Lung Cancer

Watch: Dr. Eric Anderson explains how a new diagnostic tool can help patients receive a diagnosis within hours instead of weeks.

State-of-the-art molecular profiling can identify targets that respond effectively to advanced therapies.

An accurate diagnosis is critical for determining the best treatment options. State-of-the-art biomarker and genetic testing allow us to identify molecular characteristics that may predict how well a tumor will respond to innovative therapies like immunotherapy or groundbreaking targeted drugs. We learn as much as we can about your specific cancer through lung tissue samples and bloodwork, which allows us to personalize our treatment approach.

Combined robotic assisted thoracic surgery (CRATS)

One procedure diagnoses and treats patients with high-risk lung cancer

Combined Robotic Assisted Thoracic Surgery (CRATS) can detect, biopsy, diagnose, stage, and remove lung tumors during a single, minimally invasive procedure. This procedure significantly shortens the time between diagnosis and treatment, cutting it from weeks to hours and limiting the chance for the cancer to spread.

How Combined Robotic Assisted Thoracic Surgery works

The entire process is completed during a single procedure. Patients first undergo a low dose CT scan of the lung to look for tumors. If a tumor is found, the Ion robot bronchoscope is used to biopsy the tumor and determine if it’s cancerous. If cancer is found, a special types of ultrasound called endobronchial ultrasound is used to find out if the cancer has spread to lymph nodes.

If the lymph nodes are normal, the patient immediately has surgery to remove the portion of the lung with the tumor. This surgery is done using the DaVinci robotic video-assisted thoracic surgery system. The entire procedure, from CT scan through surgery, is done during a single administration of anesthesia.

Advantages of CRATS

• Less time between diagnosis and treatment can reduce the risk of the cancer spreading and improve outcomes.
• Minimally invasive procedure makes recovery quicker.
• Patient only has to go under anesthesia once.

Types of lung cancer

There are two main types of lung cancer named for how the cells appear under the microscope:

Non-small cell lung cancer (NSCLC)

About 80 percent of lung cancers are non-small cell lung cancer, which usually grows and spreads to other parts of the body more slowly than small cell lung cancer. The main subtypes of NSCLC are:

• Adenocarcinoma: Develops in epithelial tissue cells, often in an outer area of the lung
• Squamous cell (epidermoid) carcinoma: Usually found in the center of the lung next to an air tube (bronchus)
• Large cell (undifferentiated) carcinoma: Can occur in any part of the lung and tends to grow and spread the fastest

Small cell lung cancer (SCLC)

Small cell lung cancer (SCLC) represents about 10 to 15 percent of cases and is fast-growing, typically found in both lungs, and usually symptom-less until it reaches later stages. It is almost always associated with smoking and often spreads before it's found. The two sub-types of SCLC are:

• Small cell carcinoma (oat cell cancer)
• Combined small cell carcinoma (mixed small cell/non-small cell carcinoma)

Other types

It is possible to develop lung cancer with small and non-small cell lung cancer features. While rare, a third type is possible, called lung carcinoid tumors. Fewer than five percent of cases are lung carcinoid tumors, which don't spread quickly and can typically be treated with surgery.

Cancer can spread (metastasize) to the lungs from other parts of the body, through the bloodstream, or lymphatic system. So even though the cancer is now found in the lungs, it's still classified and treated based on where it started.

Lung cancer stages

Once we know the types of lung cancer you have, we determine stages, which tells us how far your cancer has spread to nearby lymph nodes and organs.

• Stage I - Stage I lung cancer is an isolated tumor in one lung. At this point, it has not yet spread to the other lung, lymph nodes or any other organ which makes it easier to treat surgically, if the patient is in otherwise good health.
• Stage II - During this stage, lung cancer typically has spread to a lymph node on the side closest to the tumor. This stage could also be determined by the size of the tumor. Often, we treat stage II lung cancer with surgery and a combination of radiation and/or chemotherapy. If patients are not good candidates for surgery due to underlying medical conditions or other lung diseases, we would take a different approach that may involve targeted radiation.
• Stage III - Lung cancer has spread to lymph nodes in the center of the chest and the other side. Lymph nodes serve as the drainage organ of the body so if cancer spreads, it often starts at the drainage side closest to the side of the lung with cancer. At this stage, it likely spread to the other side as well, and potentially to other organs. Typically, cancer at this stage involves more invasive treatment with a combination of surgery, chemotherapy, radiation, and/or immunotherapy.
• Stage IV - This is the most advanced stage of cancer, as cancer has spread to the other lung or elsewhere in the body. Stage IV is the most difficult to cure and treatment options are often working toward extending your life expectancy with the least amount of symptoms and the greatest quality of life. However, even some stage IV cancers respond well to immunotherapy and targeted therapy, offering more hope than ever before.

