Question: I recently received a stage IA lung cancer diagnosis. Is surgery or radiation the best treatment for me?  

For very early-stage lung cancer, the two most common types of treatment are surgery to remove the cancer and targeted radiation to zap the small spot(s) of cancer. Sometimes when surgery and radiation are both good options, the person may be given a choice between surgery or radiation. 

Deciding which option is best for you is a conversation to have with your doctor and care team including the radiation oncologist and thoracic surgeon. There are several factors to consider when deciding, including your personal risks and benefits of each opinion. It is also wise to get a second opinion on which treatment is right for you. 

Surgery:  

For most people with early-stage lung cancer, surgery is the first choice for treatment. In this case, you should look for a lung cancer (thoracic) surgeon that is board-certified and does a lot of lung cancer surgeries. The surgeon should only do lung/chest cancer surgeries, not also heart.  

Your time in the hospital will likely be from three days to a week, and new, less invasive ways of doing lung surgery can mean shorter hospital stays and less recovery time. Not everyone can have less invasive surgery, however, and in those cases an open type of surgery, called a thoracotomy, is needed.  Read more about the different types of surgeries. 

Scans, like CT, PET and MRI are usually done before surgery to see if the cancer has spread. These scans can’t always detect small bits of cancer in the body. During surgery, tissue samples from the tumor and several lymph nodes and the tissue from the area around the tumor will be checked for cancer. This deeper look is not usually possible if someone chooses to have radiation instead of surgery. If cancer is found outside the area where the tumor was removed during surgery, the team can discuss if further treatment is needed.  

There are possible side effects with any treatment, including surgery. Aside from pain right after surgery, there may be ongoing nerve pain or numbness along the area where the surgery was done. The surgeon can talk about other possible side effects but pain and numbness after surgery are commonly reported.  

Before surgery, many people worry that their lungs will not work as well after part of the lung is removed. For most it is not noticeable, but in cases where it does happen it is minor. Most people who have lung surgery do not require the use of oxygen, unless they have other issues that affect how their lungs work.   

Targeted Radiation:  

While surgery to remove lung cancer is often the preferred option for early lung cancer, targeted radiation is increasingly being recognized as good alternative for some. For some people surgery isn’t an option at all. This may be due to where the cancer is in the lung or whether the person is in poor health that would make surgery too risky. In these cases, targeted radiation may be suggested.  

Radiation is done by a radiation doctor who specializes in cancer called a radiation oncologist. Typically, stereotactic radiotherapy known as SBRT or SABR is used to target and treat the tumor. Read more about the different types of radiation. 

Like any treatment, radiation can also have side effects. The most common include skin irritation, fatigue, and a short-term cough. Also note that tumors that are located close to the esophagus, central bronchus, or heart might not be ideal for radiation therapy. 

Here are some questions to ask your care team about surgery and targeted radiation:  

Questions about surgery:  

  1. What type of lung surgery will be done?  
  2. What are the risks of surgery? 
  3. What might I expect the recovery to be like? 
  4. What might my quality of life be like 6 months to a year after the surgery? 
  5. What are the chances of the cancer returning? (The answer to this may vary depending on what is found during surgery) 
  6. Is there anything else you want me to know about this treatment option? 

Questions about radiation:  

  1. How is targeted radiation delivered? 
  2. What can I expect during radiation treatments? 
  3. What are the risks of radiation? 
  4. How many times will I need radiation? How often? 
  5. What are possible side effects I can expect immediately after and up to six months to a year after treatment? 
  6. What might my quality of life be like after radiation? 
  7. Is there anything else you want me to know about this treatment option. 

Follow-up after both surgery and targeted radiation is important. After surgery or radiation, CT scans will be needed every six months for two to three years then once a year after that.  

Asking questions and gathering information is the best way to decide which treatment is best for you. Lean into your support system or grow a new one by getting involved with our support programs. 

In each issue of Your Community, we will be answering your questions about lung cancer and/or GO2 programs and services, questions about screening, treatment types and advancements, clinical trials, support services, and the lung cancer community. Please email your questions to yourcommunity@go2.org. 

Please note that the information included in any published answers is for educational pursuit only and is not intended or implied to be a substitute for professional medical advice. The reader should always consult their healthcare provider to determine the appropriateness of the information for their own situation. Nothing from GO2 for Lung Cancer should be construed as an attempt to offer or render a medical opinion.