Lung Cancer

Lung cancer. It’s the l eading cause of cancer death for both men and women, killing more people than colon, breast, and prostate cancers combined. The Saint Vincent Cancer Care Center is the region’s authority in diagnosing, evaluating and staging lung cancer.

To do this, our pulmonologists order and perform a number of procedures, including bronchoscopy, needle biopsy, computerized axial tomography (CAT) and positron emission tomography (P ET) scans or a combination of these tests. The results of these diagnostic tests enable the physicians to determine the disease involvement and staging, and work in collaboration with the patient’s surgeon and oncologist to make an appropriate recommendation for surgery, chemotherapy, radiation or a combination of these three treatments.

Bronchoscopy
Bronchoscopy is a diagnostic or therapeutic procedure, in which a tube with a tiny camera on the end is inserted through the nose or mouth into the lungs. The procedure provides a view of the airways of the lung and allows doctors to collect lung secretions or tissue specimens for biopsy. Bronchoscopy may also be performed to determine the extent of lung cancer or destroy growths in the airway, in conjunction with the radiation oncologist, in a procedure known as brachytherapy.  

Physicians utilize two types of bronchoscopes. A flexible bronchoscope is a long, thin tube that contains many small, clear fibers or a small camera that can transmit light images as it bends. The flexible bronchoscope is used more often than the rigid bronchoscope because it is usually safer, does not require general anesthesia, is more comfortable for the patient, and offers a better view of the small airways. Small samples of tissue can also be removed using a flexible bronchoscope. It can also be used to widen the airway or destroy a growth using a laser.

A rigid bronchoscope is a straight, hollow metal tube that can be used for better visibility when there is major bleeding in the airway, when a larger tissue sample is required, or when it is necessary to widen the airway or destroy a growth using a laser.

Pulmonologists (lung specialists) complete comprehensive evaluations, direct diagnostic studies and coordinate multidisciplinary team care. For lung cancer patients the care team may include a pulmonologist, a radiologist, a surgeon, a medical oncologist and a radiation oncologist.

Mediastinoscopy Diagnosis
Mediastinoscopy is a procedure in which the surgeon inserts a camera through a small incision in the neck in order to diagnose lung cancer, infections and lymphoma.

Surgical Options
Surgical management of lung cancer is typically performed by one of two methods: video-assisted thorascopic surgery (VATS) or open thoracotomy.

Video-Assisted Thorascopic Surgery (VATS)
Video-Assisted Thorascopic Surgery (VATS) can be performed on tumors that are clinical stage I. This minimally invasive procedure makes use of a telescopic lens and video camera to view the surgical target and guide the surgeon through the procedure. Three to four small (one-to two-inch) incisions may be used in a VATS as compared to one seven-inch incision in a thoracotomy. With a VATS procedure the chest wall musculature is not disrupted. This results in less post-operative pain which allows the patient to breathe deeper, minimizing lung collapse, and usually results in a shorter length of stay. The types of complications are similar in both VATS and thoracotomy procedures. Saint Vincent Health Center cardiothoracic surgeons perform both of these procedures for lung cancer with the latest in video-assisted technology.

This process benefits the patient through:
• Smaller scars
• Less post-operative pain
• Reduced post-operative pain allows the patient to cough and take • deep breaths
• Decreased need for pain medications post-operatively
• Shorter length of stay
• Less risk of infection

Thoracotomy
The traditional approach to lung resection is a thoracotomy. During a thoracotomy an incision is made on the side of the chest between the ribs. This allows for excellent exposure and enhanced options for resection.