Cardiovascular and Thoracic Surgery

ALERT BAR

Lung Cancer Screening 

Lung cancer remains the leading cause of cancer-related deaths in the United States with the worst five-year survival rate than any other cancer. Hence, lung screening is recommended early and showed a 20% increase in survival, according toThe New England Journal of Medicine(vol 365 no. 5). UTMB offers low-dose computer tomographic (LDCT) screening for lung cancer at its League City Campus location. This method of screening reduces mortality from lung cancer by 20 percent over traditional radiography methods.

Screening is recommended for current or former smokers ages 55-74 who have at least a 30-pack-year history and who currently smoke or have quit within the past 15 years. 

A process of informed and shared decision making with a clinician related to the potential benefits, limitations and harms associated with screening for lung cancer with LDCT should occur before any decision is made to initiate lung cancer screening. 

Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation.

A video-assisted thoracoscopic surgery (VATS) may be done before or instead of a thoracotomy. This procedure involves inserting a long, thin tube (videoscope) with a camera attached and small surgical instruments into your chest through small cuts made between your ribs. 

The VATS method may be used to:

  • Confirm the diagnosis of lung cancer.
  • Biopsy lymph nodes in the center part of your chest (mediastinum).
  • Benign nodules can be removed by VATS
  • Perform a wedge resection of your lung cancer. This removes the cancer and the lung tissue surrounding the cancer.
  • Remove the segment (lobe) of the lung that contains the cancer, in some cases. Your lungs are divided into parts called lobes. Your right lung has three lobes, and your left lung has two lobes. Removing a lobe is called a lobectomy.  Removal of an entirelung is called pneumonectomy, also performed by VATS techniques 
Lung cancer death rates compared to other cancers Lung cancer death rates compared to other cancers Lung cancer death rates compared to other cancers

It is critical to completely assess the stage or extent of spread of the cancer to other parts of the body before therapy is initiated.

Diagnostic studies needed in the work up of most lung cancers:

  • CXR (chest X-ray)
  • Chest CT (computed tomographic) scan - shows the structure of and blood flow to and from organs; will identify the size and location of the lung tumor and any enlarged lymph nodes in the chest
  • Whole body PET (positron emission tomography) scan - give us additional information about possible spread of the tumor to lymph nodes and to other parts of the body
  • MRI (magnetic resonance image) of the brain -determine if there is spread to this organ, for which PET is not reliable
  • Pulmonary function tests (PFTs) - sometimes also called lung function tests; measure how well your lungs work

Staging for cancer is conducted using the following procedures:

In some patients, we will recommend performing biopsies of the lymph nodes in the chest. This may be carried out by a procedure called mediastinoscopy or, in some cases, by a new technique called endobronchial ultrasound (EBUS) that allows us to biopsy these lymph nodes from inside the airway. Knowledge about lymph node involvement is important, because if the lymph nodes in the chest contain tumor, we may recommend giving chemotherapy or chemoradiation prior to surgery. Once the diagnosis of lung cancer is made and the staging process is completed, cancer therapy can begin.

  • Flexible Bronchoscopy - A bronchoscope is a device used to see the inside of the airways and lungs. Although it can be flexible or rigid, a flexible bronchoscope is almost always used. The flexible bronchoscope is a tube less than 1/2 inch wide and about 2 feet long. Rarely, a rigid bronchoscope is used. The scope is passed through your mouth or nose, through your windpipe (trachea), and then into your lungs. Going through the nose is a good way to look at the upper airways. The mouth method allows the doctor to use a larger bronchoscope.
  • EBUS (Endobronchial ultrasound) - An endobronchial ultrasound is a procedure that may be performed during a bronchoscopy, to provide further information to diagnose or determine the stage of a lung cancer. This relatively new technique allows doctors to view regions of your lungs and surrounding chest area that have traditionally required more invasive surgical procedures to evaluate.
  • Video Cervical Mediastinoscopy - Mediastinoscopy with biopsy is a procedure in which a lighted instrument (mediastinoscope) is inserted in the space in the chest between the lungs (mediastinum), and tissue is taken (biopsy) from any unusual growth or lymph nodes."Cervical" is an anatomical term pertaining to the neck or the female cervix.
  • VATS (video-assisted thoracoscopic surgery)- may be performed in conjunction with mediastinoscopy