Robert Wood Johnson University Hospital
 

Lung Cancer Treatment

The Thoracic Center

732-235-8515

Lung Cancer Treatment

Overview

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:

  1. squamous cell carcinoma (also known as epidermoid carcinoma)
  2. adenocarcinoma, and
  3. 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:

Causes

There are several causes of lung cancer:

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

Symptoms often do not appear until lung cancer is advanced. Patients with small tumors frequently do not have any symptoms. Symptoms include:

Other symptoms of lung cancer may not be respiratory in nature. These include:

If the lung cancer has spread to other parts of the body, a person might have bone fractures, bleeding, blood clots, or other symptoms.

Diagnosis

Lung cancer is diagnosed with any combination of the following exams, tests and procedures:

Treatment/Surgery

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:

  1. surgery
  2. chemotherapy
  3. 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.

Surgery

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.

Exceptional Outcomes

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.

Comprehensive Care

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.

Supportive Services

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.

Adjuvant Therapy

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.

Prevention

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:

Research

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.

732-235-8515

 

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