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The American Lung Association 1740 Broadway NY, NY 10019 1-800-LUNG-USA
American Cancer Society 1599 Clifton Road, N.E. Atlanta, GA 30329 1-800-ACS-2345
National Heart, Lung, and Blood Institute 31 Center Drive MSC2470 Bethseda, MD 20892-2470 1-301-496-4236
National Jewish Center for Immunology and Respiratory Medicine 1400 Jackson Street Denver, CO 80206 800-222-LUNG
Cancer Information Service 1-800-4-CANCER
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ABOUT YOUR LUNGS
The lungs are responsible for adding oxygen, which a person breathes in or inhales from the air, to the blood; and for removing carbon dioxide from the body by exhaling, or breathing out. The lungs are located in the chest on either side of the heart. The lungs are divided into sections called lobes. The right lung has three lobes: upper, middle, and lower. The left lung has two lobes: upper and lower. The left upper lobe also has a section called the lingula. The lungs are made of pink, sponge-like tissue which contains breathing passages called bronchial tubes. The air which is inhaled and exhaled flows through these tubes. Small air sacs called alveoli are located at the end of these bronchial tubes. Millions of air sacs, or alveoli, are within each lung. As a person breathes in, or inhales, these alveoli fill with fresh air (oxygen). The heart pumps “used” blood from the body to the lungs. This “used” blood is lacking oxygen, since the body organs removed the oxygen and nutrients to maintain function. As the “used” blood is pumped to the lungs and passes the alveoli, the alveoli then replace the oxygen in the blood. The new blood goes back to the heart and is pumped out again to the body. The air in the alveoli is now deprived of oxygen and contains exchanged carbon dioxide, which we breathe out (exhale). This cycle remains continuous. The chest is divided from the abdomen (stomach) by the diaphragm. The diaphragm is a large muscle that helps the lungs to expand and deflate. As a person inhales, the lungs expand, and the diaphragm pushes downward. Likewise, when a person exhales, the lungs deflate, and the diaphragm pushes upward. What Causes Lung Disease? With every breathe of air that is inhaled, not only is oxygen brought in to the lungs; airborne bacteria, fungus spores, viruses, and allergens are also inhaled. These are some of the environmental factors that can cause lung problems. Some of these factors, or irritants, are minor; and the effect on breathing is temporary. Other irritants may have a longstanding effect on lung function, and endanger a person’s health.
What are Some Examples of Lung Disease? Sever asthma, lung cancer, emphysema (caused by damage to the air sacs from smoking), and cystic fibrosis (a genetic disorder causing chronic lung infections). These are the more serious lung disorders which may require specialized treatment. It is important to diagnose these disorders early in order to treat them more effectively. What are Some Symptoms That May Suggest Lung Disease? Among symptoms are difficulty in breathing, shortness of breath, or coughing that lasts longer than a normal cold or continuously produces green mucus. These symptoms may indicate that you may need to visit a primary care physician or a lung specialist ( a pulmonologist). COMMON REASONS FOR LUNG SURGERY Surgery if often done to get a closer look at the inside of the lungs and to treat lung problems. If a mass is found in the lung, surgery can help determine the cause. The mass can also be removed at the time of surgery, if indicated. Surgery may also be done for other conditions, such as collapsed lung or fluid around the lung, among a few. A Lung Mass If a mass has been found in the lung, a biopsy or sample of the mass can be removed and examined to determine whether the growth is not cancerous (benign) or cancerous (malignant). Also, the exact location and size of the mass can be measured, and other areas can be examined to check if the mass has spread. Mass size, location, and spread determine how much of the surrounding lung tissue also needs to be removed. Removal of part or all of the lung is termed lung resection.
A Collapsed Lung If a portion of lung wall is thin or ruptured (as which may happen with emphysema), air may leak into the pleural space. When air collects in the pleural space, the lung may collapse (pneumothorax). Tubes placed during surgery can drain the air from the space so the lung re-expands. The wall of the lung can also be repaired during surgery so the lung does not collapse again. Fluid Around the Lungs Fluid can collect in the pleural space aroung the lungs. One cause of fluid collection is a lung infection, which may be a complication of certain types of surgery or an illness such as pneumonia. Again, tubes can be placed during surgery to drain the fluid and help heal the lungs. WHAT IS LUNG SURGERY? Lung surgery involves entering the chest wall either through an incision between the ribs below the shoulder (thoracotomy), or using a camera and small incisions (thoracoscopy). The surgeon chooses the best method to treat your condition. What Can Lung Surgery Do for Me? Your doctor recommends lung surgery when it is the best way to treat your lung problem. Your doctor will also explain what the goals of surgery are for you, and what risks and benefits are involved. EVALUATION AND TESTS Imaging Tests These tests take pictures of your lungs, and can detect problems such as a mass, infection, or air in the pleural space. They cannot definitively tell the physician if the mass is benign or malignant, though, on occasion, the visual characteristics of the mass can give the physician an idea of what to expect. Imaging tests may include: chest x-rays, CT (computed tomography) scans, MRI (magnetic resonance imaging), or PET (positive emission tomography) scans. Visualization and Biopsy Tests Visualization tests let your doctor look directly inside of your lungs and at the area around your lungs. A biopsy of lung cells or tissue may also be used for later examination under a microscope. Possible tests include: 1. Bronchoscopy, which is done using a thin, lighted tube with a camera which is inserted through the nose or mouth and down the trachea to examine the breathing passages. This is done with the patient sedated or completely asleep.
