SEGMENTECTOMY 2

Segmentectomy 2: Tests help to determine whether cancer cells have spread within the lungs or to other parts of the body after a diagnosis of lung cancer. The following tests and procedures may be used in the staging process to diagnose lung cancer:
• complete physical exam, including personal and family medical history
• chest x ray
• computed tomography (CT) scan
• positron emission tomography (PET) scan
• other radiologic exams
• laboratory tests (tissue, blood, urine, or other substances in the body)
• bronchoscopy
• mediastinoscopy
• anterior mediastinotomy
• lymph node biopsy
Treatment is determined when the stage of the tumor is known. Such routine preoperative preparations, as not eating or drinking after midnight on the night before surgery are typically ordered for a segmentectomy. Information about expected outcomes and potential complications is also part of the preparation for this surgery.

Aftercare
After a segmentectomy, patients are usually cautioned against doing moderate lifting for several days. Other activities may be restricted (especially if lymph nodes were removed) according to individual needs. Pain is often enough to limit inappropriate motion, and is generally controlled with medication. If pain medications are ineffective, the patient should contact the physician, as severe pain may be a sign of a complication requiring medical attention. Women who undergo segmentectomy of the breast are often instructed to wear a well-fitting support bra both day and night for approximately one week after surgery.

The length of the hospital stay depends on the specific surgery performed and the extent of organ or tissue removed, as well as other factors.

Radiation therapy usually begins four to six weeks after surgery, and continues for four to five weeks. The timing of additional therapy is specific to each patient.

Risks
The risks for any surgical procedure requiring anesthesia include reactions to the medications and breathing problems. Bleeding and infection are risks for any surgical procedure. Infection in the area affecting a segmentectomy occurs in only 3–4% of patients. Pneumonia is also a risk.

Normal results
Successful removal of the tumor with no major bleeding or infection at the wound site after surgery is considered a normal outcome.

Morbidity and mortality rates
Although the incidence of breast cancer has been rising in the United States for the past two decades, the mortality rate has remained relatively stable since the 1950s. Mortality rates range from 15% of the incidence rate for Japanese women to 33% of the incidence rate for African American women. The highest age-adjusted mortality occurs among African American women, followed by Caucasian and Hawaiian women. African American women have the highest mortality rates in the age groups 30–54 years and 55–69 years, followed by Hawaiian, and Caucasian non-Hispanic women. The mortality rate for Caucasian women exceeds that for African American women in the 70-year and older age group.

Five-year survival rates for liver cancer patients are usually less than 10% in the United States. The reported statistics for these cancers often include mortality rates that exceed the incidence rates. The discrepancy occurs when the cause of death is misclassified as “liver cancer” for patients whose cancer originated as a primary tumor in another organ and spread to the liver, becoming a secondary cancer. For primary liver cancer, non-Hispanic white men and women have the lowest age-adjusted mortality rates in the United States, roughly one-half that of the African American and Hispanic populations.

Liver cancer mortality rates for Asian American groups are several times higher than that of the Caucasian population. The highest age-adjusted mortality rates for all groups are among the Chinese population. Alaskan Native and American Indian populations have a very low incidence of liver cancer.

Factors that affect the prognosis (chance of recovery) for lung cancer include:
• stage of the cancer (whether it is in the lung only or has spread to other places in the body)
• tumor size
• type of lung cancer
• presence of symptoms
• shortness of breath during activities
• shortness of breath with less and less activity
• the patient’s general health

Current treatments are not a cure for most patients with non-small cell lung cancer. If it returns after treatment, it is called recurrent non-small cell lung cancer. The cancer may reappear in the brain, lung, or other parts of the body. Further treatment is then required.

Alternatives
Other cancer treatments include:
• chemotherapy
• radiation therapy
• radiosurgery
• laser therapy
• photodynamic therapy
• chemoprevention

Using a segmentectomy to remove breast cancers (as a technique that conserves the aesthetic appearance of a breast) is being investigated for large tumors after several cycles of preoperative chemotherapy. Cancers in some locations (such as where the windpipe divides into the left and right main bronchi) are difficult to remove completely by surgery without also removing an entire lung.