Lung Cancer Treatment
The Thoracic Center
Lung Cancer Treatment
Lung cancer is the leading cause of cancer deaths in both men and women. Approximately 178,000 people die annually from lung cancer in the United States. Deaths from lung cancer account for 30% of the cancer deaths in men in New Jersey, and 23% of cancer deaths in women. However, when detected early lung cancer is a highly curable disease with surgery alone.
There are two major types of lung cancer: non-small cell lung cancer and small cell lung cancer. The difference is based on how the cancer cells look under a microscope and how the cancer grows and spreads. The treatment is different for each.
Non-small Cell Lung Cancer
Non-small cell lung cancer is the most common type of lung cancer. It grows and spreads to different parts of the body more slowly than small cell lung cancer. There are three main types of non-small cell lung cancer:
- squamous cell carcinoma (also known as epidermoid carcinoma)
- adenocarcinoma, and
- large cell carcinoma.
Small Cell Lung Cancer
Small cell lung cancer is also called oat cell cancer. It is less common than non-small cell lung cancer. Small cell lung cancer grows more quickly and is more likely to spread to other organs in the body. There are two major stages for this cancer:
- limited if the cancer is confined to the chest
- extensive if the cancer has spread throughout the chest or from the chest
There are several causes of lung cancer:
- Smoking tobacco. Smoking is the number one risk factor for lung cancer. Cigarettes, cigars, and pipes have proven cancer-causing substances (called carcinogens). Smoking is the number one risk factor for lung cancer. It is beneficial to stop smoking since it lowers your risk of lung cancer. It also reduces the risk of developing heart disease, stroke, and chronic obstructive pulmonary diseases.
- Secondhand smoke. Nonsmokers who breathe the chemicals in smoke are also at increased risk for developing lung cancer.
- Radon. Radon is the second leading cause of lung cancer in the United States. It is an odorless and radioactive gas that comes up through the soil and enters a building through gaps in the foundation or insulation, or through pipes and drains.
- Asbestos, Uranium, Arsenic, Petroleum Products, and Others. Work-related exposure to carcinogens is another risk factor.
- Other risk factors include air pollution and tuberculosis.
The risk of getting lung cancer is even greater when more than one risk factor exists. Changes in the lung can begin as soon as a person is exposed to a risk factor.
Symptoms often do not appear until lung cancer is advanced. Patients with small tumors frequently do not have any symptoms. Symptoms include:
- Changes in a “smoker’s cough” (dry, rough cough)
- Chest, shoulder, or back pain unrelated to coughing
- Chronic cough (persisting more than two weeks)
- Changes in sputum (change in color, increase in volume, presence of blood)
- Recurrent pneumonia or bronchitis
Other symptoms of lung cancer may not be respiratory in nature. These include:
- Loss of appetite
- Headache, bone pain, aching joints
- Neurologic symptoms such as unsteady gait or memory loss
- Neck and facial swelling
- Unexplained weight loss
If the lung cancer has spread to other parts of the body, a person might have bone fractures, bleeding, blood clots, or other symptoms.
Lung cancer is diagnosed with any combination of the following exams, tests and procedures:
- Physical examination by your doctor.
- Analysis of the sputum you produce when you cough to check for cancer cells under a microscope.
- Imaging tests, such as a chest X-ray, computed tomography (CT) scans, bone scans, and Magnetic Resonance Imaging (MRI), help to locate abnormal areas of the lungs and show whether cancer has spread to other organs in the body.
- Low-dose helical (spiral) CT scan lets the doctor use less radiation than a regular CT scan and can detect tumors even when they are small.
- Positron Emission Tomography (PET) scan can identify metabolic signals of actively growing cancer cells in the body.
- Bronchoscopy involves the insertion of a bronchoscope through the nose or mouth and into the bronchi. The doctor examines the bronchial passages and may take a tissue sample to analyze for cancer cells. The tissue sampling is called a biopsy.
