What tests are performed before lung cancer surgery?

Brian D. Mott, MD
Thoracic Surgery (Cardiothoracic Vascular)

There is two parts to this answer. The first is from a cancer standpoint. Is the cancer confined to the lung or has it spread beyond what surgery is able to cure. A PET scan is often used to look for spread of cancer to other organs or lymph nodes that could make surgery useless. This test is a lot like a CT scan. A bronchoscopy is used frequently to get a tissue diagnosis, check airway anatomy, and sample lymph nodes in the chest. Finally a mediastinoscopy to biopsy lymph nodes is frequently done to stage cancer and determine resectability.

The second part is can you tolerate safely having lung surgery and removing part of the lung. The two most common tests after a good history and physical are pulmonary function tests and a cadiac stress test. This will enable surgeons to gauge your operative risk. Some people are just too frail to undergo surgery safely.

The lung is very sensitive to radiation. So, unlike breast cancer, we can’t just take the lump, irradiate the rest of the lung, and leave it intact. In general, we need to know if you'll tolerate having one of the five lobes of your lung removed and still have a good quality of life and good breathing capacity, so we do pulmonary function tests. The two major risks to your life around the time of surgery is if you have any complications related to breathing or your heart. We’ll do an electrocardiogram (EKG) to check your heart. But principally, we want to know what your overall function is: Are you caring for yourself, shopping for yourself, working?

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