2. Mediastinoscopy is a procedure done in the operating room with the patient completely asleep. An incision is made at the base of the neck just above the breastbone, and a camera is passed into the incision and under the breastbone to look at enlarged lymph nodes in that area. Biopsies are routinely obtained. 3. Mediatinotomy is a more invasive procedure, also done with the patient asleep, where an incision is made in the front aspect of the chest wall, and biopsies of the lymph nodes in this area are obtained. 4. Needle biopsy, involves insertion of a needle either through the chest wall or through the bronchoscope to collect tissue or fluid. Pulmonary Function Tests These tests measures how well your lungs are working or functioning. They include: · Spirometry, which measures how much air your lungs hold. · Lung volume tests, which measure the amount of air left in your lungs after you exhale, or breathe out. · Lung diffusion tests, which measure how much oxygen is passed from your lungs to your blood. · Pulse oximetry, which measures the percentage of oxygen in the blood Thoracoscopy is often used to repair a collapsed lung; to examine, biopsy, and stage a mass in the lung; or to drain fluid from around the lungs. The anesthesiologist gives you a general anesthetic, which keeps you asleep and pain-free during the surgery. The surgeon looks into your chest and performs the appropriate procedures through small incisions in the chest wall. The thoracoscope is the camera which is placed through one of the small incisions, and projects the image of the inside chest onto a television monitor. Other instruments are placed through 2 or 3 more small incisions in order to examine the inside chest and perform biopsies or drainage of fluid or repair of lung tissue. When the procedure is finished, a drainage tube will be place temporarily in the chest to drain fluid or air while the lung heals. The chest wall incisions are closed with absorbable sutures. If a thoracoscopy cannot be continued, the procedure may need to be converted to an open surgey (thoracotomy) to obtain the information needed for the diagnosis or to complete the appropriate treatment. Preparing for Your Surgery · Ask your doctor any questions you have about the procedure. · Have blood tests or other routine tests that your doctor orders. · STOP SMOKING IMMEDIATELY · Tell your doctor about any medications you are taking (including aspirin, Plavix, Pletal, Coumadin), and ask if you should stop them. · Do not eat or drink anything after midnight the night before your planned surgery. Risks and Complications of Thoracoscopy · Wound infection · Bleeding · Air leak through the lung wall, requiring a longer hospital stay · Pain or numbness at the incision sites · Inflammation of the lungs (pneumonia) Recovering in the Hospital After surgery, you will wake up in the recovery room. You will feel groggy and thirsty. An IV will provide you with fluids and medications to relieve pain. You will be connected to heart monitors and will be wearing tubing around your mouth or nose which provides oxygen. To help keep your lungs clear and prevent inflammation, a respiratory therapist will teach you breathing exercises using a spirometer. A nurse or therapist will help you get out of bed and walk on the evening of your surgery or the following day. The hospital stay after a thoracoscopy is usually about 1 to 4 days. You will go home after the drainage tubes are removed from your chest. Recovery at Home · Walk to keep your blood moving and strengthen your muscles; but avoid strenuous activity, and no heavy lifting greater than 10 pounds, and no driving for 2 to 3 weeks. · Continue to do the breathing exercises taught to you by your therapist. · No sexual relations for 2 weeks, then slowly resume sexual activity when you are ready. · Your doctor will instruct you on when to return to work after your 2 week postoperative office visit. · Take your pain medications as prescribed to help relieve soreness and make activity and deep breathing easier. · Follow up with your doctor 2 weeks after your discharge from the hospital. You should call the office for an appointment, or an appointment will be made for you before your discharge from the hospital. (269) 979-6310. Call your doctor if you have any/all of the following symptoms: · Shortness of breath · Very red or draining incision · Sudden, sharp chest pain · Fever over 101’F · Coughing up bright red blood THORACOTOMY Thoracotomy is a surgical procedure where your surgeon makes a long incision between the ribs just below your shoulder blade. Again, prior to the surgery, the anesthesiologist will give you medications to put you completely asleep. Also recommended to be placed before your procedure is an epidural, or saddle block, which will help with post-surgery pain control. Once you are asleep in the operating room, the surgical team places you on your side, having the side of your chest to be operated on facing the surgeon. The surgeon then makes the incision between the ribs, then spreads the ribs gently to look inside your chest. No ribs are broken or removed. Once your chest is opened, your surgeon will perform the planned procedure that was discussed with you and your family prior to surgery. This may involve removing a portion or all of a lung and/or lymph nodes, or removal of other abnormal masses lining the inside of the chest wall. When the procedure is finished, one or more tubes will be placed in your chest temporarily to drain fluid and air. The ribs are closed with permanent suture. The skin is closed with either staples or absorbable suture. The entire procedure may take 2 to 5 hours. Preparing for Your Surgery · Have blood tests or other routine tests that your doctor recommends. · Have a heart stress test or EKG if recommended by your doctor. · Ask your doctor about the possibility of blood transfusion before or after your surgery. · STOP SMOKING IMMEDIATELY. · Tell your doctor about any medications you are taking (including aspirin, Plavix, Pletal, or Coumadin), and ask if you should stop them. · Do not eat or drink anything after midnight the night before your surgery.
