Before Lung Cancer Surgery

Before Lung Cancer Surgery

After being diagnosed with lung cancer, you likely will have discussed your treatment options with your medical team.

If your doctors recommend surgery, you will meet with a thoracic surgeon prior to the operation. He/she will describe the operative procedure, the operative approach and incisions, the risks and benefits, and other potential options.

The more you know about your operation and what to expect before, during, and after, the smoother your recovery will be. Don’t hesitate to ask questions, so that you are comfortable with your decisions going into the operation. Take plenty of notes, and consider bringing a friend or relative to the meeting, as they may be able to help you remember certain details.

Preoperative Testing

Before your operation, you may require tests to help your surgeon make decisions about your risks, anesthesia choices, and managing your recovery. In addition to blood and urine tests, these tests may include:

• Chest x-ray: This noninvasive, painless test can show spots (nodules) or other abnormal areas in your lungs and airway.
• Pulmonary function test: This test measures how well you can breathe and how effective your lungs are at bringing oxygen into your bloodstream. It will help your surgeon determine whether you can tolerate having part of your lungs removed.
• Quantitative ventilation-perfusion scan: This is a nuclear medicine study that is useful for patients with compromised lung function to assess whether they are appropriate candidates for lung resection.
• Computed tomography (CT) scan: A CT scan (sometimes called a “CAT scan”) uses x-rays to create a three-dimensional picture of the inside of your body. CT images provide more details about the size and location of abnormalities found on a regular chest x-ray.
• Positron emission tomography (PET) scan: A PET scan may be ordered to help determine whether or not your cancer has spread. You will be given a radioactive sugar that collects in areas of your body that have high levels of metabolism.
• Magnetic resonance imaging (MRI): MRI uses a magnetic field, radio waves, and a computer to produce detailed images of the inside of your body.

For more information on these tests, visit our common diagnostic tests page.

Your doctor also may want a tissue sample (biopsy) either before or during your surgery for further examination. Tissue samples may be obtained through any of the following procedures:

• Bronchoscopy: A thin, flexible tube containing a tiny video camera (bronchoscope) is passed through your nose or mouth and then your windpipe (trachea) into your lungs. The camera allows the doctor, usually a pulmonologist or cardiothoracic surgeon, to see inside your air passages, where tissue and fluid samples can be taken.

• Robotic navigation bronchoscopy: This study uses a flexible robotic scope which goes into the patient’s mouth and can utilize a 3D scan to navigate out to a peripheral lung lesion. This technique can be used to biopsy suspicious lung lesions or mark tumors with fluorescent dye prior to surgical resection.
• Endobronchial ultrasound: A bronchoscope with a sound-wave probe is used to visualize the airway wall and surrounding structures so that a pulmonologist or cardiothoracic surgeon can locate and see masses and lymph nodes. Needles are then used to obtain tissue samples.

• Mediastinoscopy: A specially designed tube (mediastinoscope) is inserted through a small incision that is made above or on the side of the breastbone so that tissue can be removed.
• Thoracoscopy: A narrow tube with a mirror or camera (thoracoscope) is inserted through a small incision in the inside layer of the chest (pleura) to inspect and biopsy the pleura.

Preparing For Your Surgery

• Quit Smoking: The number one thing you can do to help ensure a successful surgery is to quit smoking. Smoking can cause problems during and after your surgery in a number of ways; learn more from Dr. Rishindra Reddy in his blog post, “Why Surgery and Smoking Don’t Mix!” While you ideally want to quit smoking permanently, quitting at least 4-6 weeks prior to your surgery and staying smoke-free for 4 weeks afterward can reduce your chance of wound complications by 50%.

• Make a Medication Plan: Talk to your doctor about whether you will need to stop taking certain medications prior to or after surgery. Some medications can interfere with your surgery and recovery. This is especially true if you are on a blood thinner, such as warfarin (Coumadin) or clopidogrel (Plavix). Write a list of all medications you take on a regular basis, including prescription and over-the-counter medications, vitamins, supplements, and herbs. If you are diabetic, ask about a plan for managing your insulin the day of your surgery, since you will not be able to eat. Some programs have rapid recovery programs that involve ingesting pain medications and fluid preparations before surgery. Your surgeon or his/her office will give you specific instructions regarding these types of strategies.
• Coordinate Coverage for Your Return Home: Organize a plan ahead of time for your transportation home, and for getting help when you return home. Who can help you get dressed, move in and out of bed, and with chores? Can someone arrange meals and shop for you? Who will drive you to your doctor’s appointments? You will not be able to do any heavy lifting for up to 6 weeks.
• Exercise: If you are currently exercising, keep it up prior to your surgery, and if you aren’t, consider starting a daily exercise plan after speaking to your physician. If approved by your doctor, try to start daily exercise at least 2 weeks before your operation. Aerobic exercise can improve your breathing capacity and strengthen your pulmonary muscles. Walking or riding an exercise bike are great options. Aim for 30 minutes a day.
• Eat a Healthy Diet: Eat a well-balanced, healthy diet before your surgery. Do not eat a heavy meal the evening before your operation. Talk with your doctor or nurse about meeting with a dietitian.
• Appoint a Decision Maker: Be sure to appoint someone in your family to make decisions about your care in the event that you are unable. Discuss your medical history with whomever you appoint so that he or she is aware of any allergies or prior conditions that may affect your surgery. It also is good to discuss what could happen if you have a complication during or after surgery so that your wishes are known.