Thoracic surgery is the general term for surgery pertaining to the thorax, including the lungs and esophagus. While thoracic surgery can also include the field of cardiac surgery, the term thoracic surgery is generally used to describe all surgeries except for those pertaining to the heart; specifically the lungs and esophagus.
The lungs are organs in the body that allow for the exchange of gases between the air we breathe and our blood. Oxygen is carried into the body and carbon dioxide is removed. Human beings have two lungs, and each is lung is subdivided into lobes (anatomic divisions). There are three lobes on the right side: upper, middle and lower, and two on the left side: upper and lower. Because the heart is mostly on the left side, the left lung is smaller than the right.
Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas of the lung, derived from epithelial cells. Lung cancer, the most common cause of cancer-related death in men and the second most common in women, is responsible for 1.3 million deaths worldwide annually. The most common symptoms are shortness of breath, coughing (including coughing up blood), and weight loss.
The main types of lung cancer are small cell lung carcinoma and non-small cell lung carcinoma. This distinction is important because the treatment varies; non-small cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation. The most common cause of lung cancer is long term exposure to tobacco smoke. The occurrence of lung cancer in non-smokers, who account for as many as 20% of cases, is often attributed to a combination of genetic factors, radon gas, asbestos, and air pollution, including second-hand smoke.
Bronchoscopy is a technique of visualising the inside of the airways. A bronchoscope is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient’s airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation. Specimens may be taken from inside the lungs: biopsies, fluid (bronchoalveolar lavage), or endobronchial brushing. The practitioner may use either a rigid bronchoscope or flexible bronchoscope.
Mediastinoscopy is a surgical procedure to examine the inside of the upper chest between and in front of the lungs (mediastinum). During a mediastinoscopy, a small incision is made in the neck just above the breastbone or on the left side of the chest next to the breastbone. Then a thin scope (mediastinoscope) is inserted through the opening. A tissue sample (biopsy) can be collected through the mediastinoscope and then examined under a microscope for lung problems, such as infection, inflammation, or cancer. See an illustration of mediastinoscopy.
In many cases mediastinoscopy has been replaced by other biopsy methods that use computed tomography (CT), echocardiography, or bronchoscopy to guide a biopsy needle to the abnormal tissue. Mediastinoscopy may still be needed when these methods cannot be used or when they do not provide conclusive results.