Lung Cancer Surgery Options at Manatee Memorial Hospital

Lung cancer is by far the leading cause of cancer death among both men and women; about one out of four cancer deaths are from lung cancer. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined, according to the American Cancer Society (ACS). Surgery to remove the cancer, often along with other treatments, may be an option for certain types of lung cancer. Here to discuss lung cancer surgery options at Manatee Memorial Hospital is John C. Brock, MD. He is a Board certified Cardio Thoracic Surgeon, and a member of the medical staff at Manatee Memorial Hospital.
Lung Cancer Surgery Options at Manatee Memorial Hospital
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John C. Brock, MD
John C. Brock, MD is a Board certified Cardio Thoracic Surgeon, and a member of the medical staff at Manatee Memorial Hospital.

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Lung Cancer Surgery Options at Manatee Memorial Hospital

Melanie Cole (Host): Lung cancer is a diagnosis that no one wants to hear. However, surgery to remove the cancer and often along with other kinds of treatments; may be an option, for certain types of lung cancer. My guest today is Dr. John Brock. He is a board certified cardiothoracic surgeon and a member of the medical staff at Manatee Memorial Hospital. Welcome to the show Dr. Brock. So, what’s the first line of defense if someone is diagnosed with lung cancer? That’s a terrible thing to hear from a doctor, what do you first tell them?

Dr. John C. Brock, MD (Guest): Well number one, thanks for having me. But the first thing is the most important aspect of lung cancer is to determine what stage you are in. Stage I and stage II cancers are amenable to surgical resection. Stage III and IV require chemotherapy and radiation and are not in the realm of surgery for surgical resection for cure. So, the first thing are the scans and biopsies and to place you in one of the four stages of lung cancer.

Melanie: So, if they’re in stage I or II, and they are a candidate for a surgical resection of this tumor; what are some of their surgical options? What do you tell them is going on out there in the field of lung cancer surgery?

Dr. Brock: Well for the majority of lung cancer patients, the best choice is lobectomy which is you have three lobes on the right, two lobes on the left and the reason why we take the entire lobe out of a patient is because that’s the drainage of the lymphatic system. So, that’s the best chance for complete cure of the lung cancer; is removal of the lymph nodes as well as the lobe which includes the lymph nodes and the surrounding area of lymph nodes. And so, that offers the best chance of cure. Very seldom, in certain unusual circumstances; we would take the whole lung out, but it is rare that we do that. And you may or may not depending on what the specimen that’s removed, after it goes to the pathologist whether you need radiation or chemotherapy following the resection.

Melanie: So, how are these resections done Dr. Brock? Is this something that patients – what would you like to ask them about this type of procedure? Is it done video assisted, is this considered minimally invasive? Speak about the procedures themselves.

Dr. Brock: Well most all we try to do most all of the procedures that we do here are attempted but minimal invasive technique. Mostly thoracoscopy. The other minimally invasive technique of course is robotics which we have available here. It’s just that I don’t use that, because my concern – there are pluses and minuses but the robotic surgery though the surgeon can see maybe a little bit differently – can see a little bit better sometimes; if you get into certain aspects of the pulmonary artery etc., it takes about ten or fifteen minutes to disengage the robot. With the thoracoscopy; if you have problems, you get in to bleeding, that can be rectified immediately, where the other device it takes a while. So, for safety reasons and there’s only three holes as opposed to four or five usually, we prefer to do the – and Dr. Smith did with a single hole and sometimes we can use a single hole, do minimally invasive thoracoscopy with a lobectomy. Now, depending on your anatomy, depending on how the situation is with individual cases; sometimes we will opt for a thoracotomy which is a little bit bigger incision and spreading of the ribs and about 70% of the cases nationwide are done that way. But we try to do more with the minimally invasive thoracoscopy here at Manatee.

Melanie: That’s fascinating how this field is changing and what is life like for somebody who has had one of these procedures afterwards if they have had the minimally invasive, I imagine that their recovery time is certainly shorter and they are out of the hospital sooner. When does it require those adjuvant therapies and what is their life like?

Dr. Brock: Well for stage I cancers as a rule; they will be in the hospital for 3-5 days, when the air leak stops depending on their again their anatomy and how their born and whether they have an incomplete fissure or not. Usually they are out of the hospital in 3- 5 days with some pain. There is a still a modicum amount of pain, but we usually try to block them postoperatively and then with all the opiate problems we have had in this state; we try to just give them a week or so of narcotic coverage and then after that just extra strength Tylenol. So that within a couple of weeks they are driving, and they are fairly active, and they can resume back to their normal activities depending on what their tidal volume or their amount of lung that they have left. We usually always check that and make sure we don’t leave someone with in appropriate pulmonary functions where they would, God forbid, lie in a bed the rest of their life or not be able to function normally. So, the whole goal is to remove the tumor, stage I or stage II and then get them back to doing what they were doing and most of our patients 95% of them go back to their active lifestyles and just keep going on and they are cured.

Melanie: That’s amazing and where do you see the field going as far as any of these other therapies, immunotherapy, I mean you see a lot of lung cancer; where do you think the field is going in the next ten years Dr. Brock?

Dr. Brock: I think pretty much it’s going to be genetically mediated depending on the type of tumor and like you said, more than immunotherapy, it will be genetically determined – targeted for your particular genetics. You know each one of our DNAs as you know from TV shows that are unique like fingerprints and but there are certain commonalities these tumors have, and they can be targeted with chemotherapy. I don’t see that resection – I don’t see that resection is going to go away, but I think it certainly I think the cure rate for lung cancer is going to be improved quite a bit. In the meantime, of course, there’s smoking cessation and lifestyles but 10-12% of our patients don’t – have never smoked and they developed lung cancer. And so again, the etiology of that in it but I do see it being all biochemically mediated through DNA.

Melanie: And Dr. Brock, you told me before that you are a marathon runner, so not only are you a cardiothoracic surgeon, but you are also an avid exerciser. If you were to give your best pieces of advice; you mentioned smoking cessation and there has also been a lot of talk in the media about lung cancer screening as an option now. What would you tell people and what do you tell people every single day about possibly preventing it in the first place?

Dr. Brock: Well obviously you can look on the CBS news and find out about how to prevent it without smoking and then if you have a strong family history; you should be screened. We have screening here at Manatee Memorial Hospital. You should take advantage of that. I think and if you had a strong family history of lung cancer and if you are a previous smoker, I think you should be screened for it.
That in itself, that won’t prevent it, but it certainly would catch it earlier and that’s the treatment of choice. I mean and then other than that, your lifestyle is what will prevent it as best you can. And then there’s that 10-20% of folks that just will get it and in which case if you are screened we can catch it early and it can be treated. If it is stage III or IV, it can still be treated but cured, that makes it a little more difficult to cure it.

Melanie: What great information. Thank you so much for being with us today. Really it is so important for people to hear. You’re listening to Manatee Talk Radio with Manatee Memorial Hospital. For more information, please visit , that’s . Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if minimally invasive surgery is right for you. This is Melanie Cole. Thanks so much for listening.