Lung Cancer

Information on Lung Cancer Symptoms, the Diagnosis and Staging Process, PET-CT, EBUS, Biopsy, VATS, Segmentectomy, Lobectomy and Surgical Treatment.

What Is Lung Cancer? Symptoms, Diagnosis and Surgical Treatment

Lung cancer is a group of diseases that develop as a result of the uncontrolled growth of cells in the lung or bronchial tissue.

It is not a single disease. It includes various tumor types with different cellular characteristics, biological behaviors and treatment approaches.

In lung cancer, the treatment plan is not determined by tumor size alone. The type of cancer, the stage of the disease, the status of the lymph nodes, the tumor's location within the lung, its molecular characteristics, the person's respiratory capacity and general health are all evaluated together.

Surgery may be one of the treatment options, particularly for non-small cell lung cancers that can be completely removed. However, surgery is not suitable for every lung cancer patient, and some patients may need medication-based treatments, radiation therapy or a combination of different treatments.

What Are the Types of Lung Cancer?

Lung cancers are generally classified into two main groups:
  • Non-small cell lung cancer
  • Small cell lung cancer
Determining which group and subtype the cancer belongs to is important for treatment planning.

Non-Small Cell Lung Cancer

Most lung cancers fall into the non-small cell lung cancer group.

The main subtypes are:
  • Adenocarcinoma
  • Squamous cell carcinoma
  • Large cell carcinoma
  • Other, less common subtypes


Surgery may be one of the treatment options, particularly when the disease can be completely removed. However, the decision to operate is not based solely on the cellular type of the cancer. The stage of the disease, the anatomical features of the tumor, the status of the lymph nodes and whether the person can physiologically tolerate the operation are also evaluated.

Small Cell Lung Cancer

Small cell lung cancer generally tends to grow faster and spread earlier. For this reason, medication-based treatments and radiation therapy play a greater role in its treatment. Surgery may be considered only in selected patients with very early, limited disease.

What Causes Lung Cancer?

Lung cancer does not develop from a single cause. Many environmental, occupational and individual factors can affect the risk of developing the disease. Important risk factors include:
  • Smoking and the use of other tobacco products
  • Exposure to secondhand smoke
  • Radon exposure
  • Long-term exposure to asbestos and certain occupational substances
  • Air pollution
  • Certain chronic lung diseases
  • Previous radiation therapy to the chest area
  • Family history and genetic predisposition
Smoking is the most important preventable risk factor for lung cancer. However, lung cancer can also occur in people who have never smoked.

What Are the Symptoms of Lung Cancer?

Lung cancer may not cause any symptoms, especially in the early stages. Some early-stage tumors may be detected incidentally on lung imaging performed for another reason.

Possible symptoms may include:
  • A persistent or long-lasting cough
  • A change in the character of an existing cough
  • Coughing up blood
  • Shortness of breath
  • Chest pain
  • Recurrent lung infections
  • Hoarseness
  • Loss of appetite
  • Unintentional weight loss
  • Fatigue
  • Shoulder or back pain
These symptoms are not specific to lung cancer. Similar complaints may also be seen in lung infections, COPD, bronchiectasis and other respiratory diseases.

Can Lung Cancer Appear as a Lung Nodule?

Some lung cancers may be detected on imaging as a lung nodule. However, a lung nodule and lung cancer are not the same thing. A lung nodule is an imaging finding. It can arise from many non-cancerous causes, such as infection, scar tissue, inflammatory diseases and benign growths. When assessing the likelihood that a nodule is cancer, its size, density, shape, margin characteristics, change over time and the person's individual risk factors are considered together.

Lung Nodule

How Is Lung Cancer Diagnosed?

Imaging methods can help detect and evaluate a suspicious lesion in the lung. However, a definitive diagnosis is usually made by examining cells or tissue obtained from the suspicious area in a pathology laboratory.

