Surgery or No Surgery: What Would You Choose?

H. Jack West, MD, Founder, President and CEO

I'm heading off today to Hawaii (Maui), which I must hasten to add is for a conference, the Eighth International Lung Cancer Congress, not just a vacation, although working in Hawaii often seems better than time off at home. The meeting not only includes a lot of good lectures and debates, but it gives us the opportunity to actually discuss the importance and implications of the trials that were just presented a few weeks before at ASCO. Some of the important clinical trials and collaborations are developed during free hours at this meeting.

In addition to participating in a panel discussion on optimal management of never-smokers with lung cancer, I'll be arguing in a debate on how to manage stage IIIA NSCLC. The specific topic is whether this stage of cancer should be treated with surgery (generally combined with chemo and sometimes also radiation) or whether chemo and radiation together without surgery should be more commonly recommended. Some of my posts that discuss the controversy about this issue are here and here. My debate will be with a surgeon from the MD Anderson Cancer Center, so it should be a challenge, but it's all pretty light-hearted. We couldn't have a debate if there was a clear right answer.

In lung cancer, as in many other types of cancer, people generally receive surgery if it's possible to resect the tumor, and other treatments are considered alternatives. Part of this is historical: before there was chemotherapy or radiation, surgery was the only way to manage cancer. In addition, surgeons are often the first specialists to meet a cancer patient, since they often perform the biopsies that establish a tissue diagnosis. And, in truth, surgery often is a very effective treatment, particularly for earlier stage cancers.

So I have a question for members here: would most people definitely prefer surgery if it's possible ("get it out!"), and consider non-surgical treatments to be a less desirable alternative, or would people be very happy to pursue a non-invasive approach if it produces comparable results? I'm making this the new polling topic for the next several days. When options produce similar outcomes, patient preferences should be a key component of what strategy to follow. So offer your comments here, and I hope you'll vote in the poll on the right column.

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