Lung cancer is one of the most common cancers and it affects millions of people in India every year. It is one of the leading causes of cancer-related deaths. The number of cases have also been on the rise, including in non-smoker population. 1 in 16 people will be diagnosed with Lung cancer in their lifetime. The rising incidence and delayed diagnosis of lung cancer in India are grave concerns. For those who are suffering from this condition, finding the best lung cancer surgeon in Delhi is crucial in order to get the best treatment. In this article we will try to present all the important information about lung cancer and its treatment, including surgery and other options. We will also try to highlight the important factors to keep in mind while choosing your treating physician. Introduction to Lung Cancer Abnormal and uncontrolled growth of cells in the lung tissue can lead to formation of lung cancer. The cancer that originates in the cells of the lung is called a “Primary Lung Cancer” and if the cancer cells reach the lung from some other organ, it is called a “Secondary Lung Cancer“ Broadly, Primary lung cancers are classified into 2 main types, based on the cell of origin: NSCLC is the most common type of lung cancer, accounting for approximately 80 – 85% of all cases. The three main varieties of NSCLC are: SCLC occurs in about 15-20 people out of 100, mostly in smokers. It is a type of Neuroendocrine tumour (NET). It is characterised by a rapid spread of tumour in the body. Lung cancer is the 2nd most common cancer in the world (most common in men, 2nd most common in women), according to Global Cancer Observatory (World Health Organization). Read more about Lung cancer statistics here. It is also one of the leading causes of cancer-related deaths in India. Lung cancer kills almost 3 times as many women as Breast cancer, and almost 3 times as many men as Prostate cancer Smoking is the most common risk factor for lung cancer. Other risk factors for lung cancer include second-hand smoke, exposure to certain chemicals, air pollution, radon gas and asbestos exposure, genetic predisposition, underlying lung disorders like COPD, arsenic in drinking water and increasing age. Symptoms of Lung Cancer The symptoms of lung cancer vary depending on the type and stage of the disease. Early signs of lung cancer may include: Read more about: Symptoms of Lung Cancer Lung Cancer Signs & Symptoms Causes of Lung Cancer Smoking is the number one cause for development of lung cancer. Cigarette smoke contains thousands of dangerous chemicals, out of which about 70 are cancer causing agents. Cigarette smoke is responsible for about 80% to 90% of all lung cancer cases in India. There is also a lot of Bidi and Hukka smoking in India as well. Second-hand smoke: Adults who are exposed to second hand smoke have a 20-30% risk of developing lung tumours. Other risk factors for lung cancer include exposure to certain chemicals, air pollution, asbestos exposure, increasing age, family history, previous lung diseases like COPD, exposure to Radon gas, arsenic in drinking water etc. Diagnosis of Lung Cancer The diagnosis of lung cancer requires a detailed history and a complete physical examination in the clinic. If your doctor suspects lung cancer you will be asked to undergo a battery of investigations. These may include: Treatment Options for Lung Cancer The type and stage of lung cancer decides the treatment. The options available are: Surgery for Lung Cancer Surgery is the first-line choice for early stage lung cancer which means when the tumour has not yet spread beyond the lungs. When done timely surgery has the potential to cure the patient completely. But unfortunately very few lung cancers that present to doctors are operable due to delayed diagnosis. Since it is a complicated surgery you should opt for the best lung cancer surgeon in Delhi or your city. Radiation therapy Radiation therapy uses high-energy X-rays or other particles to kill cancer cells and shrink tumours. Chemotherapy It is a form of treatment that is used to kill cancer cells. Anti-cancer medications are administered in the vein, and the session lasts up to a few hours. The treatment is performed in cycles of 1-3 weeks. It can be given pre-surgery, post-surgery or even as definitive treatment alone or with radiation therapy. Targeted therapy It is a type of treatment that uses drugs to target specific cancer cells. So your doctor may recommend molecular targeted therapy that includes the administration of drugs that work in subsets of patients whose tumours have specific genetic changes that have the potential of promoting tumour growth. Proton therapy Proton therapy is a type of radiation therapy that uses protons instead of X-rays to treat cancer. It can be used to treat lung cancer, but it’s relatively new, and not all centers have the capability to provide it. Immunotherapy Immunotherapy is a type of treatment that helps the body’s immune system to fight cancer. It can be used alone or in combination with other treatments. Checkpoint inhibitors: These drugs block certain proteins on the cancer cells that help them evade the immune system.CAR T-cell therapy: This is a type of immunotherapy that involves removing T cells from the patient’s blood, altering them in a lab to recognize and attack cancer cells, and then infusing them back into the patient. Supportive Care Supportive care is an essential part of lung cancer treatment. It includes measures to control symptoms, improve quality of life, and prevent complications. It can include: Finding the Best Lung Cancer Surgeon in Delhi This can be a daunting task because there are many surgeons in the city. So it can be difficult choice to make. To find the right or best lung cancer surgeon in Delhi or your nearby city is to do some research and ask for referrals from your doctor or other healthcare professionals. Once you have zeroed

