at risk for second cancers?

Dr. Varghese: It's a great question. Yes, they are. One of the things that we do is we tell patients that the surgery is only one step in the overall treatment. After surgery, we discuss the patient's case at our multidisciplinary tumor board, make sure that they don't need any other therapies at that particular time, but then we follow them for the next five years.

What we do is we periodically check scans to make sure that no other lesions come back. Once they reach that five-year window period of time where they have no other evidence of lung cancer, that's when we relax and say that we've cured them of their cancer.

Dr. Miller: Let's say that we have a patient who is just been diagnosed with lung cancer. How would they arrange a consultation with you or how should they proceed if surgery potentially could be curative?

Dr. Varghese: Our philosophy on that is that we are willing to see patients at any stage. Even if they're workup hasn't been complete, we're more than willing to see these patients because I think that this is one of those diagnoses of any type of cancer where patients can get overwhelmed. Our role in this is to, first, reassure the patients that we can come up with a plan, and then if surgery is indeed the case, we sort of out-lie the plans going forward, make sure that all the different steps are done, and make sure that we address any questions that the patient has.

Announcer: is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at

For Patients