Lung cancer develops as a result of uncontrolled cell division leading to uninterrupted growth. Cancerous cells begin their growth microscopically, but as they continue to multiply, turn into masses called tumors. These tumors may remain local in the tissue in which they originated or in more advanced cases, invade into surrounding structures or spread throughout the body, known as metastasizing. A cell with the ability to invade or spread is considered malignant or “cancerous”.
There is the mistaken impression that lung cancer is a disease that only strikes smokers. This is not the case. While cigarette smoking is the greatest risk factor for the development of lung cancer, an increasing number of patients are developing lung cancer with no history of smoking or smoke exposure.
There were over 224,000 new lung cancers diagnosed in the United States in 2014 with 159,000 deaths reported. It is the leading cause of cancer death. However, new programs aimed at the early detection of lung cancer coupled with innovative treatments hold promise for improved survival in the future. To learn more about lung cancer statistics, see LungCancer.org.
Lung cancer in its early stages has no symptoms. Often, it is picked up on an x-ray or CAT scan as an incidental finding. As the diseases progresses, symptoms such as chest pain, shortness of breath, cough and weight loss can develop. Diagnosis typically requires some form of biopsy; a sample of the tissue of concern for cancer. These biopsies can be performed with a needle guided by a CAT scan or by a bronchoscopy (a small camera inserted into the patient’s windpipe through the mouth or nose). Occasionally, a surgical biopsy is required. A biopsy is important to determine whether or not the growth is cancerous and to determine the type of cancer.
Recent studies have demonstrated that screening patients with risk factors for lung cancer using CAT scans of the chest can pick up lung cancer in its early stages when cure is likely. These studies have demonstrated a significant reduction in death from lung cancer using CAT scan screening. Widespread utilization of this screening technique holds great promise in improving survival from lung cancer. To learn more about your eligibility for lung cancer screening at Baylor University Medical Center click here.
Lung cancer is diagnosed and treated by pulmonologists (lung specialists), thoracic surgeons (surgeons who specialize in lung surgery) as well as medical and radiation oncologists (doctors who treat cancers using chemotherapy or radiation therapy). These doctors work together to choose the best treatment for each patient dependent on the stage of the cancer (how advanced it is) and a patient’s overall medical condition. At the Baylor University Medical Center in Dallas, our team of experts works together to choose the best treatment for you. Use our Physician Finder to search for a specialist.
The most important determinants of how a patient will be treated are the stage of the cancer (whether the tumor is localized in the lung or if it has moved) and a patient’s overall health condition. The treatment most likely to achieve a cure is chosen while being mindful of maintaining the patient’s quality of life.
Staging allows physicians to understand the extent of a patient’s cancer, helps guide treatment decisions and predict outcomes. Staging used by physicians is specific, but a straightforward way to describe staging is shown below:
In most cases, the treatment of lung cancer is determined by its stage. Localized cancers are treated by surgery. Regional cancers are treated by a combination of therapies including chemotherapy, radiation and surgery. Distant disease is treated by chemotherapy.
Surgery for lung cancer presents the best chance for cure in treating localized lung cancer and is considered the “gold standard” against which all other treatments are compared. Surgery for lung cancer requires the removal of the tumor as well as a surrounding rim of normal lung tissue. The extent of the surgery is determined by the size and location of the tumor. Most surgery for lung cancer can now be performed at Baylor University Medical Center using minimally invasive approaches such as VATS (video assisted thoracic surgery) or robotically (using small incisions and robotically controlled operative arms). To see more about the surgical approaches to lung cancer at BUMC see our T Boone Pickens Center.
Surgery for lung cancer should be performed by surgeons with specific training and focus on cancers of the chest. All our thoracic surgeons at BUMC focus specifically on chest malignancies. To see our team see BUMC Cardiothoracic Surgeons.
Your surgeon will determine whether your tumor is resectable (removable), the extent of the surgery (how much lung needs to be removed with the tumor) as well as the surgical approach (minimally invasive vs traditional larger incisions). Your surgeon works closely with pulmonologists (lung doctors) to determine fitness for surgery and optimize lung function before and after surgery.
Radiation therapy uses high-energy X-ray beams to kill cancer cells. It can be used alone as primary therapy or in conjunction with other therapies such as chemotherapy or surgery. It can be used to treat patients with advanced cancers to relieve pain and obstruction (blockage) of the airways, thereby relieving shortness of breath and cough. Additionally, it can be used to improve cure rates in patients with regional cancers when combined with chemotherapy and or surgery. Patient who have localized cancers but are not medically fit to undergo surgery due to other medical problems or poor lung function can be treated with an innovative, high technology approach known as “radiosurgery”. High doses of precisely focused therapy are aimed at tumors to kill tumor cells in the place of surgery. Your expert team at Baylor University Medical Center will work together to choose the best therapy for each patient.
Chemotherapy uses drugs designed to kill rapidly growing cancer cells while sparing normal ones. Chemotherapy is delivered through intravenous therapy although some recently developed chemotherapy drugs can be given as a pill. Newly developed “targeted” medicines use newly discovered weaknesses in the growth pathways of cancer cells and provide the potential for improved outcomes with less side-effects when compared to traditional IV approaches. All tumors evaluated at BUMC are tested for their unique genetic profile to determine whether they are candidates for treatment using these novel therapies (see link). Chemotherapy is used to treat patients whose tumors have been removed to prevent the recurrence (return) of their cancer and in patients whose tumors have spread (metastasized).
Gary Schwartz - Minimally Invasive Management of Lung Cancer