“There are no symptoms of lung cancer at an early stage”

— Andrey Olegovich, why does lung cancer remain one of the most dangerous malignant nosologies?

— Lung cancer is an insidious disease because it does not have specific symptoms. They may be similar to a cold or other pulmonary diseases, for example, cough, shortness of breath. And therefore, it is almost impossible to notice harmful changes in the lungs yourself. Usually people begin to understand that the condition of the lungs has worsened already in the last stages of cancer development, when there are chest pains, coughing up blood, etc. At this stage, even modern medicine may not save a person’s life. This is due to the fact that lung cancer is extremely aggressive, it is one of the top “killers” around the world along with cardiovascular diseases. Some types of lung cancer, such as small cell lung cancer, develop very quickly: it can take several months from the first stage to the last stage. But even in the case of slow development (up to several years), the danger is that symptoms in the early stages, when a person can still be cured, do not appear in any way.

— Therefore, a logical question arises: who is at risk and how to detect cancer at an early stage if there are no symptoms?

— The main cause of lung cancer is smoking tobacco and nicotine-containing products. Therefore, those at risk are heavy smokers, that is, people who have smoked or smoke one pack a day for 30 years or more. The second factor is age. As a rule, lung cancer develops after 50 years of age, but the peak incidence occurs after 55 years of age.

The main task of doctors and the person himself at this time is to identify lung cancer at an early stage and remove the tumor as soon as possible. The most effective method for detecting lung cancer in the early stages is low-dose computed tomography (LDCT). Thanks to it, we, doctors, can see even the smallest tumors in the lungs and quickly take measures to eliminate them. LDCT, unlike fluorography, which every person undergoes annually, allows one to identify small lesions. Fluorography often helps detect tumors in the final stages, when they are already noticeable. But during this period, even the most breakthrough achievements of modern medicine may be ineffective.

Our main principle: prevention is the best cure. Therefore, it is important to give up cigarettes first.

If this cannot be done, then you need to take a responsible approach to your health and undergo a low-dose computed tomography scan. Such tests are available almost throughout Russia. The main thing is to come for the test and make sure that everything is fine with your lungs.

— What types of lung cancer are there and what is the prognosis for each?

— There are two types of lung cancer: non-small cell lung cancer (NSCL) and small cell lung cancer (SCL). Each of them has different subtypes and subtypes.

Non-small cell lung cancer has several subtypes. Adenocarcinoma is the most common subtype of NSCL. The prognosis depends on the stage at the time of discovery. In the early stages, if detected early, the prognosis is often better. With squamous cell carcinoma, the prognosis may be less favorable, especially in later stages. Large cell carcinoma also has a variety of subtypes. The prognosis depends on the stage and presence of metastases. Finally, undifferentiated cancer is a more aggressive type and may have a poorer prognosis.

Small cell lung cancer (SCL) usually grows quickly and can often spread beyond the lungs by the time it is diagnosed. Treatment may include chemotherapy and radiotherapy. The prognosis is usually less favorable than that of NMCL.

The prognosis depends on the stage of the cancer at the time of diagnosis. When cancer is detected at an early stage, the chances of full recovery and survival are much higher. However, when cancer is detected at advanced stages or has already metastasized, the prognosis may be less favorable.

In addition to the types and stages of cancer, the prognosis also depends on the patient’s general condition, age, presence of other diseases and availability of modern treatments.

However, each case of lung cancer is unique, and only an oncologist can provide an accurate assessment of prognosis and treatment recommendations based on the specific characteristics and circumstances of the patient. Timely consultation with a doctor and low-dose computed tomography help detect lung cancer in the early stages and increase the chances of successful treatment.

— How has the situation changed with the advent of new treatment regimens (targeted therapy) and is surgery always required?

“New cancer treatment methods, such as targeted therapy and immunotherapy, certainly increase a person’s chances of survival and freedom from cancer. However, the treatment approach always depends on the type of cancer, stage of the disease, general condition of the patient and other factors.

To understand how new treatments help get rid of cancer, it is important to know how they work. Targeted therapy aims to destroy specific molecules, called targets or proteins, that play a key role in the growth and spread of cancer cells. Targeted drugs are usually much more specific than chemotherapy, they only affect the cancer cells rather than the whole body as with chemotherapy, and they have fewer side effects. Targeted therapy is effective primarily for certain subtypes of non-small cell lung cancer, such as adenocarcinoma, and is often used when certain mutations are present in the cancer cells’ genes.

Immunotherapy aims to activate or strengthen the immune system to fight cancer cells. It can be used as a stand-alone treatment or in combination with other methods such as surgery, chemotherapy and targeted therapy.

Surgery to remove the tumor can be used in the early stages of lung cancer, when the tumor has not yet spread beyond the organ. It can be effective, especially if the tumor is completely removed. However, surgery is not always possible or is the only treatment method. In later stages of lung cancer, when the tumor has already metastasized or spread to other organs, surgery may be less effective. And combined methods are used as treatment: chemotherapy, immunotherapy and targeted therapy.