Methods that may be used in the diagnostic process include:
  • Computed tomography
  • PET-CT
  • Bronchoscopy
  • EBUS
  • Transthoracic needle biopsy
  • Pleural fluid analysis
  • Pleural biopsy
  • Lymph node biopsy
  • Mediastinoscopy
  • Surgical biopsy
The choice of the most appropriate method may vary depending on the size and location of the tumor and its relationship to the airways, blood vessels and lymph nodes.

Why Is Computed Tomography Used in Lung Cancer?

Computed tomography helps evaluate a suspicious lesion in the lung in detail.

CT can provide information about:
  • The size of the tumor
  • Its location within the lung
  • Its relationship to surrounding structures
  • Lymph nodes within the chest
  • Other lesions in the lung
This information can be used both in the diagnostic process and in assessing the extent of the disease.

Why Is PET-CT Performed in Lung Cancer?

PET-CT allows the metabolic activity of tissues to be evaluated.

When lung cancer is suspected, it may be used for:
  • Evaluating the primary tumor
  • Examining the lymph nodes
  • Searching for suspicious areas in other parts of the body
However, PET-CT alone does not provide a definitive cancer diagnosis. Increased metabolic activity can also be seen in non-cancerous conditions such as infection and inflammation. Similarly, some small tumors or tumors with low metabolic activity may not show significant uptake on PET-CT.

Why Is Bronchoscopy Performed in Lung Cancer?

Bronchoscopy allows the windpipe and airways to be examined with a camera. Particularly for tumors close to the central airways, it may be used for:
  • Visualizing the tumor
  • Evaluating its relationship to the airways
  • Taking a tissue sample
The diagnostic suitability of bronchoscopy depends on the tumor's location within the lung.

What Is EBUS in Lung Cancer?

Endobronchial ultrasound, or EBUS, is a method that combines bronchoscopy with ultrasound imaging. It can allow certain lymph nodes within the chest to be visualized and sampled with a needle. Because lymph node involvement in lung cancer can change the stage of the disease and the treatment plan, EBUS may be an important part of the diagnostic and staging process in some patients.

How Is a Biopsy Performed in Lung Cancer?

The method used for a lung cancer biopsy may vary depending on the location of the tumor. Bronchoscopic methods may be used for centrally located lesions, while a CT-guided transthoracic needle biopsy may be performed for some lesions near the outer regions of the lung. In some cases, samples may be taken from other sites, such as a lymph node, the pleura or pleural fluid. A surgical biopsy may be considered for some lesions that cannot be diagnosed by other methods or that are deemed suitable for surgical removal. The goal is not simply to obtain tissue, but to obtain an adequate and appropriate sample for diagnosis using the most suitable method possible.

Why Is Pathological Examination Important?

Pathological examination allows the cells or tissue obtained to be evaluated under a microscope and, when necessary, with additional laboratory methods.

This examination can determine:
  • Whether cancer is present
  • The cellular type of the lung cancer
  • Certain tumor characteristics
In suitable patients, evaluation of molecular and biological characteristics may also affect treatment planning. For this reason, not only imaging findings but also pathological and, when necessary, molecular evaluation are part of the treatment decision.

How Is Lung Cancer Staged?

Staging is performed to determine how far the cancer has spread.

In non-small cell lung cancer, staging is based mainly on:
  • The size and local spread of the primary tumor
  • Involvement of lymph nodes within the chest
  • Whether there is spread to distant organs
This evaluation is generally carried out within the framework of the TNM system.

Depending on the patient's condition, staging may use:
  • Computed tomography
  • PET-CT
  • Brain imaging
  • EBUS
  • Lymph node biopsies
  • Mediastinoscopy
  • Other necessary imaging or biopsy methods

How Is Lung Cancer Treatment Planned?

Lung cancer treatment is not determined by the stage of the disease alone.

Treatment planning may take the following into account together:
  • The cellular type of the cancer
  • The stage of the disease
  • The location of the tumor
  • Molecular and biological characteristics
  • The status of the lymph nodes
  • Lung function
  • Function of the heart and other organs
  • General health
  • Previous treatments


In suitable patients, treatment options may include:
  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Immunotherapy
  • Targeted therapies
While a single treatment method may be sufficient for some patients, others may need different treatments given together or in a specific sequence.

What Is Multidisciplinary Evaluation in Lung Cancer?

The diagnosis and treatment of lung cancer may require joint evaluation by different medical specialties.

Specialties that may be involved in the process include:
  • Thoracic surgery
  • Pulmonology
  • Medical oncology
  • Radiation oncology
  • Radiology
  • Nuclear medicine
  • Pathology
This approach can be particularly important for confirming the diagnosis, achieving accurate staging and determining the order in which different treatment options should be given.

When Is Surgery Performed for Lung Cancer?

The goal of lung cancer surgery is to remove the cancerous lung tissue with appropriate surgical margins and to evaluate the relevant lymph nodes. Surgery is one of the important treatment options, particularly for non-small cell lung cancers that can be completely removed. However, suitability for surgery is not determined by the stage of the disease alone.

The following are also evaluated:
  • The location of the tumor
  • Its relationship to the airways
  • Its relationship to the major blood vessels
  • The status of the lymph nodes
  • Spread to distant organs
  • Respiratory capacity
  • Cardiovascular function
  • General health
In some patients, surgery may be the first treatment. In others, depending on the characteristics and stage of the disease, chemotherapy, immunotherapy, radiation therapy or combinations of these may be given before or after surgery.

What Are the Types of Lung Cancer Surgery?

The amount of lung tissue removed in lung cancer surgery is not the same for every patient. The size, location and stage of the tumor, the surgical margins and the person's respiratory capacity are taken into account. When appropriate, the main goal is to preserve as much healthy lung tissue as possible while performing adequate cancer surgery.

Wedge Resection

In a wedge resection, the tumor or nodule is removed together with a limited amount of surrounding lung tissue. This procedure does not follow the anatomical boundaries of the lung segments. It may be used for diagnostic purposes and may also be considered in selected patients with small, peripheral lung tumors.

Segmentectomy

Segmentectomy is the removal of an anatomical segment of a lung lobe together with the airway and blood vessels belonging to that segment. It is more anatomical and extensive than a wedge resection, but it allows more healthy lung tissue to be preserved than a lobectomy. It may be considered as a surgical treatment option in selected patients with small, early-stage lung cancers without lymph node involvement.

In making the decision, the following are evaluated together:
  • The size of the tumor
  • The location of the tumor
  • Whether adequate surgical margins can be achieved
  • The status of the lymph nodes
  • Lung function

Lobectomy

Lobectomy is the anatomical removal of the lung lobe in which the tumor is located. It is one of the most commonly performed anatomical resections for operable non-small cell lung cancer. However, not every early-stage lung cancer automatically requires a lobectomy. In appropriately selected patients, more limited anatomical resections such as segmentectomy may also be considered depending on the characteristics of the tumor.

Sleeve Resection

In a sleeve resection, the section of the airway affected by the tumor is removed and the remaining airway is reconnected. In selected centrally located tumors, this method can allow the cancerous tissue to be removed without the need to remove the entire lung. In some cases, adjacent blood vessels may also need to be removed and reconstructed.

Pneumonectomy

Pneumonectomy is the removal of an entire lung. It may be necessary for some central tumors affecting the main bronchus or major blood vessels if adequate cancer surgery cannot be achieved with a more limited operation. Because pneumonectomy has a greater effect on respiratory capacity than more limited lung resections, preoperative physiological evaluation is especially important. When appropriate, surgical methods that can preserve more healthy lung tissue are considered.

Why Are Lymph Nodes Removed During Lung Cancer Surgery?

Whether lung cancer has spread to the lymph nodes within the chest can affect the stage of the disease and the treatment plan after surgery. For this reason, during lung cancer surgery, samples may be taken from lymph nodes in specific areas, or the lymph nodes may be systematically removed. Pathological examination can reveal microscopic spread of cancer that was not detected on preoperative imaging. For this reason, the evaluation of lymph nodes is an important part of lung cancer surgery.

