Non-Small Cell Lung Cancer Treatment Options
Non-Small Cell Lung Cancer Diagnosis and Staging
Diagnostic imaging is used to identify lung nodules, which may or may not be cancerous. A tissue sample is then taken to the lab to determine if it is cancerous. An individually tailored approach is used to obtain the most accurate diagnosis, based on nodule/mass location, suspected lymph node involvement and the patient's medical condition (i.e., emphysema).
Tissue used for diagnosis may be obtained using an image-guided biopsy, bronchoscopy, endoscopic bronchial ultrasound guided biopsy (EBUS), mediastinoscopy or by video-scopic assisted lung wedge.
Primary treatment for non-small cell lung cancer depends on the stage of the disease. Accurate staging is critical to determine the most effective therapy. Staging is accomplished by evaluating all information obtained with imaging (chest CT, integrated PET CT and head MRI), bronchoscopy, EBUS, endobronchial naviagation guided biopsy, mediastinoscopy (when indicated).
Non-Small Cell Lung Cancer Treatment Options
At a lung cancer treatment center such as Fox Chase, primary treatment for non-small cell lung cancer depends on the stage of the disease, therefore accurate staging is crucial to determining therapy. Each case is discussed by a multidisciplinary group at the thoracic tumor board meeting, which includes:
- thoracic surgeon
- medical oncologist
- radiation oncologist
- intensiveists (ICU physicians)
The tumor board develops an individualized and tailored treatment plan.
Possible treatment may involve surgery, radiation therapy or chemotherapy for lung cancer; or a combination of these therapies. Our surgeons work closely with your referring physician so that you can stay close to home for the majority of treatment and follow-up. Fox Chase surgeons are the area's most experienced doctors for minimally invasive oncologic video-assisted thoracic surgery (VATS) for lung cancer. Therefore, minimally invasive resection is offered whenever possible.
As a top lung cancer treatment center, Fox Chase is also conducting cutting-edge research with new lung cancer targeted therapies. Targeted therapies use drugs or other substances to identify and attack specific cancer cells without harming normal cells.
Surgery for Lung Cancer
Video-Assisted Thoracoscopic (VATS) Lobectomy
Fox Chase surgeons, Walter J Scott, MD, FACS and Prashant Shah, MD, are some of the area's most experienced surgeons in the use of VATS for lobectomy to treat lung cancer. Research has proven VATS lobectomy benefits patients by resulting in:
- reduced post-operative pain
- faster recovery
- shorter hospital stay
- improved survival rates
VATS is a minimally invasive surgical technique in which doctors use state-of-the-art telescopes, video cameras and other instruments to view and operate inside the chest through several small incisions (about 3 inches), rather than cutting through muscle and the chest wall. Surgeons at Fox Chase now use VATS to perform lung biopsies, pleural biopsies, wedge resections and lobectomies. Read more »
Improving Patient Care in Thoracic Surgery
Thoracic walkers, which are only available at a handful of hospitals in the country, are now being used at Fox Chase. These custom-designed walkers are used to mobilize thoracic surgery patients earlier, resulting in a shorter hospital stay, better outcome and reduced risk of infection.
Surgical Options Available at Fox Chase
Not all patients with lung cancer are candidates for surgery. However, for those who are appropriate, there are 3 types of lung cancer surgery:
- Wedge resection - this procedure can be used to diagnose lung cancer or to treat it. It is performed through a thoracotomy (surgery to open the chest) or a Video-Assisted Thoracoscopic Surgery (VATS). The tumor is removed along with a margin of healthy lung tissue in order to collect any microscopic cells that remain. Most patients, even those with limited pulmonary function, can undergo this procedure successfully.
- Lobectomy - in this procedure, an entire lobe is removed surgically. The lungs are divided into sections called lobes. There are 3 lobes on the right and 2 on the left. Patients with good pulmonary function can survive without one lobe. In this procedure, the surgeon removes more of the healthy surrounding lung tissue to take the microscopic cancer cells that may be left behind. Lobectomies can be done using thoracotomy or Video-Assisted Thoracoscopic Surgery (VATS).
- Pneumonectomy - in this procedure, which is the most invasive surgery for lung cancer, an entire lung is removed. In some cases, when the tumor involves more than one lobe or is located centrally, a pneumonectomy may be the only treatment option that can remove all of the lung cancer. It can only be performed on patients with a high level of lung function.
RadioFrequency Ablation is used for patients with non-small-cell lung cancer. It works by using high-energy radio waves to treat the tumor. A thin, needle-like probe is temporarily placed into the tumor to release the radio waves. It is guided accurately using ultrasound or CT scans. The probe releases high frequency alternating current that creates frictional heating and destroys the cancer cells. This has become a major treatment method for patients with tumors that are small in size.
Chemotherapy for Lung Cancer
Fox Chase has a dedicated team of medical oncologists specializing in thoracic cancers. Fox Chase researchers are among the first in the United States to conduct clinical trials for lung cancer in which personalized chemotherapy was administered based on a patients' tumor's molecular profile. After evaluating the tumor of each patient for specific genes, a personalized treatment 'cocktail' is developed, consisting of a combination of chemotherapy and/or targeted agents.
Researchers hope that such rationally selected treatments will improve response rates and survival rates over randomly selected chemotherapy combinations. Such personalized treatments are delivered to patients on and off clinical trials in the thoracic program at Fox Chase Cancer Center.
The thoracic program also offers a multidisciplinary team of specialists who work towards optimally integrating and combining systemic therapy (chemotherapy or targeted drugs) with local therapy (radiation or surgery) for patients with earlier stages of lung cancer. Hossein Borghaei, DO , Scot Ebbinghaus, MD, Ranee Mehra, MD, Michael Millenson, MD and Joseph Treat, MD, are also active members of Fox Chase's medical oncology team.
Radiation Treatment - Brachytherapy
Stereotactic radiotherapy is a very precise method of delivering high doses of radiation in only a few treatment in comparison to a more prolonged radiation course( 6 or 7 weeks) for select patients with early stage lung cancers. Results to date have been excellent with minimal side effects and is currently being offered on a clinical study.
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