Lung cancer questions answered

Lung cancer is a silent killer. Many patients do not know they have lung cancer until it is picked up in a chest X-ray or they have a sign of metastasis that causes the physician to do further testing. Those signs include spitting up blood, pain while taking deep breaths and shortness of breath. 

A cold that does not resolve or pneumonia, especially among smokers, may also be signs of lung cancer, and anyone experiencing those symptoms should receive a chest X-ray. 

What are the various types of lung cancer? 

There are many types of lung cancer, but for clinical purposes they are placed into two broad categories: small cell and non–small cell. Small cell lung cancers usually must be treated with chemotherapy or radiation, whereas non–small cell lung cancers can often be treated with surgery and other combinations of treatment. Of course, all treatment plans must be individualized for the specific person and the specific cancer type. 

What is interventional pulmonology? 

Interventional pulmonology is a relatively new field that has evolved over the past 25 to 30 years. It uses minimally invasive endoscopic approaches to help diagnose, stage and treat cancers affecting the lung, chest and airways. Interventional pulmonologists are trained in internal medicine before going through a three-to-four-year pulmonary and critical care fellowship. 

What role does interventional pulmonology play in lung cancer? 

It plays multiple roles in the diagnosis and the management of lung cancer. First, interventional pulmonologists help identify the specific tissue type and stage of the tumor by using advanced, minimally invasive diagnostic approaches. 

We also help maximize the breathing and pulmonary functions of lung cancer patients, especially those with a smoking history, giving them the best chance to tolerate the treatments they need to control the disease. About 30 percent of all lung cancer patients develop obstructions in their airways. By opening patients’ airways and minimizing shortness of breath, we can improve their performance status and their ability to go on with further therapies. 

Multiple side effects can also occur in the lungs, so we can help diagnose and manage those complications as well. 

How can interventional pulmonology benefit other cancer patients? 

Interventional pulmonology can benefit patients facing many different types of cancer. Breast, colon, kidney and melanoma cancers frequently spread to the lungs and the airways. As a result, the affected patients have a relatively high likelihood of experiencing symptoms of shortness of breath due to airway obstruction or fluid accumulation in the chest cavity. 

Interventional pulmonologists can treat lung metastases using cold and/heat ablation such as lasers, an argon plasma coagulator, cryoablation, and are skilled to maintain patency with special stents if needed. Pleural effusions (fluid buildup between the lung and the chest wall), can also be managed by various procedures that include talc pleurodesis or tunneled pleural catheters.  

Further, an interventional pulmonologist plays an important role in the multi-disciplinary approach in the management of patients with malignant or benign lung diseases. 

Dr. Rabih Bechara is chief of interventional pulmonology, pulmonary and critical care medicine at the Cancer Treatment Centers of America in Georgia. Dr. Mark Lund is director of interventional pulmonology, bronchoscopy, and the intensive care unit at the Cancer Treatment Centers of America in Pennsylvania. Dr. Bechara will be speaking at this week’s Conquering Cancer event. 

Dr. Bechara
Dr. Bechara