Lung Cancer -- February 11, 2008 -- Dr. Jeffrey Wright & Dr. James Wudel - NewsChannel5.com | Nashville News, Weather & Sports

Medical Mondays: Lung Cancer & Advanced Treatment Options  Jeffrey Wright, MD, pulmonologist James Wudel, MD, cardiothoracic surgeon Lung Cancer & Thoracic Center SAINT THOMAS HOSPITAL Monday, February 11, 2008

Saint Thomas' Lung Cancer & Thoracic Center
222-LUNG

  

• Integrated, single point care

• Rapid Diagnosis and Treatment Plan Formulation

• Nurse "navigator" to assist the the patient through the Center and any treatment plan coordination; as well as point of contact for the referring physician's office.

• Direct access to futuristic, regionally unique technologies including electromagnetic navigational bronchocoscopy, radiation therapy, brachytherapy, interventional bronchoscopy, endobronchial, endotracheal and esophageal stent placement

• State-of-the-art medical oncology, including innovative clinical research protocols

  

Saint Thomas is proud to announce, the first multidisciplinary center in the Southeast preventing and treating cancers of the chest, the Saint Thomas Lung Cancer and Thoracic Center provides patients access to thoracic surgeons, pulmonologists, oncologists, radiation oncologists and nurse navigators all in one setting.

Lung cancer is the leading cause of cancer death for both men and women in the United States. We believe there is no better time to come together to provide patients the finest care possible. Our multidisciplinary approach ensures that each patient benefits from the combined expertise of our clinical caregivers.

There are more than 14 physicians on the medical staff of the Saint Thomas Lung Cancer and Thoracic Center, all experts in their respective fields, including: the Center's Medical Director, pulmonologist, Jeffrey Wright, MD, cardiothoracic surgeon L. James Wudel, M.D., radiation oncologist Paul Rosenblatt, M.D., and oncologist Jerry Foster, M.D. 

Our physicians provide the fastest path to diagnosis and treatment, and as you know, less waiting time means less anxiety for patients, and more importantly, moving treatment forward may make a difference in the quality of life for our patients.

Saint Thomas Hospital performs more lung cancer surgery than any other hospital in the region, and with better outcomes. We are the only area hospital with dedicated cardiothoracic operating rooms, and we provide 24-hour in-house critical care coverage.

Saint Thomas is also one of the first hospitals in the country and the only Nashville hospital to utilize an advanced navigation technology that enables the detection, diagnosis, and staging of lung cancer in its earliest stages, when a cure for the disease is still possible. Pulmonologist Jeff Wright, M.D., uses the superDimension®/Bronchus System (SDBS), which operates like a global positioning system (GPS), to navigate to suspicious masses throughout the lungs in real time. This treatment leads to earlier and more appropriate treatment and, hopefully, will help reduce the high mortality rates for lung cancer. 

Leading our cardiothoracic surgery specialty, Dr. L. James Wudel has been trained by one of the top physicians in the world specializing in cancers of the esophagus. Dr. Wudel provides the finest surgical care to patients with diseases of the lungs, trachea, esophagus, diaphragm, chest wall and mediastinum.

News Notes via webMD.com

Lung Cancer - Treatment Overview

Treatment for lung cancer depends on the stage of your cancer and may include surgery to remove the cancer, radiation therapy, or medications (chemotherapy). Treatment for non-small and small cell cancer may be different.

Treatment for lung cancer may include one or more of the following therapies:

• Surgery (taking out the cancer). Surgery may involve removing the cancer (wedge resection), removing the affected lobe of lung (lobectomy), or removing the entire lung (pneumonectomy). Surgery is the most effective treatment for early-stage non-small cell lung cancers (stages I and II). Lung function studies and a lung scan are often done before surgery to predict whether you will have enough remaining lung function after surgery to live a fairly normal life.
• Radiation therapy (using high-dose X-rays to kill cancer cells). Radiation therapy is often used in combination with surgery or chemotherapy or both. Radiation following surgery for stages IIA, IIB, and IIIA (with lymph node involvement) may reduce the risk of cancer returning in the chest.
• Chemotherapy (using medications to kill cancer cells). Chemotherapy is the most effective treatment for small cell lung cancer. It can help control the growth and spread of the cancer, but it is a cure in only a small number of people. Chemotherapy has been shown to improve survival in non-small lung cancer when it is given after surgery for early-stage cancers.¹¹ It may also be used to treat more advanced stages (stages III and IV) of non-small cell lung cancer.
• Targeted therapy. Targeted therapies use medications or antibodies to block growth factors that allow some cancers to grow. At this time, targeted therapies are used for advanced stages of lung cancer.