- Mediastinoscopy involves the insertion of a scope into the lymph nodes in the chest through a small incision in the neck. A tissue sample is obtained.
- Mediastinotomy is the same as mediastinoscopy except the incision is made in the chest instead of the neck.
Each patient's treatment regimen is individualized according to the type of lung cancer, the size of the tumor, the location of the tumor, whether the cancer has spread, and the general health of each patient. There are three main forms of cancer treatment for lung cancer:
- radiation therapy
They may be used alone or in different combinations.
Surgery is the preferred treatment for early staged lung cancer. In some selected patients chemotherapy is given prior to surgery. In these selected patients chemotherapy has been shown to improve survival.
The Thoracic Center incorporates the varied disciplines to provide the most modern approaches in comprehensive care. These approaches include the most sophisticated techniques in diagnosis and preoperative assessment by a team of specialists that include medical oncologists, thoracic surgeons, radiologists, radiation oncologists, pathologists, social workers, and nurses. Together with the referring physician a treatment plan is determined.
Type of procedure
Surgery removes a small part of the lung (wedge resection), entire lobe of the lung (lobectomy), or the entire lung (pneumonectomy). Video-assisted thoracoscopic surgery (VATS) has rapidly become a commonly performed procedure for lung cancer among some surgeons specializing in thoracic surgery. Thoracic Surgeons at Robert Wood Johnson University Hospital have been performing VATS since the early 1990’s. VATS lobectomy is a definitive surgery for lung cancer in properly selected patients. The mini-thoracotomy muscle sparring procedure is also performed by The University Thoracic Surgeons and provides the same anatomical dissection and lymph node removal as performed with standard thoracotomy. VATS and mini-thoracotomy provide less pain and restriction of movement when compared to a standard thoracotomy.
What do we mean by properly selected patients for VATS lobectomy? We mean that the surgeons tailor their surgery to the each patient’s unique situation. Since the goal is thorough removal of the tumor, the surgeon chooses the method that is best suited to accomplish the goal. This is the VATS approach for some patients, but not for all. Approximately 74% of patients who had a lobectomy performed by The University Thoracic Surgeons at Robert Wood Johnson University Hospital between 1993 and 2003 had the VATS approach.
Our in-hospital complication rate has been equally low for both the VATS and mini-thoracotomy approaches.
The post-operative complication rate for lobectomy surgery at Robert Wood Johnson University Hospital is lower than the New Jersey state average.
Early mobilization is key to our success in reducing postoperative complications. Frequent ambulation, deep breathing, and respiratory treatments are essential components of the postoperative care at RWJUH.
The survival rate for Stage 1A and Stage 1B lung cancers treated at RWJUH is better than the survival rate reported in the National Cancer Data Base.
Health care team members at Robert Wood Johnson University Hospital utilize comprehensive clinical pathways to guide patient care in the preoperative, operative, and postoperative stages. Team members include highly trained nurses, anesthesiologists, pain management specialists, respiratory therapists, social workers, and others. The high volume of lung surgeries performed at RWJUH each year enables practitioners to maintain exceptional competency.
Studies have shown that the best outcomes following an operation on lung cancer occur with experienced surgeons and experienced hospitals. Patients who underwent lobectomy by high-volume surgeons in high-volume hospitals usually had significantly lower risk-adjusted mortality rates than did patients who had low-volume surgeons, low-volume hospitals, or both low-volume surgeons and low-volume hospitals [Hannan EL, Radzyner, M, Rubin, D, Dougherty, J & Brennan, MF. The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. Surgery, 131(1) 6-15, 2002].
Robert Wood Johnson University Hospital is a high-volume hospital with high-volume surgeons. The hospital is in the top quartile of New Jersey hospitals based on volume of lung surgery.
Depicted below is the volume of lung lobectomy cases at RWJUH, which shows increased activity for our hospital. High-volume and high-quality are critical success factors for our program.
