How We Approach Lung Cancer Treatment
Lung cancer treatment is individualized according to the type and stage of cancer, the tumor’s genetic and molecular changes, its location within the lung, and the patient’s overall health and lung function. Treatment may involve surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, or a combination of approaches.
At Saint John’s Health Center, thoracic surgeons work with medical oncologists, radiation oncologists, pulmonologists, radiologists, pathologists, and other specialists to develop a coordinated treatment plan.
About Lung Cancer Surgery
Surgery is an important treatment for many patients with early-stage non-small cell lung cancer and selected patients with more advanced disease. Before surgery, the thoracic team evaluates the location and extent of the cancer, lymph nodes, lung function, overall health, and whether additional treatment may be needed before or after an operation.
The amount of lung removed can range from a small portion of lung tissue to an entire lung. For selected small, peripheral early-stage cancers, segmentectomy or another sublobar resection may provide appropriate cancer control while preserving more functioning lung tissue. Other tumors are better treated with lobectomy, sleeve resection, or, less commonly, pneumonectomy. Lymph node evaluation is also an important part of lung cancer surgery because it helps determine the cancer stage and whether additional treatment may be beneficial.
For patients who are candidates for surgery, minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracic surgery may allow lung tumors to be removed through smaller incisions without spreading the ribs. The surgical approach and amount of lung removed are selected according to the tumor’s size, location, stage, lymph node involvement, and the patient’s pulmonary reserve, with the goal of achieving effective cancer control while preserving healthy lung tissue whenever possible.
Types of Lung Cancer Surgery
Wedge Resection
A wedge resection removes the tumor along with a wedge-shaped margin of surrounding lung tissue. It preserves more lung than an anatomic segmentectomy or lobectomy and may be appropriate for selected small tumors or for patients whose lung function or overall health limits the amount of lung that can safely be removed.
Segmentectomy
A segmentectomy removes one or more anatomical segments of a lung lobe together with the tumor and appropriate margins. For selected small, peripheral early-stage non-small cell lung cancers, segmentectomy can provide cancer outcomes comparable to lobectomy while preserving more functioning lung tissue. The decision depends on tumor size and location, surgical margins, lymph node evaluation, and the patient’s overall condition.
Lobectomy
A lobectomy removes one entire lobe of the lung. The right lung has three lobes and the left lung has two. Lobectomy remains a common operation for localized non-small cell lung cancer when the tumor and surrounding anatomy make removal of the affected lobe the most appropriate oncologic treatment.
Sleeve Resection
A sleeve resection removes a portion of an airway involved by the tumor and reconnects the remaining healthy airway. In selected centrally located lung cancers, this approach can allow surgeons to remove the cancer while preserving functioning lung tissue that might otherwise be lost with a pneumonectomy.
Pneumonectomy
A pneumonectomy removes an entire lung and is generally reserved for tumors that cannot be completely removed with a less extensive operation. Because it has a greater effect on breathing capacity and recovery, careful evaluation of lung and heart function is especially important before this procedure is recommended.
Minimally Invasive Lung Cancer Surgery
Many lung cancer operations can now be performed using minimally invasive techniques. Video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracic surgery use small incisions and a camera rather than the larger incision and rib spreading associated with a traditional thoracotomy. When appropriate for the tumor and the patient, minimally invasive surgery can reduce the physical impact of an operation while maintaining the same fundamental cancer-surgery goals.
Video-Assisted Thoracoscopic Surgery (VATS)
VATS uses a small camera and specialized surgical instruments inserted through several small incisions in the chest. The camera provides a detailed view of the lung, blood vessels, lymph nodes, and other structures while the surgeon performs the operation without routinely spreading the ribs.
VATS can be used for wedge resection, segmentectomy, lobectomy, and selected more complex thoracic procedures. Compared with open thoracotomy, minimally invasive approaches are associated with less surgical trauma and can support a more comfortable recovery and shorter hospitalization for appropriately selected patients.
Robot-Assisted Thoracic Surgery (RATS)
Robot-assisted thoracic surgery is another minimally invasive approach that provides the surgeon with a magnified three-dimensional view and highly articulated instruments controlled from a surgical console. These instruments can help surgeons work precisely around small blood vessels, airways, lymph nodes, and other structures within the chest.
Robotic surgery may be used for procedures such as segmentectomy, lobectomy, and selected complex lung resections. The robot does not perform the operation independently; every movement is controlled by the thoracic surgeon. Whether VATS, robotic surgery, or an open approach is most appropriate depends on the tumor, anatomy, prior treatments, and complexity of the operation.
Open-Chest Surgery (Thoracotomy)
Thoracotomy remains an important surgical approach when minimally invasive surgery is not appropriate. It involves a larger incision between the ribs and provides direct access to the chest. Open surgery may be necessary for large or centrally located tumors, tumors involving major blood vessels or other nearby structures, extensive scar tissue, or operations that require complex reconstruction.
The goal is not to avoid open surgery at all costs, but to use the least invasive approach that allows the cancer to be removed safely and effectively.
Radiation Therapy for Lung Cancer
Radiation therapy can be used at several stages of lung cancer treatment. It may be the primary treatment for an early-stage lung cancer when surgery is not appropriate, combined with chemotherapy or other therapies for locally advanced disease, used after surgery in selected situations, or used to control tumors and relieve symptoms when cancer has spread. The type and schedule of radiation depend on the cancer type and stage, tumor location, nearby structures, previous treatments, and the patient’s overall health.