If you smoke and have lung cancer, quitting smoking will make your treatment more effective and may help you live longer. Smoking delays healing after surgery, so you may have a better recovery from lung cancer surgery if you have quit smoking. People with early-stage lung cancer who continue to smoke during radiation therapy have been shown to have shorter survival times that those who do not smoke.¹² It may also make chemotherapy less effective; the nicotine in tobacco seems to help the cancer cells and their blood supply multiply while also protecting the cancer cells from destruction.¹³ For information and help quitting smoking, see the topic Quitting Tobacco Use.

Initial treatment

The kind of treatment and the long-term outcome of lung cancer depends on the type and stage of the cancer. Your age, overall health, and quality of life must also be considered. Many people with lung cancer are diagnosed with the disease when the cancer is already in an advanced stage. Only about 16% of lung cancers are diagnosed in the early stages when lung cancer is likely to be cured by surgery.¹

  

Non-small cell lung cancer grows and spreads more slowly. Lung surgery (thoracotomy) is usually the standard treatment for non-small cell stage I to stage IIIA cancers. Treatment for non-small cell lung cancer also includes:

• Treatment with a combination of the three therapies.

• o Lung surgery (thoracotomy) takes out the cancer.
• o Radiation therapy follows surgery for stages IIA, IIB, and IIIA (with lymph node involvement) and may reduce the risk of cancer returning in the chest.
• o Chemotherapy may be used to treat more advanced stages (stages III and IV). Chemotherapy may also be used after surgery for early stages such as IB, IIA, IIB, and IIIA to reduce the risk of cancer returning.

Small cell lung cancer grows very rapidly in most people and is more likely to spread (metastasize) to other organs. Treatment for small cell lung cancer includes:

• Chemotherapy, which usually is the standard treatment for this type of lung cancer.
• Radiation therapy, which may help shrink a rapidly growing large tumor that is causing symptoms.

Radiation therapy is combined with chemotherapy to treat small cell cancer that is limited to the chest.

Home treatment measures may help relieve some common side effects of your cancer treatment. For more information, see the Home Treatment section.

If you have been recently diagnosed with lung cancer, you may feel denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer; it varies from person to person. You can take steps, though, to manage your emotional reactions to learning that you have lung cancer. You may find that talking with family and friends is comforting, or you may need to spend time alone to understand your feelings about your disease.

If your emotions interfere with your ability to make decisions about your health and to move forward with your life, it is important to talk with your health professional. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.

What to think about during initial treatment

Your quality of life is critical when considering your treatment choices. Discuss your personal preferences with your oncologist when he or she recommends treatment.

Treatment for advanced-stage lung cancer is intended to control your symptoms and increase your comfort (palliative care), but it will not cure your cancer.

You may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. People who do not want standard treatments or are not cured by standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries around the world for all stages of lung cancer.

There are many clinical trials being done to see if combining chemotherapy or radiation treatments either before or after surgery is more effective for the different stages of lung cancer. Other clinical trials are studying different medication combinations for different stages of lung cancer. Discuss what choices are available for your lung cancer with your oncologist. For more information about specific lung cancer treatments, see the topics:

• Lung Cancer, non-small cell-Health Professional Information [NCI PDQ].
• Lung Cancer, non-small cell-Patient Information [NCI PDQ].
• Lung Cancer, small cell-Health Professional Information [NCI PDQ].
• Lung Cancer, small cell-Patient Information [NCI PDQ].

Ongoing treatment

After initial treatment for lung cancer, it is important to receive follow-up care.

• Your oncologist will schedule regular checkups, usually every 3 to 4 months, depending on the therapies used in initial treatment. After 2 to 3 years, regular checkups will occur less often but more than just once a year, depending on your medical history.
• Checkups include a physical exam, blood tests, chest X-rays, and any other laboratory tests recommended by your oncologist. A CT scan is usually done every 3 to 6 months for the first 2 to 3 years, and then once a year after that.

