Lung nodules generally don’t require treatment if there are no signs of being cancerous. In such cases, the doctor is likely to perform follow-up scans to monitor the nodules for any changes in their nature over time.

If a nodule is caused by infection, the doctor may prescribe treatments like antibiotics or antifungal drugs.

If a nodule grows, causes symptoms, or becomes cancerous, it may need surgical removal. Surgeries and procedures to remove suspicious and cancerous lung nodules include minimally invasive procedures, thoracotomy, chemotherapy, and radiation therapy.

Minimally invasive thoracic surgery

The procedure is a minimally invasive surgery (MIS) for the diagnosis and treatment of various conditions inside the chest, including lung diseases.

Surgeons perform surgery in the chest through small incisions between the ribs instead of a large opening. They use a tiny camera and special surgical instruments to reach the lung through these small incisions to remove lung lesions. Compared to thoracotomy, it may bring benefits to the patient, including lower risk of surgery and complications, less postoperative pain, shorter hospital stay, and a more rapid recovery period. As a result, it’s now being used more frequently.

Most commonly used are two types of minimally invasive thoracic surgeries:

• Video-assisted thoracoscopic surgery (VATS): This is the most commonly performed procedure for removing cancerous nodules. During VATS, the surgeon first makes one or more small incisions in the chest. Then, he inserts the thoracoscope through these incisions. The thoracoscope is a long, thin tube with a tiny camera at the end. Specially-designed surgical instruments are also inserted through the incisions. The surgeon then removes lung tissue with reference to images from the camera.

• Robotic-assisted thoracic surgery (RATS): RATS is relatively new and significantly improved over VATS, although it’s more expensive. Similar to VATS, RATS uses a tiny camera and surgical instruments through one or more small incisions to operate. However, In RATS, with high definition 3-D vision, the surgeon operates and controls robotic arms from a console to remove the lung tissue. The robotic system provides the surgeon with more flexibility, accuracy and safety.

Thoracotomy

A minimally invasive surgery (MIS) may not be available due to factors such as the central location of the tumor, comorbidities, frailty. The surgeon in these cases may recommend a thoracotomy.

A thoracotomy is traditional, open thoracic surgery. This approach is carried out under general anesthesia to open the chest to diagnose, biopsy, and treat organs in the chest, such as the lungs. It’s most often performed on one side of the chest. During the procedure, the surgeon makes a larger incision between the ribs and reaches the lung directly to remove part or all of it.

Within days of the procedure, a tube drains excess fluid or air from the chest.

As a major operation, a thoracotomy is more invasive. So it is typically recommended when another simpler, less risky approach has not worked. Before deciding on an open approach, it is important to have a detailed discussion with your doctor about the available treatment options. Your doctor will suggest the surgical option that is most suitable for you based on your medical condition, health status, and perhaps your own preferences.

Chemotherapy / Radiation therapy

Chemotherapy and Radiation therapy are two common methods to treat lung cancer.

Chemotherapy or chemo is a drug treatment that uses anticancer drugs to kill cancer cells. It targets fast-growing and dividing cells. Since cancer cells grow and multiply far more quickly than normal cells, chemotherapy has a greater impact on cancer cells. It can prevent cancer cells from growing, dividing, and multiplying. There are many kinds of chemotherapy drugs to treat different types of cancer.

Radiation therapy or radiotherapy is another cancer treatment. It uses high-energy radiation to damage the DNA of cancer cells in order to control or destroy them. The most common type of radiation used in radiation therapy is X-rays. Other rays or particles include protons, gamma rays and electron beams.

Chemotherapy and Radiation therapy are often used together. The combination of the two therapies may be more effective to shrink tumors and kill cancer cells.