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Once it’s been determined that surgery is indicated based on what we think the diagnosis is, and also what we think the stage is based on the staging workup thus far, if surgery makes sense from an oncologic or a cancer standpoint, that’s when we start to discuss, well, does surgery make sense for this specific patient? And not all patients are the same, we’re all individual people. So this is a conversation that has to happen with your physician, but typically we will obtain pulmonary function tests so that we can say, “Okay, well, if this is the total capacity of both of your lungs and we remove this fraction of a lung, what is that going to look like after surgery?” What is that residual lung capacity going to be? Is it going to require you to wear oxygen or are you not even going to notice that that piece is gone because you have excellent lung function to start with. And everyone is really different in that regard. A marathon runner may notice losing a little bit of lung because they use every bit of their lung, whereas someone who just performs normal activities of daily living might not be using their entire lung capacity anyway.
Once we’ve got that pulmonary function tests done, we can go even further if there is a borderline result. So if we say, “You know what, this is sort of in a gray zone, we’re not sure exactly what that impact is going to be for removing your lung cancer,” we can also do what’s called a quantitative perfusion scan, which looks at both of the lungs and tells us which lung is working harder than the other, and which proportion of each lung is working harder. The upper, the lower, the right, the left.
And it gives us an even more specific way to say, “Okay, well, if we’re removing the right upper lobe, that’s really only about 10% of your lung function.” So even though anatomically, it may be 20 to 25% of what we see on the scan, if it’s only indicative of 10% of the function, it may be less of an impact, which may make that patient more or less amenable to surgery based on those numbers. So that’s all very important. Your surgeon may also recommend that you see a cardiologist prior to surgery to make sure that you can withstand the surgical procedure from a cardiac standpoint. Also primary care has a real role here. If there are a bunch of other medical problems that the patient has, you may need to consider all of those things as well.