Radiation therapy may be used to prevent small cell lung cancer from growing in the brain. This is called prophylactic cranial irradiation (PCI). PCI may be most beneficial if you have limited small cell lung cancer and have had successful treatment with chemotherapy and radiation therapy to the chest.

Your emotional reactions are likely to vary during your treatment depending on how you feel, your prognosis, the treatment methods used, and your decisions about treatment.

Treatment if the condition gets worse

The long-term outcome (prognosis) for lung cancer that does not respond to treatment as hoped or that comes back after being treated is poor, and treatment focuses on managing your pain and improving your quality of life (palliative care).

Treatment to help control your symptoms (such as pain, coughing up blood, shortness of breath, and weakness) may include:

• Radiation therapy. This may be done to shrink cancers that make swallowing or breathing difficult or that are causing pain.
• Chemotherapy.
• Chemotherapy combined with radiation therapy.
• Surgery, if your cancer has spread to your brain.
• Laser surgery or internal radiation therapy (brachytherapy).
• Radiation applied directly to the cancer during surgery.

Other treatments being studied for lung cancer include radiofrequency ablation, microwave ablation, and cryoablation. Each of these is a way of trying to destroy the cancer cells without major surgery. These treatments may be useful for people who are not able to have surgery either because they are in poor health or because their cancer is too advanced.¹⁴

Additional treatment measures

• Oxygen therapy may relieve your shortness of breath. It is usually used at the end stage of the disease, but it may also be used for pneumonia or other treatable conditions.
• Thoracentesis is used to remove fluid from around your lungs (pleural effusion). A large amount of fluid may cause pain and shortness of breath.
• Pleurodesis is used to prevent fluid buildup around your lungs. Pleurodesis is a procedure that is intended to cause inflammation of the lining around your lungs. The irritated tissue reacts by producing scar tissue, which causes the two layers of the lung lining to stick together. This removes the space where fluid can build up around your lungs. Pleurodesis is commonly used to treat fluid buildup around your lungs that returns after repeated thoracentesis.
• Small tubes (pleural catheters) to drain fluid from around the lungs are used to relieve ongoing fluid buildup (pleural effusion).
• Treatments that burn (cauterize) selected areas of blocked airways or that place stents-small, coiled, wire-mesh tubes that can be inserted into a blocked airway and expanded to hold it open-are also becoming more common.
• Pain medications can be taken regularly. These may include prescribed narcotic medications, such as codeine; or medications you can buy without a prescription, such as aspirin and similar drugs.

Complementary therapies

In addition to conventional medical treatment, you may wish to try complementary therapies to help you manage pain and improve your quality of life.

• Acupuncture
• Herbs
• Biofeedback
• Meditation
• Yoga
• Guided imagery
• Vitamins and nutritional supplements

Before you try any of these therapies, discuss their possible benefits and side effects with your health professional. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

What To Think About

If surgery is part of your treatment, you also may be given radiation therapy or chemotherapy before surgery or after surgery to try to kill any cancer cells that may remain. Radiation or chemotherapy may be given before or after surgery when only microscopic areas of cancer may still be present. In some studies, people who receive radiation or chemotherapy after they had surgery to remove non-small cell lung cancer have been found to live longer, but other studies have shown little or no increase.^{15, 16}

Most treatments for lung cancer cause some side effects. Which side effects you experience depends on the type of treatment used and your age and overall health. Your health professional can talk to you about your treatment choices and the side effects related to each treatment.

Side effects of chemotherapy

Side effects of radiation therapy

Side effects of surgery

Clinical trials

If standard treatments are not effective or are causing more side effects than desired, you may want to consider being part of a clinical trial. These trials study new or different ways to treat cancer.

Palliative care

As your cancer gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different than care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life-not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.

Some treatments for advanced-stage lung cancer are considered palliative care. These treatments cannot cure your cancer, but they can control your symptoms, reduce your pain, and make you feel more comfortable. They include:

• Radiation therapy.
• Medications, including chemotherapy.
• Therapies such as radiofrequency ablation, microwave ablation, or cryoablation that can destroy cancer cells without major surgery.
• Complementary medicine.

In addition to helping your body feel better, palliative care can help you feel better emotionally and spiritually. Talking with a palliative care provider may help you cope with your feelings about living with a long-term illness. It may also help your loved ones better understand your illness and how to support you. Or it could help you make future plans around your health and medical care.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

If you have advanced-stage cancer, you may choose not to have treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult.