 I am Dr. Madhav Kamath, cardiothoracic and vascular surgeon attached to the Manipal group of hospitals here in Mangalore and I would like to talk to you briefly about the work that we do in our specialty. Cardiothoracic and vascular surgery implies surgical treatment of diseases involving the cardiac that is the heart, the thorax or what is called the chest and vascular that implies surgery on the major blood vessels in the body. So surgery of the heart, the chest and the blood vessels in the body encompasses the specialty eye practice, cardiothoracic and vascular surgery. I would like to talk to you briefly about diseases of the chest. Now the chest cage is situated above the stomach and below the neck and contains the major organs that serve the human body. The first of course is the heart. Then we have two lungs, one on the right and one on the left and the major foot pipe that carries the food that we eat from the mouth to the stomach. I would like to talk to you briefly about diseases that affect the lungs. The lungs as you know are the organs that provide the human body with the breath of life that is oxygen and the efficient functioning of the lungs is essential to provide adequate oxygen to meet the needs of the human body. Since we have two lungs, we have one on the right and one on the left, the body is eminently capable of surviving even with the loss of one of the two lungs that serve it. So we are lucky in that if a major disease affects one lung, life can still go on if the opposite lung is functioning well and that is why I would like to talk to you about the diseases of the lungs. The major diseases that affect the lungs are broadly classifiable into two categories. Infective diseases that is caused by infections and second non-infectious diseases, the majority of which are tumors and by tumors we are talking about the big C that is cancer. Of course tumors may not be cancerous, not all tumors are cancerous but suffice to say most tumors do pose dangers to the human body. Non-cancerous tumors, we are lucky in that they do not spread elsewhere but exert their influence on the body by virtue of their location in the chest and by virtue of the pressure that they can put on surrounding important organs. This mandates treatment even though the tumor is not a cancer. Cancerous tumors of course need to be treated because they have a tendency to spread and affect the whole body and kill by virtue of the spread even if the primary tumor in the lung is not the fatal one. Let us talk about cancerous tumors of the lungs. As we all know most cancers are best treated by surgical removal. The lung tumors are no different, however not all tumors are treatable by surgery. It is only in the early stages of any tumor that the tumor can be totally treated successfully treated by surgical removal. Lung tumors are no different. Early tumors that is stage 1 and stage 2 are tumors which can be completely and successfully treated by surgery and that is where the cardiothoracic surgeon plays the crucial role in treating patients with lung tumors. Patients who come to us, come to us with various complaints. The most important of which is cough. Now we live in an increasingly polluted world and the environment around us is saturated with pollutants, smoke, dust, industrial efflents, industrial smoke etc and all of these play an important role in the origin of lung tumors. So most patients who come to us present with a cough. So let me say do not ignore a persistent cough and say to yourself that it will go away. I do not need to see a doctor for it. A cough may be the first indicator of an underlying lung tumor. Other symptoms are also present. The most important of which is a cough which is associated with blood in your spit or sputum. So when you cough and you have a persistent cough and you are bringing up blood in your sputum that is a warning sign that should alert you to the possibility of a cancer in your lung. Other symptoms are a heaviness in the chest that is affected by the tumor, pain in the shoulder which can come down into the arm on the affected side, breathlessness making routine work difficult because you are becoming breathless, short of breath forcing you to take rest. Loss of weight which as we all know is one of the main systemic symptoms of cancer. All these symptoms should alert you to the possibility that you have a cancerous growth inside you. Do not delay in consulting your family physician or your treating physician with these complaints so that the doctor can go ahead with evaluating you and start the appropriate treatment protocol which will save you from the effects of this cancer. The most important and probably the simplest investigation is an x-ray of the chest. This chest x-ray will show a patch which may be the first indication that you have a tumor. Subsequently the presence of a patch should mandate further investigations in the form of a chest CT scan and once the presence of the tumor is confirmed a biopsy of the tumor to identify what sort of cancer it is because as we all know not all cancers are alike. There are different varieties of cancer and an identification of the type of cancer will give us important clues and guidelines as to how best it can be treated. Once the diagnosis is made the next step is to ascertain whether the tumor is restricted to your lung or whether it has seeded sites elsewhere and it has spread beyond the confines of your lung and chest. If you are fortunate in the that the tumor is restricted to the chest treatment can be completely and 100 percent successful provided the right treatment is instituted. If tragically it has spread beyond the confines of the lung then success is not necessarily guaranteed. So once you consult your doctor the relevant tests are made the diagnosis is established then we come to treatment and that is where you are treating doctor a cardiothoracic surgeon steps in. Early disease stages one and two are completely curable as I said with surgery. Now what is this surgery that we do in our specialty? Surgery of lung tumors involves removal of the tumor a term that is easier said than done. Now the lungs as we know are large organs situated in the right and left sides of the chest. The right lung is slightly bigger than the left the right has three lobes and the left which is slightly smaller has two lobes. Now the tumor is usually restricted to one lobe in the early stages and surgery instituted at this stage entails removal of the affected lobe only leaving the remaining lung behind. So removal of a portion of the lung in the form of a lobe means that the patient can go on with his life with most of his functioning lung left behind. This is called a lobectomy. Sometimes however if the tumor is so situated that it bridges a gap between one or more lobes then removal of one lobe will not be sufficient and the whole lung will have to be removed. This is called a pneumonectomy or a pulmonectomy and this means this entails removal of the entire lung. Luckily as I mentioned earlier in my talk we are blessed by God with two lungs. Removal of one lung does not necessarily mean the end of life if the other lung is functioning well life can go on without any major restrictions. So removal of the whole lung does not mean the end of your life after recovering from your surgery and completing the course of treatment for the cancer that is affecting you you can the patient can lead an absolutely normal life with normal life expectations. So a lobectomy or a pneumonectomy are the surgical treatments for early lung cancer. Advanced lung cancer as I told you before is not treatable with surgery alone but requires additional modalities of treatment where surgical removal of the tumor will have to be supplemented with either radiotherapy where you bombard the chest with x-rays called radiation or you give systemic injections long term injection therapy called chemotherapy that is beyond the limitations of this talk. So I will restrict myself to talking about the surgery alone. What about the surgery? Early surgery on the lung is a major undertaking 30 to 40 years ago when surgeries were still not streamlined as they are today this was a surgery which was associated with a high degree of risk. Today in the 21st century the surgical techniques for lung resections or lung removal have been so streamlined that surgical risks have reduced from double figures in the past to less than 2 percent today. It is not just the surgical technique that has been important in reducing this surgical risk but also advancements in anesthetic techniques, anesthesia techniques with excellent anesthesia care to take care of the patient during the major surgical procedure, intensive care following surgery, nursing care and the availability of excellent instruments for the performance of the surgery. All these have contributed in making lung surgeries safe and which will convey to the patient major benefits in the form of a longer life expectancy, normal life expectancy with a good quality of life. So here is my entry to you, any symptoms that are persistent with respect to the chest do not hesitate do not wait to consult your family physician consult your family physician undergo the necessary evaluation and proceed with appropriate treatment as the diagnosis mandates. Just because it is a cancer does not mean you have to think that it is the end of your life there is life after cancer as more and more survivors today will testify. Lung surgery is one of those cancers where as I said before and I iterate again stages one and two are 100 percent curable with surgery and with a good five year life expectancy following surgery. So take care of yourself and do not hesitate to consult your physician if you do have any of the symptoms that I spoke about. Have a nice day.