Risks and Complications of Thoracotomy · Risks of general anesthesia · Wound infection · Bleeding · Inflammation of the lungs (pneumonia) · Air leak through the lung wall, requiring a longer hospital stay · Worsening of any existing heart problems · Heart rhythm (rate) abnormalities · Blockage of a blood vessel in the leg (deep vein thrombosis) with potential for blood clots which travel to your lungs (pulmonary embolism) which can be fatal · Nerve injury causing vocal cord problems or loss of use to that half of the diaphragm which helps with breathing · Respiratory failure requiring support by a ventilator (a machine that breathes for you) · Death In the Recovery Area After your surgery is finished, you will be taken to the recovery room where your can be closely monitored. When you first wake up from the anesthetic, you will feel groggy, thirsty, or cold. You may feel nauseated or throw up. If you remain on the breathing machine, you will not be able to talk. You will be connected to heart monitors and breathing monitors. If you are not on the breathing machine, you will be wearing a tube either over your mouth or nose to supply you with oxygen. You will be transferred to the ICU (intensive care unit) for close monitoring overnight. If you do very well after surgery, you may also be able to go to the regular medical floor right after recovery. You will be given breathing treatments and taught breathing exercises that will help prevent the development of pneumonia or lung infection after surgery. Physical therapy or nursing staff will also help you move from the bed to a chair or to walk in your room or hallways. The hospital stay after a thoracotomy varies from patient to patient, but ranges between 5 to 10 days. Your Home Recovery For the first several weeks after your surgery, you will feel very tired but will gain a little more energy and strength each day. Breathing may be uncomfortable initially, and you may get short of breath. You may also go home with oxygen therapy if needed. Caring for Your Incision You may shower, but wash your incision gently with warm water. Do not use soap, lotions, or powders on the incision. Bruising, itchiness, soreness, and numbness at your incision site are normal for several weeks following surgery. Taking Medications Take your pain medications regularly as your doctor instructed. Do not wait until the pain becomes unbearable before you take them. Review your medication list with the doctor or the nurse before you are discharged from the hospital, since some of your medications may have been changed, or new medications added. Easing into Activity For 6 to 8 weeks after your surgery, avoid any activity that might put stress on your healing incision, such as heavy lifting (greater than 10 pounds) or yardwork. You can start walking, which will improve your circulation, lung capacity, and strength. It is recommended to take pain medication before your activity, since this will help make breathing more comfortable. Ask your doctor how long to wait before returning to sexual relations, driving, and work. When to Call Your Doctor Call your doctor is you have any of these symptoms: · Draining or very red incision · Sudden, severe shortness of breath · Sudden, sharp chest pain · Fever over 101F · Rapid heartbeat or “fluttering” in your chest LIFE AFTER LUNG SURGERY Recovering from major surgery can be difficult emotionally and physically. A diagnosis of cancer can cause additional stress and concern. Talk with your doctor about your feelings, and stay close to your family and friends. They can help support you through difficult times. It is common to feel depressed and anxious after your surgery. You may have trouble sleeping or eating. If your surgery was for cancer, you may feel scared or insecure about your future. Share your feelings with your loved ones as well as your doctor, and tell them how they can help. Now is not the time to withdraw from those around you. Following Up with Your Doctor As you recover from the surgery, you will see your doctor for regular visits. Your healing and recovery can be monitored. Your doctor can also discuss your plan of care and outline your options if you need further treatment. SUPPORT GROUP INFORMATION Support groups can help you through a diagnosis of cancer or to give aid in stopping smoking. Meeting and talking with others you may have a similar problem can help you and your family cope. The American Lung Association 1740 Broadway NY, NY 10019 1-800-LUNG-USA
American Cancer Society 1599 Clifton Road, N.E. Atlanta, GA 30329 1-800-ACS-2345
National Heart, Lung, and Blood Institute 31 Center Drive MSC2470 Bethseda, MD 20892-2470 1-301-496-4236
National Jewish Center for Immunology and Respiratory Medicine 1400 Jackson Street Denver, CO 80206 800-222-LUNG
Cancer Information Service 1-800-4-CANCER |
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