Lung cancer develops when genetic changes occur in a normal cell within the lung. As a result, the cell becomes abnormal in shape and behavior, and reproduces endlessly. The abnormal cells form a tumor that, if not surgically removed, invades neighboring blood vessels and lymph nodes and spreads to nearby sites. Eventually, the cancer can spread to locations throughout the body.
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Lung Cancer Diagnosis
Lung cancer is typically diagnosed through a physical examination, chest X-rays and computed tomography, or a CT scan.
- In a small percentage of cases, a routine chest X-ray reveals the first signs of lung cancer. Usually, however, symptoms of existing lung cancer, such as coughing, chest pain, and blood in the sputum, will lead to a chest x-ray.
- Computed tomography (CT), particularly the specific technique called low-dose spiral (or helical) CT, is more effective than x-rays for detecting cancer in patients with suspected lung cancer. It is the standard imaging procedure for determining if and where the cancer has spread (metastasized). Surgeons also use CT scans to evaluate patients before lung surgery.
Lung Cancer Treatment at NYM
At New York Methodist, physicians from various clinical areas (pulmonology, oncology, radiation oncology and thoracic surgery) work as a team to evaluate your medical condition and recommend an appropriate treatment.
Lung cancer is generally diagnosed in older individuals so there's an increased need for techniques that are well tolerated among the elderly. For a variety of reasons, seniors recover more easily following minimally invasive techniques.
The type of surgery a patient needs depends on the amount of lung or other tissue that needs to be removed.
- Wedge resection and segmentectomy remove only a small part of the lung. They preserve almost normal breathing function after the operation.
- Removal of one of the lobes of the lung is called lobectomy. The patient must have enough lung function to undergo this procedure. The patient has a 3 - 5% risk of death after this operation, with older patients having the highest risk.
- Pneumonectomy removes the entire lung. The patient has a 5 - 8% risk of death after this procedure. The oldest patients have the greatest risk, and they almost always have a recurrence.
Surgical advances are allowing a wider range of options, including minimal surgeries for early cancers and surgeries that relieve cancer symptoms in the late stages of the disease.
- Thoracoscopy, also known as video-assisted thoracic surgery (VATS), is a less-invasive technique that uses a thin tube containing a miniature camera and surgical instruments. It involves much smaller incisions than open surgery and speeds recovery to the point that patients are up within hours. Though the procedure is not appropriate in all cases, it offers significant advantages, especially in older or frail patients.
- Laser surgery allows surgeons to remove small amounts of lung tissue. Laser surgery may also be beneficial in treating cancers that have spread to, and are obstructing, the throat.
- Photodynamic therapy uses bronchoscopy and special laser light beams combined with a light-sensitive drug, called porfimer sodium (Photofrin), to kill cancer cells.
- Cryosurgery uses a probe chilled to below freezing to destroy the tumor cells on contact. It is being investigated in combination with radiation therapy. It may also be an alternative in early stage cancer for patients who cannot have surgery.
- Electric cauterization, which uses electricity to produce heat that destroys tissue, is also under investigation as a treatment for early-stage disease.
- Radiofrequency ablation is a non-surgical technique that uses an x-ray guided electrode to deliver heat to tissues may benefit lung cancer patients who are not eligible for surgery, radiation, or chemotherapy.
The goal of radiation treatment is to administer doses as high as possible to kill as many cancer cells as possible, without destroying surrounding healthy tissues or causing a dangerous reaction. Doctors may try different procedures for the same patient. The exact radiation procedure depends on the site of the cancer or how far it has spread.
- External-beam radiation therapy focuses a beam of radiation directly on the tumor. It is generally used for cancer that has spread.
- Brachytherapy implants radioactive seeds through thin tubes directly into the cancer sites. Brachytherapy may be used for lung cancers that have spread to the throat and caused obstruction. High-dose-rate brachytherapy may also have some value for patients with inoperable tumors in the central region of the lung.
Three-Dimensional Conformal Radiotherapy
Three-dimensional (3-D) conformal radiotherapy delivers external-beam radiation specifically to targeted organs or tissues. This allows doctors to administer significantly higher doses to attack the cancer, while reducing the risk to healthy cells. This technique is generally considered the standard method of delivering radiation to lung tumors.
Learn more about radiation oncology treatments at New York Methodist.
Chemotherapy is the use of drugs given by mouth or injection to destroy cancer cells that may have spread beyond the tumor.
Learn more about chemotherapy and infusion therapies at New York Methodist.
For more information on lung cancer, please call 718.780.5835.