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Prior to proceeding with lung cancer surgery, we need to know if the cancer has spread beyond the lung.
A PET scan will show us if there are any other areas throughout your body which might represent other cancer activity. PET scan works by injecting sugar with radiotracers into your body and letting the sugar get absorbed by cells that are active – these cells are usually infection or cancer cells. A detector will look for these radiotracers in your body. If a “hotspot” is found in your body, this can be due to either infection or cancer. PET scan is not 100% and can give a false diagnosis. With lung cancer, we are especially interested in the lymph nodes (glands like the one you get in your neck when you are sick) around the middle of the chest. These lymph nodes are the first place a lung cancer will spread to and it will determine the stage of the cancer.
The second thing we need to know before surgery is if your lung capacity is good enough to have a portion of the lung removed.
Your lungs have three lobes on the right and two lobes on the left (there are only two on the left because of the space taken by the heart.) A healthy person with normal lungs can tolerate removal of the entire left or right side (either two or three lobes) without noticing any difference, although may become short of breath with activity.
Pulmonary function testing (PFT) is done to measure lung function prior to surgery. With this study a person will be asked to give their maximal effort in deep breathing and exhaling. By analyzing this study, we can determine how much of the lung we can safely remove.
The last thing we need to know before surgery is if a person can undergo general anesthesia.
Lung surgery is done under general anesthesia and a person needs to be healthy enough to undergo a general anesthetic. Often we will obtain a cardiac stress test to make sure the heart is strong enough to undergo the stress. Patients are also asked to see their primary physician for preoperative clearance for surgery (preoperative H&P).