What Is VATS Lung Cancer Surgery?

Video-assisted thoracoscopic surgery, or VATS, is a minimally invasive surgical method performed through small incisions in the chest wall using a camera and special surgical instruments.

In suitable patients, the following can be performed with VATS:
  • Wedge resection
  • Segmentectomy
  • Lobectomy
  • Lymph node procedures
  • Lung and pleural biopsies
Suitability for VATS is not determined by the stage of the cancer alone.

The tumor's:
  • Size
  • Location
  • Relationship to the major blood vessels
  • Relationship to the airways
are evaluated together with any previous chest surgery, adhesions within the chest and the complexity of the planned procedure.

What Does It Mean When VATS Surgery Is Converted to Open Surgery?

Although some operations are started with a minimally invasive approach, it may become necessary to switch to open surgery during the operation. This alone does not mean that a complication has occurred.

When necessary, the surgical approach may be changed in order to:
  • Complete the operation safely
  • Control bleeding
  • Evaluate anatomical structures safely
  • Achieve appropriate oncological surgical margins

What Is Open Lung Cancer Surgery?

Thoracotomy is an open surgical method in which the chest cavity is accessed through an incision made between the ribs.

Open surgery may be used:
  • For large tumors
  • For centrally located tumors
  • For cancers affecting neighboring structures
  • When complex airway reconstruction is required
  • In some operations requiring blood vessel reconstruction


The choice between minimally invasive and open surgery is not based solely on incision size. The main goal is to perform the necessary cancer surgery safely and in accordance with oncological principles.

What Tests Are Performed Before Lung Cancer Surgery?

Before lung cancer surgery, two main questions are evaluated:
  1. Can the disease be appropriately removed surgically?
  2. Can the person physiologically tolerate the planned lung resection?
Depending on the patient's condition, the following may be used:
  • PET-CT
  • Computed tomography
  • Brain imaging
  • Pulmonary function tests
  • Cardiac evaluation
  • Exercise capacity tests
  • Bronchoscopy
  • EBUS or other lymph node sampling
  • Blood tests
  • Anesthesia evaluation
When removal of part of the lung tissue is planned, the lung function expected to remain after surgery can also be estimated.

How Does Lung Function Affect Lung Cancer Surgery?

In lung surgery, it is not enough for the tumor simply to be removable. It is also evaluated whether the lung tissue remaining after the planned resection will be able to meet the person's breathing needs. For this reason, pulmonary function tests and, when necessary, additional tests that assess exercise capacity may be used. As the extent of the planned operation increases, assessing the expected postoperative respiratory capacity may become more important.

What Does the Pathology Report Show After Lung Cancer Surgery?

The tumor, lung tissue and lymph nodes removed during surgery are examined in detail in the pathology laboratory.

The pathology report can provide information about:
  • The exact type of cancer
  • The actual size of the tumor
  • The status of the surgical margins
  • Involvement of blood vessels or the lymphatic system
  • Pleural involvement
  • Whether cancer is present in the lymph nodes
  • The pathological stage
The clinical stage determined before surgery may differ from the pathological stage revealed after surgery.

Is Additional Treatment Needed After Lung Cancer Surgery?

Not every patient needs additional treatment after surgery.

The need for additional treatment may be assessed based on factors such as:
  • The pathological stage
  • The status of the lymph nodes
  • The surgical margins
  • The biological characteristics of the tumor
  • Molecular characteristics
  • Previous treatments
  • The person's general health
In suitable patients, medication-based treatments or radiation therapy after surgery may be part of the treatment plan.

How Is Follow-Up Carried Out After Lung Cancer Surgery?

The follow-up program is planned according to the type of cancer, its pathological stage, the treatments given and the person's general health.

