Lung Nodule and Cancer Procedures

More than 225,000 Americans are diagnosed with lung cancer each year. WakeMed surgeons, pulmonologists, nurses and radiologists work together to offer personalized care to patients with lung nodules or lung cancer.

Lung cancer forms in tissues of the lung, usually in the cells lining air passages. It starts from a single cell, but usually includes millions of cells by the time it can be seen by an X-ray.

Lung nodules — small masses of tissue in the lung — are quite common. While they can be cancerous, most lung nodules are benign.

Whether a patient has a non-cancerous lung nodule or lung cancer, thoracic surgeons at WakeMed have experience and expertise in surgical procedures to remove these masses, including minimally invasive surgical techniques aided by video and robotic technology.

Symptoms of Lung Cancer

Lung nodules rarely cause symptoms. Lung cancer also may not cause any symptoms and may be found on a routine chest X-ray.

The most common symptoms of lung cancer are:

• Bone pain
• Chest pain
• Cough that doesn't go away and worsens over time
• Coughing up blood or rust-colored mucus
• Enlarged lymph nodes in the neck
• Feeling very tired
• Headache, seizures, or confusion
• Hoarseness
• Loss of appetite
• Pneumonia or bronchitis
• Shoulder pain
• Trouble breathing
• Weight loss for no known reason
• Wheezing
• Yellowing of skin and eyes (jaundice)

Types and Causes of Lung Cancer and Lung Nodules

There are two major types of lung cancer:

Non-small cell lung cancer accounts for 85 to 90 percent of lung cancers. The main types of non-small cell lung cancer include:

• Adenocarcinoma, the most common type, which usually begins along the outer edges of the lungs
• Large cell carcinomas, a group of fast-growing cancers with large, abnormal-looking cells related to hormone secreting glands
• Squamous cell carcinoma, which often begins in the bronchi near the middle of the lungs

Small cell lung cancer is sometimes called oat cell cancer. It grows rapidly and spreads to other organs. There are two types:

• Limited, in which cancer is generally found in one lung — there may be cancer in nearby lymph nodes on the same side of the chest
• Extensive, in which cancer has spread beyond the primary tumor in the lung into other parts of the body

A lung nodule is a solid area, like a marble, embedded in the lung tissue. The size of the lung nodule is usually an indicator of whether the mass is cancerous or benign.

• In general, nodules that are less than 6 millimeters have a low risk of cancer
• Nodules greater than 10 millimeters in diameter are more likely to be malignant

Diagnosing Lung Cancer or Nodules

To diagnose lung cancer or identify a lung nodule, a thorough medical history and physical exam will be conducted, followed by a series of diagnostic tests that may include:

• Biopsy
• Blood and urine test
• Bronchoscopy
• Imaging studies including chest X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan and ultrasound
• Sputum cytology studies of mucus cells under a microscope
• Thoracentesis

Treating Lung Cancer or Nodules

Treatment depends on the type and stage of lung cancer and may include surgery, chemotherapy, radiation therapy or targeted drug therapy. WakeMed thoracic surgeons offer the following procedures as part of lung cancer or lung nodule treatment:

• Lobectomy: Removal of an entire lobe of the lung. There are three lobes in the right lung and two in the left lung.
• Segmentectomy and wedge resection: Removal of only a part of the lung. There are 10 segments in each lung.
• Metastasectomy: Removal of metastases, which are secondary cancerous growths that have spread from cancer originating in another organ in the body.
• PleurX catheter placement: A drainage catheter is sometimes placed in the chest to drain excess fluid from around one or both lungs and to make breathing easier.
• Pleurodesis: A procedure sometimes performed for people with recurring excess fluid around the lungs, in which a chemical is placed between the two membranes that line the lungs causing them to scar together. This scarring obliterates the pleural space so that fluid can no longer build up.

Whenever possible, a minimally invasive approach is used, such as video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (small camera) and surgical instruments into small incisions in the chest. Minimally invasive techniques can reduce postoperative pain, shorten a patient’s hospital stay and speed up recovery time.

Make an Appointment

We welcome new patients. If you’d like to meet with one of WakeMed’s thoracic experts, please make an appointment by calling us at 919-231-6333.