 
At MedStar Health, we use the state-of-the-art da Vinci® Robotic Surgical System to perform robotic-assisted surgery for most cases of non-small cell lung cancer in stages I and II. We also perform robotic surgery for some patients who have already received chemotherapy or radiation to reduce the tumor's size. During the procedure, our thoracic surgeons use the robotic 3-D camera and tiny rotating instruments to operate with extreme precision. Patients benefit from smaller incisions, shorter hospital stays, less pain, fewer complications, and better outcomes.

Previously the time from diagnosis to treatment could take several weeks. Now, removing a cancerous tumor at the time of diagnosis is possible, thanks to robotic-assisted procedures. We're the first in the region to offer a new approach called Combined Robotic Assisted Thoracic Surgery to diagnose and treat lung cancer in the same day.

Watch: Dr. John Lazar, thoracic surgeon at MedStar Health, discusses treatment options for patients with lung cancer.

Learn More About Lung Cancer Surgery

Chemotherapy

Chemotherapy is an effective way to destroy cancer cells that break off from the main tumor. During chemotherapy, your oncology specialists use special medicines to shrink and kill cancer cells in the lungs and other affected organs. It may be given through a pill, injected by a needle into a vein or muscle, or a combination of both.

Depending on your situation, chemotherapy can be used for

• Eliminating cancer
• Supporting other treatments
• Minimizing the spread of cancer
• Symptom relief when lung cancer is too advanced to be cured

Learn More About Chemotherapy

Immunotherapy and targeted therapy

Your immune system is naturally equipped to protect you from disease. Today, new immunotherapy drugs help your immune system attack cancer cells with more strength than before. Immunotherapy uses your immune system to aggressively fight back against lung cancer cells. In many cases, immunotherapy is replacing chemotherapy because it can improve survival rates while limiting toxicity and side effects. Immunotherapy doesn't work for everyone, but it can be a path to a cure for some.

Learn More About Immunotherapy

Similarly, targeted therapies can work exceptionally well for patients with non-small cell lung cancer tumors that exhibit specific molecular vulnerabilities. When we can identify these biomarkers, we can treat cancer cells as aggressively as possible with targeted agents. These targeted therapies are focused on exclusively weakening or damaging cancer cells, which results in less damage to healthy cells (and often fewer side effects). As a leader in clinical trials involving targeted therapies, we have extensive experience with these drugs and can offer them to eligible patients sooner than other institutions.

Learn More About Targeted Therapy

Radiation therapy

Radiation uses high-energy rays, similar to x-rays, to kill cancerous cells in the lungs. Different kinds of radiation therapy offer benefits for lung cancer tumors, and we were the first in the region to provide several advanced forms of radiation, including:

• Proton therapy with HYPERSCAN™ technology uses pencil beam scanning, the latest advancement in proton therapy that targets tumors layer-by-layer. At MedStar Health, we were the first in the world to offer HYPERSCAN technology, giving us the most experience in delivering customizable radiation with unmatched precision.
• CyberKnife^Ⓡ treatment delivers high doses of concentrated radiation to unwelcome tumors from every possible angle in 3 to 5 visits compared to 40 necessary for conventional radiation. It's one of the most advanced and effective FDA-approved treatments for cancer, especially if your tumor is inoperable. It also uses a tool called Synchrony to stabilize positioning while the lungs move as patients breathe during treatment, ensuring healthy tissue remains untouched.

Here, you’ll also find other forms of radiation therapy, including:

• 3-D Conformal Radiotherapy, a radiation therapy technique that sculpts radiation beams to the shape of a tumor. This is ideal for tumors that have irregular shapes or for those that are close to healthy tissues and organs. We view a tumor in three dimensions with the help of imaging, then deliver radiation beams from several directions to the tumor.
• Intensity-Modulated Radiation Therapy (IMRT) uses devices that allow the radiation beams to move and change intensity depending on what kind of tissue they are targeting. This flexibility allows different areas of a tumor to receive different amounts of radiation and helps protect healthy tissue from unnecessary radiation exposure.
• Image-Guided Radiation Therapy (IGRT) uses high-quality imaging technology to create images of targeted areas of a tumor during the radiation procedure. Using these images, your radiation oncology team carefully adjusts radiation beams and doses to best fit the size, shape, and location of the tumor during your treatment session
• Stereotactic Body Radiotherapy (SBRT) is a new form of radiotherapy that uses high doses of radiation to target smaller lesions within the lungs. With a highly targeted dose of radiation, your treatment team can safely deliver radiation to very small regions with a high probability of destroying that particular tumor.
• 4-D Motion and Gating uses a 4-D computerized tomography scanner to plan treatment, monitor tumor motion while you breathe, and provide gated delivery during treatment. Gating allows us to treat the tumor at its smallest dimension during one phase of your breathing cycle. This limits the radiation delivered to healthy tissue. 

Watch: Dr. Kelly Orwat, radiation oncologist, explains how radiation can be used to treat lung cancer.

Learn More About Radiation Therapy