— In what cases is a lung transplant required and what is the situation with such operations in our country?

— Lung transplantation is a complex surgical procedure that is performed in cases of severe and incurable lung diseases. Lung transplantation is considered in cases where the patient is in the final stages of severe and incurable lung diseases such as severe chronic obstructive pulmonary disease (COPD), cystic fibrosis, idiopathic pulmonary fibrosis and other diseases.

Lung transplantation is also considered when severe pulmonary disease significantly limits the patient’s quality of life and other treatments have failed. In addition, if therapy for the disease does not provide significant relief and doctors can no longer offer prospects for recovery, a lung transplant may be a treatment option.

It is worth noting that lung transplantation is an extremely complex and expensive procedure. It requires highly qualified surgeons and the availability of modern equipment. In Russia, such operations are performed in several specialized medical centers. However, the number of surgeries is limited and the wait for a suitable donor organ can be long.

— What types of surgical treatment exist for patients with COPD and in what cases are they required? Is there any hope for the emergence of radical therapy for COPD in the coming years? Maybe something like an artificial lung?

— COPD is an irreversible condition in which breathing function deteriorates due to an obstruction (narrow opening) of the airways, which impedes the normal flow of air in the lungs. For patients with COPD, surgical treatment is used in some cases. For example, pulmonary volumetric resection (LVRS) is a surgical procedure that removes small areas of damaged lung tissue. This can reduce lung capacity, improve respiratory function, and make it easier for the patient to breathe. Lung transplantation, which we have already discussed, is a rare and complex procedure in which severely damaged lungs are replaced with donor lungs. Transplantation may be considered in cases of end-stage COPD and when other treatments are ineffective. There is also bulla correction, a procedure in which the injection of special adhesive materials into the bullae of the lungs (air cysts) can improve ventilation and make it easier for the patient to breathe.

Surgery is also used to eliminate complications. As for radical methods of treating COPD, such as artificial lungs, such methods are still in the research and development stage. Despite intensive research in the medical field, developing artificial lungs for widespread clinical use is still challenging and requires further research and testing.

— Have there been more patients in recent years who require surgical treatment for pulmonary pathologies? How has the situation with this group of diseases changed amid the pandemic?

— In my practice, there were cases that required non-standard treatment. And this happened against the backdrop of the COVID-19 pandemic. So, we had a patient who initially complained of hemoptysis after a new coronavirus infection. During the examination, we discovered the reason – an abscess (a hole in the lung) had formed in the lower lobe of his left lung. Most of this cavity was filled by a pulmonary aneurysm. In this case, time passed by minutes. We blocked this artery, which was forming an aneurysm. It was impossible to operate on him then, because his heart could not stand it. As a result, treatment due to complications from coronavirus took almost a year. He gradually underwent operations on his heart and lungs. Now the patient is alive and well, but he and we had to go through a difficult path.

Another case is in the “unique” treasury and is also related to Covid. A young patient was admitted to our clinic with bilateral pneumothorax (an accumulation of gas in the chest cavity, which leads to deflation of the lung, it simply contracts, and the person cannot breathe). In this case, the man survived miraculously—most likely, his youth saved him. The fact that he was immediately admitted to a specialized hospital and we immediately identified the changes was a great success. In the end, we performed surgery on him and also saved him. We had very little time and the patient’s extremely difficult condition. I remember this incident forever.

Of course, as a practicing surgeon, I notice that it is more difficult to operate on people who have had Covid and are faced with complications – the lung tissue is deformed, which leads to a number of problems during surgery.

— What is the future of thoracic surgery?

— I think that the future of thoracic surgery lies in innovation and continuous development. With the constant development of medical technology and continuous scientific research, I think we will encounter a number of trends.

Minimally invasive procedures: Thoracic surgery increasingly uses minimally invasive techniques such as laparoscopy and thoracoscopy. These procedures allow surgery to be performed with smaller incisions, which reduces the risk of complications, pain and recovery time after surgery.

Robotic surgery: Robotic systems allow surgeons to perform complex surgeries with greater precision and dexterity.

Targeted and Individualized Treatment Approaches: Advances in molecular diagnostics and targeted therapy are helping to personalize treatment for each patient based on their unique tumor characteristics and molecular features.

Use of artificial intelligence (AI): Artificial intelligence technologies are becoming increasingly important in medicine and surgery. AI can help analyze medical data, diagnoses and plan surgeries, leading to more efficient and accurate treatment.

Organ transplantation: Advances in organ preservation techniques and improvements in organ donation systems may increase the availability of such procedures and favorably impact transplant outcomes.

Overall, I think the future of thoracic surgery will be about innovation, improving patient outcomes, and personalizing the approach to each patient. However, the introduction of new methods and technologies also requires a cautious approach, testing of effectiveness and safety, and long-term monitoring of results. Therefore, we ourselves are looking forward to this future and are ready to help as many people as possible.