MARK K. FERGUSON, M.D.
Professor, Cardiac & Thoracic Surgery
The Role of the Surgeon in Diagnosing
and Treating Lung Cancer
Since the first successful resections were performed for lung cancer 75 years ago, substantial progress has been made in
the surgical management of lung cancer. As a result, despite numerous advances in our understanding of the
pathobiology of this disease and the resultant development of therapies, surgery remains one of the mainstays of
curative therapy for lung cancer.
Techniques such as flexible fiberoptic bronchoscopy and sputum cytology remain the basic tools for lung cancer
diagnosis.Advances in radiology have led to the introduction of low dose helical computed tomography for screening
for lung cancer, which is effective in identifying small lung nodules not evident on plain chest radiographs. Such
nodules are not amenable to bronchoscopic biopsy, percutaneous aspiration for cytology, or further characterization by
PET scanning. As a result, the identification of a small peripheral nodule often requires the input of surgeons for
diagnostic assistance.Thoracoscopic biopsy techniques, sometimes directed by fluoroscopic identification of radiopaque
markers placed under CT guidance, offer the ability to diagnose and treat some such early stage cancers.The benefit and
cost-effectiveness of this technique are currently under investigation.
An additional new screening measure that is being introduced in some medical centers is LIFE (light-induced
fluorescence endoscopy) bronchoscopy. This technique relies on excitation of natural autofluorescence in precancerous
or cancerous tissues by specific wavelengths of light.
It permits detection of carcinoma-in-situ or early stage
cancers in patients who at high risk for new cancer development after successful treatment of early stage lung cancer.
Minimally invasive techniques are being used with increasing frequency for lung cancer diagnosis and staging. The recent
introduction of endoscopic ultrasonography for biopsying mediastinal lymph nodes com