Empyema Surgery in Delhi is now very easily possible. Empyema thoracis is a serious medical condition in which pus accumulates in the pleural space of the lungs. It is a life-threatening condition that can be caused by a bacterial infection, tuberculosis, a foreign body in the chest, or a complication of another medical condition. The underlying cause of empyema must be identified and managed before proceeding with any treatment. Surgery is often recommended to remove the infected pus and to restore normal lung function. This type of surgery can be a complex and lengthy procedure that requires the expertise of a thoracic surgeon. In this article, we will discuss what is empyema and how surgery can help treat it. We will review the different types of surgeries available and explain how a thoracic surgeon can help you manage your condition. What is Empyema Thoracis? Empyema is a medical condition in which pus collects in the pleural space of the lungs. An empyema is classified as a suppurative lung infection. Suppuration is the formation of pus. Because it is a serious condition so it requires prompt diagnosis and treatment since it can be fatal. The pleural space is the area outside the lungs where the pleural membranes (lung membranes) surround the lungs. The pleural membrane is a thin sheet of tissue that covers the inside of the chest wall and the outside of the lungs. It is made up of two layers – the parietal layer and the visceral layer. The visceral layer lines the outer surface of the lung and the parietal layer lines the chest wall. The pleural space is normally filled with a small amount of a clear, thin fluid that lubricates the inside of the chest, allowing the lungs to move back and forth during breathing. Often patients need surgery for empyema thoracis if they cannot be managed conservatively. Causes of Empyema It can result from a variety of bacterial infections that spread from the chest into the pleural space. Pleural empyema can result from an existing lung infection, such as tuberculosis or bacterial pneumonia. It can also occur after a lung infection that has been treated with antibiotics. This can occur if the infection is not completely eradicated or if the antibiotics are not effective against the infecting bacteria. Other common reasons are: Stages of Empyema and Stage-wise Treatment of Empyema in Delhi The evolution of Empyema goes through three stages. First Stage: The first is the presence of free-flowing fluid (effusion) which usually resolves with antibiotics and non-invasive treatment. If it is left untreated the effusion becomes complicated. Second Stage: In this there is a deposition of fibrin and membranes which leads to formation of septations or loculations in the fluid leading to comparmentalization of the fluid into different pockets. Both antibiotics as well as some form of pleural drainage is required in this stage. Third Stage: If the loculated fluid is not drained the fluid will start organising (third stage) into thick pus and the fibroblasts will coalesce to form a thick pleural peel between the visceral and parietal pleura. This peel can ultimately encase the underlying lung and will prevent the lung from expanding. For an easy understanding the collapsed underlying lung can be compared to an orange and the thickened pleural peel around the lung to the peel of the fruit. This stage requires Surgery for Empyema Thoracis because the lung is usually trapped and unable to expand. Symptoms & Signs The symptoms of empyema vary depending on the underlying cause and the extent of the infection. Most patients experience symptoms similar to pneumonia, including fever, chills, cough, chest pain, and difficulty breathing. Other symptoms of may include chest pain behind the breastbone, pleuritic pain (pain that worsens when taking a deep breath), and low oxygen levels in the blood. As the infection spreads, patients may experience sweating, high fevers, and general weakness. Patients who may be experiencing symptoms of empyema should consult a health care professional so as to determine the cause of their symptoms. A health care professional can perform a physical examination, take a medical history, and order diagnostic tests like a Chest X ray, CT scan and analysis of the pleural fluid/pus. If Pleural Empyema is diagnosed, it may need surgery. Surgery for Empyema in Delhi In many cases, empyema thoracis requires surgical treatment. A thoracic surgeon will examine the patient to identify the extent of the infection and the location of the pus. They will review the patient’s medical history and current medications to determine the best treatment plan. The surgery for empyema thoracis is called “Drainage and Decortication” The goals of this surgery are: Traditionally the approach used for empyema surgery is an open approach called a “Thoracotomy”, which is a large cut on the side of the chest and involves cutting the muscles and spreading the ribs. This allows the surgeon to put his hands inside the chest to operate. Decortication Surgery for Empyema in Delhi Dr. Kamran Ali does most of his Empyema operations by a minimally invasive technique called Video Assisted Thoracoscopic Surgery (VATS). This technique involves making tiny key hole cuts on the side of the chest (1 to 3), without muscle cutting or rib spreading. With the help of a camera (thoracoscope) and double hinged long working instruments, the whole surgery can be completed by looking at a monitor. So all goals of an empyema surgery that can be achieved by an open surgery can be safely replicated by VATS. Uniportal VATS Drainage and decortication of empyema is a special type of VATS surgery, because it utilizes only a single 3-4cm incision to perform this surgery. Occasionally these surgeries may not be possible by VATS but would need a conventional open surgery approach especially when the pleura has calcified or in case of fibrothorax. Advantages of Surgery for Empyema (in Delhi) by VATS VATS decortication usually translates to lesser post operative pain, faster recovery and a shorter hospital stay. It