Shahid Akhter, editor, ETHealthworld, spoke to Dr Khader Hussain AK, Consultant Thoracic Surgical Oncologist, Apollo Proton Cancer Centre, to know more about the advancements in thoracic surgery and how COVID-19 symptoms helped in the early detection of lung cancer.
COVID-19: Lessons learnt & Impact on lung cancer
There was a significant impact of COVID-19 on lung cancer, more precisely, those patients who were detected with early lung cancers. What we learn from COVID is that a certain subset of patients who were harbouring an early lung cancer, that could not be detected symptomatically by clinicians, were detected by these COVID symptoms. Because the patient had certain symptoms, they went to the doctor and had a CT scan, which revealed the lung nodule in those patients who had early lung cancer. So, COVID-19 has taught us a big lesson: the early lung cancers can be detected quite easily, and those lung cancers, if detected early, can be cured completely with one modality of treatment, maybe an extra modality of treatment, including chemotherapy.
The lung cancer burden, in India is quite huge high. It is one of the most common cancers in both men and women in India. Among Indians, it’s quite common in Northeast India. And the burden is almost 10 to 13 patients out of every one lakh gets lung cancer in India. It’s a huge burden and it should be targeted, specifically, by screening high risk people who are at risk of getting lung cancer. Especially those people who are smokers, who are exposed to the pollution, who are industrial workers, and who have family history of cancer. They all should be taught, screened regularly, at regular intervals, so that the lung cancer can be detected early and can be cured.
Lung cancer diagnosis: Latest advancements
The latest advances in the diagnosis and treatment of lung cancer start with a simple CT-guided biopsy. For example, if the patient has a nodule in the lung that is at the outer part of the lung, we try to do a simple, CT scan-guided biopsy. It will give us the diagnosis within three to four days. And once the diagnosis is made, we stage the patient and give the treatment according to that.
The other way of detecting lung cancer is quite easy: by doing a simple endoscopy. A small tube, which is 7 mm wide, goes inside. We take a biopsy of any nodule found within the windpipe or bronchial tree, and we get the answer. These are the two ways that we can clinch the diagnosis, and of course, by experience, even with imaging with the special cancer scan called the PET CT Scan, one can even diagnose it easily.
Lung cancer management: Robotic surgery
Robotic surgery is an ultra-minimally invasive thoracic surgery, which is the latest innovation. .This has had the greatest impact on lung cancer management because, in general, all lung cancer patients believe that the procedure is complicated and painful…There’s no shortage; there’s much more bleeding, and the length of stay in the hospital is quite high.
This robotic surgery has revolutionised the treatment of lung cancer in such a way that the patient can stay only two or three days in the hospital. 8 mm incision, not more than that, and bleeding is almost less than 50 ml for each surgery. No pain, early recovery You can start your further treatment in a few days or a few weeks, and you can start doing your routine work from day seven to day ten. Because of this, the management of lung cancer has become quite easy, thanks to this technology, for humanity, where we can give the least trauma to the patients.
Thoracic surgery: Innovations
The new innovations in thoracic surgery started with the diagnostic dilemma, where the physician sees a small nodule in the lung. How should I go about it?In India, a lot of inflammatory diseases are quite prevalent, and most physicians think that they are inflammatory diseases like tuberculosis or any fungal infection. We can’t approach those patients like that. Those were the days when we were only interested in history and imaging. Now is the time when we try to find out what the nodule is, that is present in the lung.
This is something called “image-guided VATS,” or image-guided video-assisted thoracic surgery. This was actually pioneered in China. When I was in China, in Shanghai, the image guided VATS were for those people who had these risk factors for lung cancer, because the Chinese people are screened every year. So how do they approach it? Assume they discovered a nodule measuring between 2 and 3 or 4 mm. So, what they or we do is now, in India, take the patient to the CT scan room and put a needle inside the nodule, which we are planning to remove. Then get the patient to the operating room, take out only that nodule, and send it to the pathology department during the time of surgery. And once we confirm it’s cancer, then we cnsider the proper cancer management and if it’s not cancer, then we come out with the same thing. This is a very easy and simple procedure, where there is no diagnostic dilemma at all, and it’s a one-stop care, both for diagnosis and treatment.
Thoracic surgery: Challenges
For those patients where the physician thinks that the patient is not fit for lung surgery, for those patients who are at high risk of getting lung cancer, or who are unfit, we don’t give them the anaesthesia. We prefer “non-intubated video-assisted thoracoscopy surgery.” Here we try to administer anaesthetic agents via peripheral venous line so that the patient is sedated but still able to breathe on its own.
We try to do a surgery, the same surgery that we were doing regularly but the patient is breathing, taking a breath. It is very difficult to do the surgery because you need an enormous amount of training and the correct patient to do it. The most significant benefit is that even patients with multiple comorbidities who would have died from lung cancer will be safe and achieve the same outcome as they would have with traditional minimally invasive thoracic surgery.
