Lung cancer is the No. 1 cause of cancer-related deaths globally. And it’s the second most common cancer in the United States. According to the American Cancer Society, doctors will typically
diagnose more than 234,500 new lung cancer cases, and more than 125,000 people will die from the disease each year.
In a recent webinar, thoracic and vascular surgeon Julian Guitron, MD, pulmonary disease specialist
Krishna Gannamraj, DO, and medical oncologist and chief of thoracic oncology Brittaney-Belle Gordon, MD, discussed the importance of early lung cancer diagnosis and available treatment options.
If you’re concerned about lung cancer, here’s what these experts from The Christ Hospital want you to know.
Lung cancer early detection options exist
According to Dr. Guitron, early detection is critical for lung cancer treatment. Early-stage disease is easier to treat, and more people will likely be alive five years after diagnosis and care. Screenings and early evaluations result in more people being diagnosed with stage 1 disease when tumors respond best to therapy. That means screenings and other early evaluations play valuable cancer-fighting roles.
“If we encourage our patients and raise their awareness of the need to come in and get screened and continue with follow-up, we can move the needle on survival,” Dr. Guitron says.
He says patients at The Christ Hospital have two early testing options:
Lung cancer screening for patients with a history of smoking
Existing recommendations suggest that current and recent former smokers should undergo annual
lung cancer screening with a low-dose CT scan. This preventive exam screens patients who don’t have any cancer symptoms, but who are still at high risk of developing the disease. To date, these tests have
reduced lung cancer deaths in this patient group by 20 percent.
Based on guidelines from the United States Preventive Services Task Force, you may need early screening if you:
Lung nodule clinic
Lung cancer doesn’t only affect patients with a history of smoking, though. Providers at The Christ Hospital refer any patient to the
Lung Nodule Clinic for further evaluation if they have a suspicious nodule or mass that appears on a CT or MRI scan. Doctors usually order these imaging exams for unrelated reasons like abdominal or chest pain.
Lung cancer diagnosis and staging can affect treatment
Detecting a nodule or mass in your lung with advanced imaging is just the first step in determining if you have lung cancer. Doctors will need to collect a sample of your tissue for a biopsy. This sample can help diagnose your cancer, determine how advanced your disease is and guide your treatment, Dr. Guitron says.
“A CT scan or PET scan can only go so far in telling us if you have cancer or not,” he says. “Even if your tumor is highly suspicious, we need tissue to figure out what’s going on.”
Three of the most common biopsy techniques include:
Bronchoscopy—This procedure uses a long, thin tube with a light and camera at the end (called a bronchoscope) to examine any abnormal areas in your lungs. Your doctor may use hollow needles or a small brush to collect tissue samples for biopsy.
Endobronchial ultrasound (EBUS)—This sound wave-guided bronchoscopy lets your doctor examine and biopsy the lymph nodes in your chest. Examining lymph node cells makes it easier to determine how advanced your cancer is. There are two EBUS types. Radial probe EBUS gives your doctor a 360-degree view of your airways and can reveal nodules or tumors at the outer edges of your lungs. Convex probe EBUS focuses on any abnormal areas in your main airways.
Transthoracic needle aspiration—This minimally invasive procedure is guided by a CT scan. It inserts a needle through a small cut in your chest to remove a tissue sample. This technique has a higher risk of collapsed lung (pneumothorax) or hemorrhage.
Doctors rely on your biopsy results to determine the best treatment options for you, Dr. Gannamraj says.
“Based on where the mass is and which lymph node is affected, the biopsy results help us determine how advanced a patient’s cancer is,” he says. “It helps us determine if they are a surgical candidate versus more of a medication or radiation candidate.”
Lung cancer treatment options
Multiple treatment options exist for lung cancer. The right therapy for you will depend on whether you have early-stage cancer or more advanced disease.
Surgery
Your doctor may decide surgery is the best way to treat your lung cancer. They will recommend the best procedure based on the size and location of your tumor. Your surgery options include:
Lobectomy—This extensive surgery takes out an entire lobe (section) of your lung. It removes your tumor, lymph nodes and some of the surrounding healthy tissue to reduce the risk that your cancer will come back.
Sublobar resection—Doctors use this procedure to remove a smaller piece of your lung that contains the tumor and lymph nodes. It is as effective as a lobectomy.
Whenever possible, your surgeon will use a minimally invasive method to remove your lung cancer. Both video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) require small incisions and use smaller instruments to separate—rather than cut—your muscles to reach and remove your tumor. As a result, your recovery time is much quicker.
“Patients bruise after these minimally invasive procedures, but there are no cut muscles to repair. We try to minimize the impact of the operation on the patient,” Dr. Guitron says. “We want them to go back to their daily routine and life as soon as possible. Some patients with more advanced disease still require chemotherapy after surgery, and we don’t want them to wait three or four months to heal before they get that treatment.”
Medications
Many patients need lung cancer medication in addition to having surgery. These therapies can be particularly effective against early-stage cancers.
“You may get radiation or surgery to treat an early-stage cancer,” Dr. Gordon says. “That’s when we use chemotherapy or another medical therapy to sweep up the small cancer cells that are still around your body.”
She says the specific characteristics of your tumor will help your doctors create the medication treatment plan that will best attack your lung cancer.
“We need the biopsy to see exactly the type or origin of the cancer. That determines how we treat it,” Dr. Gordon says. “The results let us know if we should use chemotherapy, immunotherapy or targeted therapy—or a combination of the three—to treat the patient’s cancer.”
These medications fight your cancer in different ways:
Chemotherapy—These chemicals attack fast-growing cancer cells. They are effective, but they also damage healthy cells and can cause uncomfortable side effects like nausea, fatigue, and hair loss.
Immunotherapy—These therapies stimulate your body’s natural immune system to recognize, attack and kill cancer cells.
Targeted therapy—These medications focus on genetic mutations found in tumors. By targeting mutations, they can reduce or stop tumor cell growth.
Palliative care options
Sometimes, it isn’t possible to treat lung cancer completely with surgery or medication. In those cases, you will need palliative care to help improve your quality of life, Dr. Guitron says. The Christ Hospital offers two options:
Stent—Surgeons can place a Y-shaped stent (an expandable, hollow tube) in your airway. The stent keeps your airway open and helps improve your breathing.
Vacuum bottles—These bottles connect to a catheter (long, thin tube) implanted in your lungs. This system lets you drain fluid from your lungs at home rather than in the hospital.
Dana-Farber Cancer Institute collaboration
The Christ Hospital is the first and only hospital in Ohio to become a Collaborative Member of the Dana-Farber Brigham Cancer Center in Boston. This collaboration allows us to deliver the most advanced care possible for all our patients with lung cancer, including individuals with rare forms of the disease.
Through this alliance, we can coordinate virtual consultations, second opinions or in-person visits for interested patients. Experts at the [Dana-Farber Cancer] Institute frequently help us identify the best therapy options for every patient, Dr. Gordon says.
“We share cases with experts from Dana-Farber and other teams,” she says. “In these conversations, we discuss each case and how the patient’s cancer presented in order to come up with their best treatment plan.”
Schedule your lung cancer screening
If you have a history of smoking, talk with your doctor about your screening options for early lung cancer detection. Catching lung cancer while the tumors are still small and haven’t spread can ensure you experience your best outcome.
Take our Lung Cancer Risk Assessment and call 513-585-0690 to find out if you qualify for lung cancer screening.