Can Lung Cancer Be Cured? A Surgeon's Honest Perspective

As a surgical oncologist who has performed over 1,000 cancer surgeries — a significant number of which have been for lung cancer — I am asked this question almost every day: "Doctor, is lung cancer curable?"

The honest answer is: Yes — when caught early, lung cancer is very much curable. And the definition of "early" is shifting in our favour every year, thanks to advances in imaging, minimally invasive surgery, and targeted therapies.

Let me explain what I mean — as a surgeon who operates on lung cancer patients in Coimbatore every week.

The Most Important Thing: Stage at Diagnosis

When patients ask me if their lung cancer can be cured, the first thing I look at is the stage — how far the cancer has spread. Lung cancer is staged from I to IV:

• Stage I: Cancer confined to one area of the lung — highly curable with surgery alone. 5-year survival: 70–90%
• Stage II: Cancer has spread to nearby lymph nodes in the lung — surgery is the primary treatment, sometimes followed by chemotherapy. 5-year survival: 50–65%
• Stage IIIA: Cancer has spread to lymph nodes in the central chest — surgery may be possible after chemotherapy or radiotherapy in selected patients. 5-year survival: 20–35%
• Stage IIIB/IV: Cancer has spread to the other lung, fluid around the lung, or distant organs — surgery is usually not the primary treatment. Treatment involves chemotherapy, targeted therapy, immunotherapy. 5-year survival: less than 15%

What Are the Symptoms of Lung Cancer?

One of the biggest challenges with lung cancer is that early-stage tumours often cause no symptoms at all. The lung has no pain receptors — a tumour can grow quietly for months before it causes any sensation. By the time symptoms appear, the cancer has often advanced.

Symptoms to watch for include:

• A new cough that does not go away after 3 weeks
• Coughing up blood — even a small amount should be investigated immediately
• Unexplained weight loss of more than 5 kg over a few months
• Breathlessness that is worsening or new
• Chest pain, especially if it is persistent or worsens with breathing
• Hoarseness of voice — particularly if new and unexplained
• Repeated chest infections in the same part of the lung
• Shoulder or arm pain (Pancoast tumour involving the apex of the lung)

Who is at Risk of Lung Cancer?

• Smokers and ex-smokers: Smoking causes approximately 85% of lung cancers. The risk is proportional to the number of cigarettes and years of smoking
• Passive smokers: Long-term exposure to others' cigarette smoke also increases risk
• Exposure to radon gas: A naturally occurring gas that can accumulate in poorly ventilated buildings
• Occupational exposures: Asbestos, arsenic, chromium, nickel — workers in mining, construction, and certain industrial settings
• Air pollution: Particularly relevant in India's rapidly urbanising cities
• Family history: First-degree relatives of lung cancer patients have a higher risk, even in non-smokers

How is Lung Cancer Diagnosed?

When I see a patient with suspected lung cancer, the workup typically includes:

1. CT scan of the chest — the most important initial investigation. Shows the size, location, and nature of the tumour
2. PET-CT scan — whole-body scan to check for spread to lymph nodes or distant organs
3. Bronchoscopy with biopsy — a camera passed into the airways to sample accessible tumours or lymph nodes
4. EBUS (Endobronchial Ultrasound) — an ultrasound probe passed through the bronchoscope to sample lymph nodes in the central chest
5. CT-guided biopsy — for peripheral tumours not accessible by bronchoscopy
6. Lung function tests (PFTs) — to assess whether the lungs can tolerate surgery and how much lung can safely be removed
7. Molecular testing — analysis of the tumour's genetic mutations (EGFR, ALK, ROS1, PDL-1) to guide targeted therapy if surgery is not possible

Surgery for Lung Cancer — The Only Cure

For Stage I and Stage II lung cancer, and selected Stage IIIA patients, surgery is the primary curative treatment. The type of surgery depends on the tumour's size and location:

Lobectomy

Removal of the entire lobe of the lung containing the tumour. This is the most common and most effective operation for early-stage lung cancer. The lung has five lobes (three on the right, two on the left) and patients adapt well after removing one lobe.

Segmentectomy

Removal of only the segment of the lung containing the tumour — preserving more lung function. Increasingly preferred for smaller tumours (under 2 cm) and in patients with limited lung reserve.

Wedge Resection

Removal of a small wedge-shaped piece of lung containing the tumour. Used for very small peripheral tumours or in patients with poor lung function who cannot tolerate more extensive surgery.

Uniportal VATS — The Modern Way to Remove Lung Cancer

For the past several years, I have been performing lung cancer surgery using Uniportal VATS (Video-Assisted Thoracoscopic Surgery) — where the entire operation is done through a single 3–4 cm incision. No rib spreading. No large chest wound.

The benefits for my patients are dramatic:

• Discharge in 2–3 days instead of 7–10 days for open surgery
• Significantly less post-operative pain
• Return to normal activity in 2–3 weeks instead of 6–8 weeks
• Equivalent cancer control — the same lymph nodes removed, the same margins achieved
• Earlier return to chemotherapy if it is needed after surgery

What About Non-Surgical Treatments?

When surgery is not possible — due to advanced stage, poor lung function, or patient preference — other treatments include:

• Stereotactic Ablative Radiotherapy (SABR/SBRT): High-dose, precisely targeted radiation — an alternative to surgery for Stage I patients who cannot undergo an operation. Excellent results in selected patients.
• Chemotherapy: Used before surgery (neoadjuvant) to shrink tumours, after surgery (adjuvant) to reduce recurrence risk, or as primary treatment for advanced disease.
• Targeted therapy: Pills or infusions that target specific genetic mutations in the tumour (EGFR, ALK, ROS1). Dramatically effective in selected patients — often with fewer side effects than chemotherapy.
• Immunotherapy: Drugs that help the immune system recognise and attack cancer cells. Can achieve remarkable responses in some patients with advanced lung cancer.

Lung Cancer Screening — Detecting it Before Symptoms

The best way to cure lung cancer is to find it before it causes symptoms. Low-dose CT (LDCT) screening is recommended for high-risk individuals:

• Age 50–80 years
• Current or ex-smokers with a smoking history of at least 20 pack-years
• Quit smoking within the last 15 years

Annual LDCT screening in this group has been shown to reduce lung cancer death by 20–24% in large trials. If you or a family member falls into this category, please discuss screening with your doctor.

My Message to Patients

If you have been told you have a spot on your lung, or if someone you love has been diagnosed with lung cancer, please do not lose hope. Early-stage lung cancer is one of the most curable solid tumours when operated on correctly.

Get a proper staging workup. See a specialist. Ask whether surgery is possible. And if you are a smoker — the single best thing you can do for your health today is stop smoking.

I see patients from across Tamil Nadu and beyond at KG Hospital, Coimbatore. If you have any questions about a diagnosis, I am happy to discuss your case.