Lung Cancer

With more than 200,000 individuals diagnosed annually, lung cancer is the leading cause of cancer-related deaths in the U.S. and claims more lives each year than colon, prostate, and breast cancer combined.

While lung cancer is one of the most devastating diseases, it is also one of the most preventable. Tobacco smoking accounts for about 90% of lung cancer cases, including thousands of individuals who fall victim to the disease from second-hand smoke.

Lung cancer is most treatable in its earliest stages, when the cancer is limited to lung tissue and nearby lymph nodes. For this reason, lung cancer screening has become incredibly important for high-risk individuals. Depending on the stage of cancer and a variety of patient-specific variables, treatment usually involves surgical resection of the tumor in combination with chemotherapy and/or radiation therapy.

Lung cancer diagnosis and staging

Lung cancer is notoriously difficult to diagnose in its early stages.

Many patients remain without symptoms for years because the lungs can accommodate large tumors without compromising breathing. Lung nodules, or masses, are often detected incidentally on X-ray/CT scans conducted for another purpose. When symptoms do present, however, they may include:

• A persistent cough
• Coughing up blood
• Shortness of breath
• Chest pain
• Unexplained weight loss

If cancer is suspected, further diagnostic tests (blood work, PET/Bone scans, tissue biopsies) are needed to determine the cancer type, stage, and appropriate course of treatment.

Lung cancer staging may require one or several different biopsy techniques:

• Mediastinoscopy: An important staging procedure, during which a fiber-optic camera (mediastinoscope) is inserted through a small incision at the base of the neck into the mediastinal space to examine the lung surface and take a tissue sample from each of the lymph nodes surrounding the lungs
• Navigational bronchoscopy: A thin endoscopic device (bronchoscope) that can be inserted through the airways and guided by a computer system to examine and biopsy specific locations within the bronchial lining and inside of the lungs
• Endo-bronchial ultrasound (EBUS): A bronchoscope with a built-in ultrasound probe that can be used to visualize and biopsy lymph nodes through the airway walls
• CT/ultrasound-guided biopsy: A thin needle guided by CT/Ultrasound to the tumor, lymph node, or surrounding fluid to remove a small sample for analysis
• Wedge resection: A minimally invasive VATS procedure that can be used to obtain a small amount of tissue from a suspected tumor in the lungs

Treatment for lung cancer

Modern lung cancer treatment involves a multi-therapy approach and is highly individualized to a patient’s cancer stage, tumor characteristics, and general health. Following a diagnostic work up, lung cancer is classified as either non-small cell lung cancer (accounting for 85% of lung cancers) or small cell lung cancer. Non-small cell lung cancer is traditionally divided into four stages, each indicating a slightly different treatment regimen:

• Stage 0: In the earliest stages of lung cancer, a tumor limited to the bronchial tubes can be treated with photodynamic therapy, which utilizes a laser to specifically destroy the cancer cells
• Stages I and II: Stages 1 and 2 include surgical resection of the tumor (Lobectomy) and lymph node dissection is the primary treatment; chest radiation and/or chemotherapy performed if surgery is not an option
• Stages III and IV: Stages 3 and 4 include chest radiation combined with chemotherapy and is the primary treatment regimen; very limited, early stage III tumors may be treated with surgery
• Small cell lung cancer is a more aggressive form of lung cancer that is rarely treated with surgery. Therapy involves chemotherapy combined with targeted radiation therapy.

Virtually every lung cancer surgery performed by our surgeons is done using the video-assisted thoracic surgical (VATS) technique. This minimally invasive approach significantly reduces the postoperative pain and recovery time compared with traditional open surgery.

To schedule a consultation with a thoracic surgeon, call 714-456-8000.