Follow-up may include:
  • Clinical evaluation
  • CT imaging
  • Assessment of lung function
  • Monitoring for treatment-related effects
  • Assessing the likelihood of recurrence
  • Checking for new lung lesions
For people who smoke, quitting remains important after treatment as well. Quitting smoking supports respiratory and cardiovascular health and may reduce the risk of developing other smoking-related diseases.

Frequently Asked Questions About Lung Cancer

Does lung cancer cause symptoms in the early stage?
Not always. Some early-stage lung cancers cause no symptoms and may be detected incidentally on imaging performed for another reason.
Does a lung nodule mean lung cancer?
No. A lung nodule is an imaging finding and can arise from many non-cancerous causes. The likelihood that a nodule is cancer is assessed together with its imaging features, its change over time and the person's individual risk factors.
How is a definitive diagnosis of lung cancer made?
A definitive diagnosis is usually made by pathological examination of cells or tissue obtained from the suspicious area. The biopsy method may vary depending on the location of the tumor and other anatomical features.
Does uptake on PET-CT definitely mean cancer?
No. Conditions such as infection and inflammation can also cause increased metabolic activity on PET-CT. PET-CT results are evaluated together with other imaging and, when necessary, pathology findings.
Can every lung cancer patient have surgery?
No. Suitability for surgery is evaluated according to the type and stage of the cancer, the location of the tumor, the status of the lymph nodes and distant organs, lung function and the person's general health.
Is the entire lung removed in lung cancer surgery?
No. Depending on the characteristics of the tumor, more limited procedures such as wedge resection, segmentectomy, lobectomy or sleeve resection may be performed. In selected cases, a pneumonectomy may be necessary.
Can segmentectomy be performed for early-stage lung cancer?
In selected small, early-stage lung cancers, anatomical segmentectomy may be one of the surgical treatment options. The decision is made by evaluating the size and location of the tumor, the surgical margins, the status of the lymph nodes and the person's lung function.
Can lung cancer surgery be performed with VATS?
In suitable patients, segmentectomy, lobectomy and some other lung resections can be performed using VATS. The surgical approach is determined according to the anatomical features of the tumor and the extent of the planned operation.
Is chemotherapy needed after lung cancer surgery?
Not in every patient. The decision on additional treatment after surgery is based on the pathological stage, lymph node status, the biological and molecular characteristics of the tumor, previous treatments and the person's general health.
Can the disease recur after lung cancer surgery?
In lung cancer, the risk of recurrence may not be completely eliminated after treatment. The risk may vary depending on the type of cancer, its pathological stage, lymph node status, the biological characteristics of the tumor and other factors. For this reason, scheduled follow-up after treatment is important.

Conclusion

Lung cancer is a group of cancers that includes diseases with different cellular and biological characteristics. In diagnosis and treatment planning, not only the size of the tumor seen in the lung is evaluated, but also the following, together:
  • The cellular type of the cancer
  • The stage of the disease
  • The status of the lymph nodes
  • Spread to distant organs
  • The anatomical location of the tumor
  • Molecular characteristics
  • Respiratory capacity
  • General health


A definitive diagnosis is usually based on pathological examination of a tissue sample. CT, PET-CT, bronchoscopy, EBUS and various biopsy methods may be used at different stages of the diagnostic and staging process.

In suitable patients, surgery is one of the important components of lung cancer treatment. Different operations may be performed, such as wedge resection, segmentectomy, lobectomy, sleeve resection and pneumonectomy. Some operations can be performed with minimally invasive methods such as VATS.

The goal is not only to remove the tumor, but also to achieve accurate staging, obtain appropriate surgical margins, evaluate the lymph nodes and ensure that the person's overall treatment plan is developed together with other treatment methods.

Disclaimer: The information on this page has been prepared for general informational purposes and does not replace a medical examination, diagnosis or a personalized treatment plan. In lung cancer, diagnosis, staging and treatment decisions are evaluated individually based on the type and stage of the cancer, imaging and pathology findings, molecular characteristics, lung function, coexisting conditions and the person's general health.

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