The treatment plan for our patients involves access to specialized services at Robert Wood Johnson University Hospital and at the Rutgers Cancer Institute of New Jersey. Many services are provided to help patients and their families through some very difficult times. Support groups, educational sessions, and individual and family counseling are offered from diagnosis through treatment and recovery. They help patients and their families face the emotions associated with a cancer diagnosis; cope with cancer treatment and its side effects; adjust to changes in their bodies, relationships, work, and lifestyle; make health care decisions; and adjust to life after treatment. Numerous resources are available in the community. Our social workers and financial counselors are available to assist with transportation arrangements, advance directives, financial assistance, and more. Consultation with a registered dietitian is also available upon request.
Please call (732) 235-8515 to schedule an appointment or to learn more about the surgical experience of The University Thoracic Surgeons.
Chemotherapy is treatment with anti-cancer drugs that are given by mouth, into the vein, or into other areas (e.g., spinal fluid). Even if the cancer is removed by surgery, chemotherapy agents may also be used to kill cancer cells that may be present in the lung tissue or in the body. Side effects of chemotherapy vary by the agent used for treatment. In selected patients chemotherapy may be given to patients prior to surgery. Studies have shown that in some patients chemotherapy prior to surgery may improve survival.
Radiation therapy is called radiotherapy and uses high-energy rays to target cancerous tumors. It might be used before surgery to shrink a tumor or after surgery to be sure the cancer cells are destroyed. Radiation therapy may also be used in combination with chemotherapy. Side effects of radiation include dry throat, sore throat, difficulty swallowing, loss of appetite, fatigue, and changes in the skin around the radiation site.
Photodynamic therapy (PDT) involves injection of a chemical into the bloodstream that gets retained in cancer cells. A laser light activates the chemical to combat the cancer cells. This type of therapy makes the eyes and skin sensitive to light for six or more weeks after therapy. Other side effects include coughing, shortness of breath, painful breathing, and trouble swallowing. Although photodynamic therapy is not offered at RWJUH, referrals can be made by The University Thoracic Surgeons to centers that provide this service.
The best way to prevent lung cancer is to stop smoking and avoid secondhand smoke. Also test your home for radon. Avoid exposure to dust or fumes at work. Become an active participant in your safety at the workplace.
A large number of resources are available to help you stop smoking. The following are a few for you to consider:
- New Jersey Quitnet at www.nj.quitnet.com – a 24 hour a day, 7 day a week online resource for free peer support groups and trained counselors.
- New Jersey Quitline (1-866-NJ-STOPS or 1-866-657-8677) – access Mondays through Fridays from 8 a.m. to 8 p.m. and Saturdays from 11 a.m. to 5 p.m. with free services from counselors in 26 languages.
- American Cancer Society (800-ACS-2345 or 800-227-2345) – the organization assists callers to locate support groups that are available.
- Rutgers-Tobacco Dependence Program/Clinic at (732) 235-8222 – offers free smoking cessation counseling and has a facility equipped for handicapped access.
The Research section of the website includes information about the National Lung Cancer Screening Trial that is currently enrolling healthy men and women in research to detect lung cancer; the New Jersey Cancer Trial Connect program to enable people to identify active clinical trials that offer appropriate treatment options for patients with cancer; and more. In addition to the Research section, we encourage you to view the Useful Links for more information about lung cancer research.
Lung Cancer Study Group
An interdisciplinary group of specialists meets weekly at the Rutgers Cancer Institute of New Jersey to discuss the treatment options for patients with cancers originating in the chest and lung (small and non-small cell lung cancers), mesotheliomas, thymomas, and esophageal cancers. All multimodality treatment options are considered and the treatment plan is designed together with the referring physician. Medical oncologists, radiologists, pathologists, thoracic surgeons, nurse practitioners, research study coordinators, and others consider diagnostic test results, pathology results, past medical history, cancer history, and other critical pieces of information in the decision-making process. Each member of the interdisciplinary group provides an expert review of the case and contributes to the design of the treatment plan.