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Our Treatment Approach

Lung Cancer

Experienced Team
Diagnosing Lung Cancer
Surgical Expertise
The Role of Chemotherapy
Radiation Therapy Technology
Emotional Support

Experienced Team
The lung cancer team at the Siteman Cancer Center provides nationally recognized expertise in the diagnosis and treatment of lung and other chest cancers. Our physicians treat an average of 570 new lung cancer cases each year – far more than other facilities in the region. Our program is ranked among the best in the country by U.S. News & World Report. This experience in the treatment of chest cancers means we are able to offer the latest in diagnostic tests and cutting-edge treatments.

A multidisciplinary approach combining the opinions of expert doctors in pulmonary medicine, surgery, and medical and radiation oncology is important to our treatment approach. Our team also includes psychologists and social workers to help with the emotional and financial challenges facing people with a cancer diagnosis. In addition, a nurse coordinator schedules appointments, gathers medical records, and keeps everyone – especially patients – up-to-date on treatment progress.

Diagnosing Lung Cancer
Patients are scheduled for a diagnostic work-up usually within two days of referral to Siteman’s lung cancer program. If they already have had X-rays taken or laboratory tests done, they will be asked to bring along those results. A surgical biopsy will be scheduled, if necessary.

The diagnostic evaluation of a chest cancer usually includes a simple operation called a mediastinoscopy to sample the lymph nodes below the neck. This procedure gives a better picture of the cancer. Other tests may be scheduled. Depending on where the tumor is, doctors may look into the chest, lungs or esophagus with a lighted instrument called a scope. The work-up also may include X-rays and other radiology tests.

Washington University researchers at Siteman are pioneers in the development of the newest machines to look for tumors, including a machine that combines two often-used types of scanning – PET and CT. This machine provides high-quality images of body structures from a CT scanner as well as images showing cancer activities in the cells from a PET scanner. The images are taken at the same time in a single scan, cutting exam time by about 15 minutes. Because the scan reveals so much, it can find the smallest cancer that has metastasized, or spread, to other parts of the body. Treatment can then target the cancer with the least amount of damage possible to the rest of the body.

Lung doctors work closely with chest surgeons and medical and radiation oncologists in evaluating patients who might have cancer, especially lung cancers that are in such an early stage that there are no symptoms. When treated at this very early stage, the five-year survival rate is about 83 percent – much higher than when cancer is found at a later stage.

When diagnostic tests are complete, our specialists discuss a treatment plan. There are three major ways of treating cancer. Surgery and radiation treat local tumors. Chemotherapy treats the whole body, aiming at cells that have broken away from the cancer source and spread. The doctors decide which combination of surgery, chemotherapy and radiation will be best.

Surgical Expertise
Siteman is one of only a few facilities in the country with a dedicated chest surgery unit. Our surgeons treat the most difficult cases and have become experts through their broad experience with chest surgery. Each year, these surgeons perform about 400 lung removals. They may remove a lobe of the lung (lobectomy), an entire lung on one side of the chest (pneumonectomy) or just the part of a lung affected by cancer.

Siteman surgeons remove an entire lung only when absolutely necessary. Instead, they often perform a so-called “sleeve resection,” in which the cancer in the main bronchus, or air tube, is removed and the ends of the tube are reconnected to salvage the healthy part of the lung. The sleeve surgery is more difficult than removing the entire lung, but it saves more healthy tissue so the lung can function better.

During surgery, patients are cared for by anesthesiologists who specialize in surgery of the heart and chest. We also have a full-time pain-management team dedicated to reducing discomfort as much as possible after an operation.

The Role of Chemotherapy
Chemotherapy plays many roles in cancer treatment. It may be used to cure a cancer, to control cancer growth, to shrink a tumor before surgery, to enhance radiation therapy or to chase down cancer cells that have spread to other parts of the body. Our physicians are constantly investigating new chemotherapy drugs and looking for ways to make them more effective. These drugs and other new treatments are tested in clinical trials. About 20 percent of our patients take part in clinical trials that give them access to the latest treatments before they are generally available.

In one clinical study, Siteman medical oncologists and radiation oncologists are working together to see whether they can predict which patients’ cancers will resist chemotherapy treatments using information from PET scans and the latest genetic research. Currently, there is no way of knowing beforehand whether a drug will be effective, and up to 50 percent of lung cancers don’t respond to some commonly used medicines. If, as expected, this new process is successful, physicians will have a powerful tool to help them decide which drugs to prescribe or whether to prescribe them in combination to overcome a tumor’s drug resistance.

Radiation Therapy Technology
The goal of radiation treatment is to eliminate or shrink a tumor, either alone or in combination with surgery and chemotherapy. Radiation can be delivered from outside the body or from the inside, using radiation sources implanted in the tumor. Like surgery and chemotherapy, radiation therapy is sometimes used to control a tumor that can’t be cured to improve a patient’s comfort.

Radiation techniques have been greatly improved in the past 10 years. And radiation oncologists at Siteman are pioneers in this field, adopting and adapting new techniques at the earliest possible stages. They continue their lead role in the development of four-dimensional conformal radiation therapy. This technology creates a model of the patient’s tumor that incorporates tumor motion during breathing for use in radiation therapy treatment planning. Siteman's radiation oncology team is a pioneer in developing methods that target lung tumors and avoid radiation damage to surrounding normal tissue with strategies that are tailored to each patient's needs.

Emotional Support
A lung cancer diagnosis is devastating news. Our treatment team includes mental health experts who help patients cope with the diagnosis and treatment. They may refer a patient for additional psychological services or recommend medication for anxiety and depression. Families also can benefit from social support and educational programs. Our nurse coordinators and the Barnard Health and Cancer Information Center are good sources for helpful information.

A large number of lung cancers can be linked to cigarette smoking. Patients at Siteman who smoke are not only urged to quit, but they also are provided with help to do so. We have a six-week program, Freedom from Smoking, sponsored jointly by Siteman and the American Lung Association. We also offer one-on-one counseling sessions for hospitalized patients.