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Department of Thoracic Surgery

Lung Cancer

The Department of Thoracic Surgery and the Vanderbilt Ingram Cancer Center has extensive experience in treating patients with lung cancer. The multidisciplinary treatment plan for patients with lung cancer is specifically tailored to create the best therapy for each individual patient.  The multidisciplinary treatment team will include the thoracic surgeon, medical oncologist, radiation oncologist, and other health care professionals.   

Please follow this web link to watch a Lung Cancer video presentation by Joe B. Putnam, Jr., M.D.
Click Here for Video

Incidence

Lung cancer will affect almost 200,000 people in the United States this year, and will cause death in 170,000 of them. Smoking increases one’s risk of contracting lung cancer, but many smokers never get it and many non-smokers do. If you have been diagnosed either with lung cancer or a lung mass, it is not important what you have done in the past, but what you do in the future.

Diagnosis

Lung cancer is most often suspected on either chest radiograph or a chest CT scan. To move from a suspicion to a diagnosis requires a small piece of the cancer, to allow a pathologist to determine if there are cancerous cells. This piece of tissue can be obtained from a bronchoscopy (a scope passed into the windpipe), a fine-needle biopsy (usually done by a radiologist using CT scans), or by a surgical biopsy. It is important to know that tumors are made up of dead cells, normal cells, and cancer cells. If the biopsy contains only dead or normal cells, a false diagnosis will result. This is why surgical biopsies are the most accurate. We have at least one patient a month with cancer who undergoes a biopsy, is told they do not have cancer, and subsequently loses precious time to treat it.

Stage

It is absolutely essential to accurately stage lung cancer before commencing treatment - Staging lung cancer is important because it helps to predict how the cancer might act, and helps to direct treatment. The appropriate treatment of lung cancer depends upon how advanced the cancer is, its stage. Early cancers are best treated with surgery, while intermediate cancers (those that involve lymph nodes in the chest) are best treated with a combination of chemotherapy and surgery, and occasionally radiotherapy. Metastatic (advanced) cancer is cancer that has spread from the lung to other sites. Patients that have single metastases to their brain or adrenal glands can undergo resection of both—all other patients with metastatic, or advanced cancer are best treated with chemotherapy alone.

Staging requires searching for distant spread and for local extent. Head scans (CT or MRI), bone scans, PET (Positron Emission Tomography) scans, and chest CT scans are used to evaluate possible spread to brain, bones, liver and adrenal glands. PET scans can evaluate distant disease or, to a lesser extent nodal disease. The most accurate way to evaluate local disease is a small surgical procedure; however this procedure must be performed by an expert in the field who can biopsy all the lymph node groups in the chest. If an incomplete procedure is done, the chance of complete staging and further treatment later may be lost forever. This means that anyone with suspected lung cancer must choose providers (for even initial treatment) wisely. 

 

 STAGE  TUMOR  NODES  METASTASES
IA less than 3 centimeters in size (T1) no nodes involved no metastases
IB greater than 3 cm, or
involving lung lining (T2)
no nodes involved no metastases
IIA mass involves the chest wall (T3) no nodes involved no metastases, or
  T2 nearby nodes involved no metastases
IIIA T1 or T2 chest nodes involved no metastases, or
  T3  nearby or chest involved no metastases
IIIB lesion grows into middle of chest or causes fluid may/may not be involved no metastases, or
  may be any size extensive chest nodes no metastases
IV any size may/may not be involved metastases

 

The vast majority of patients who are cured of non-small cell lung cancer have surgery at some point in their treatment. Patients with early lung cancer (cancers that have not spread to lymph nodes within their chest) can usually be cured with surgery. Patients with more advanced lung cancer (involving lymph nodes in the chest) require a combination of chemotherapy, surgery, and sometimes radiation to have a significant chance of cure. Patients who have limited metastatic disease (spread to brain or adrenal gland) can occasionally benefit from surgery, but in general are best treated with chemotherapy.

Early lung cancer (stages I and II).................Surgery only
 
Intermediate lung cancer (stage IIIA)..............Chemotherapy followed by surgery, ? radiation

Advanced lung cancer (stage IV) ..................Chemotherapy only 

(Some patients with stage IIIB cancer can be treated with surgery, as can selected patients with stage IV disease) 

Vanderbilt Results

Since 1997, Vanderbilt has had a service of surgeons board certified in general surgery and cardiothoracic surgery who have committed themselves to the practice of diseases of the chest, only. Most surgeons who do thoracic surgery have a primary interest in belly surgery or heart surgery, and only rarely do thoracic surgery.

Perhaps not surprisingly, Vanderbilt has become one of the busiest thoracic programs, not only in Nashville, but in the Southeast.  Besides the opportunity to help more people, being a busy place has been shown to improve the results of major surgery of almost any type. This is true for lung cancer at Vanderbilt as well.

This page was last updated January 18, 2013 and is maintained by