External Beam Radiation Therapy
External beam radiation therapy delivers carefully planned radiation to a lung tumor from outside the body. Modern treatment planning allows radiation oncologists to shape the radiation dose around the tumor while limiting exposure to nearby healthy tissues and organs. Techniques such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) can be used to improve the precision of treatment.
Stereotactic Body Radiation Therapy (SBRT)
Stereotactic body radiation therapy delivers highly focused radiation in a limited number of treatment sessions. SBRT is an important treatment for many patients with early-stage non-small cell lung cancer who are not appropriate candidates for surgical resection. It may also be used in selected patients with limited sites of recurrent or metastatic disease.
Brachytherapy
Brachytherapy delivers radiation from a source placed within or close to the area being treated. It is used much less commonly for lung cancer than external beam radiation therapy but may be considered in selected situations, including treatment of tumors involving or obstructing an airway. Whether brachytherapy is appropriate depends on the tumor’s location and the goals of treatment.
Proton Therapy
Proton therapy uses proton particles rather than X-rays to deliver radiation. Because protons deposit radiation differently as they travel through the body, proton therapy may reduce radiation exposure beyond the targeted area in selected patients. Whether it provides a meaningful advantage depends on the tumor’s location, surrounding anatomy, treatment plan, and availability of the technology.
Systemic Treatment for Lung Cancer
Systemic therapies travel through the bloodstream to treat cancer cells throughout the body and have become an increasingly important part of lung cancer care. Depending on the type and stage of lung cancer, systemic treatment may be given before surgery, after surgery, together with radiation therapy, or as the primary treatment for locally advanced or metastatic disease.
Choosing systemic therapy requires more than determining the stage of the cancer. Pathology and biomarker testing can identify genetic and molecular changes and immune markers that help physicians determine whether chemotherapy, immunotherapy, targeted therapy, or a combination of treatments is most appropriate.
Chemotherapy
Chemotherapy uses medications that interfere with the growth and division of cancer cells. It remains an important treatment for both non-small cell and small cell lung cancers and may be used alone or in combination with surgery, radiation therapy, immunotherapy, or other systemic treatments.
For some patients with operable lung cancer, chemotherapy may be given before surgery to treat cancer cells beyond the primary tumor and help improve cancer control. It may also be given after surgery when the stage and pathology indicate a meaningful risk of recurrence. For locally advanced disease, chemotherapy is frequently incorporated with radiation therapy, while patients with metastatic disease may receive chemotherapy alone or as part of a combination systemic treatment plan.
Immunotherapy
Immunotherapy helps the immune system recognize and attack cancer cells. Immune checkpoint inhibitors can block signals such as PD-1 or PD-L1 that cancers may use to suppress an immune response. These treatments have significantly expanded the options available for selected patients with non-small cell and small cell lung cancer.
Immunotherapy is no longer limited to patients with advanced lung cancer. Depending on the cancer stage, tumor characteristics, genetic and molecular findings, and treatment plan, it may be used before surgery, after surgery, together with chemotherapy, following chemoradiation, or as part of treatment for metastatic disease. Biomarker testing, including PD-L1 testing in appropriate patients, can help guide treatment decisions.
Targeted Therapy
Targeted therapies are designed to interfere with specific genetic and molecular changes that help certain lung cancers grow. Comprehensive biomarker testing can identify actionable changes that may make a patient eligible for a targeted medication. These treatments are especially important in non-small cell lung cancer and have created highly individualized treatment pathways for patients whose tumors contain specific molecular alterations.
Depending on the cancer and biomarker identified, targeted therapy may be used for advanced disease or, for selected molecularly defined lung cancers, after surgery to reduce the risk of recurrence. Because the number of actionable biomarkers and available treatments continues to expand, molecular testing has become an important part of treatment planning for many patients with non-small cell lung cancer.
How Lung Cancer Treatment Is Personalized
No single treatment approach is appropriate for every patient with lung cancer. Treatment planning considers whether the cancer is non-small cell or small cell, its stage and location, lymph node involvement, genetic and molecular changes, PD-L1 expression when relevant, previous treatment, lung function, overall health, and the patient’s individual goals and preferences.
These factors also determine how different treatments are sequenced. Some patients may proceed directly to surgery, while others benefit from systemic treatment before an operation. Radiation and systemic therapies may be combined for locally advanced disease, and advanced lung cancers may be treated with targeted therapy, immunotherapy, chemotherapy, radiation, or combinations of these approaches.
Additional Condition Information
Please see Lung Cancer
Advanced Thoracic Care for Lung Cancer
At Providence Saint John’s Health Center, lung cancer care brings together thoracic surgery, pulmonology, medical oncology, radiation oncology, radiology, pathology, and other specialists to develop an individualized treatment plan. Decisions are based on the type and stage of cancer, its genetic and molecular characteristics, the patient’s lung function and overall health, and how different treatments can work together most effectively.
Treatment may include minimally invasive lung surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, or a combination of approaches. Our goal is to provide effective cancer treatment while preserving lung function, supporting recovery, and adapting care as new information about the cancer becomes available.
If you have been diagnosed with lung cancer, our multidisciplinary team can help you understand your treatment options and determine the approach that is right for you.
If you have questions regarding Lung Cancer, Screening, or Treatment, please call today. Click here to request an appointment.
