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Advancements in Treatments and Screenings Renew Hope for Lung Cancer Patients

July 08, 2022

Jennifer M Worth, MD, MBA, FACS

Medical Director of Thoracic Surgery, East Region

Hartford HealthCare Cancer Institute

Lung cancer is the most common cause of cancer death in the U.S., exceeding the number of deaths from colon, breast and prostate cancer combined. The American Cancer Society estimates that in 2022 there will be 236,740 new cases of lung cancer diagnosed in the U.S. (117,910 in men and 118,830 in women).

Lung cancer survivorship really begins at the time of diagnosis, and patients are finding ways to live along with this disease by pursuing treatments and surviving in their life in all stages of cancer activity. Given the aggressive nature of this cancer, the ideal scenario would be to prevent it from ever even occurring. Unfortunately, most cases of lung cancer are asymptomatic until the disease is more advanced. For patients with a history of smoking, lung cancer screening programs have been developed to help detect cancer at an early stage.

Lung cancer screening consists of a special CT scan that minimizes the amount of radiation used. Much like yearly mammograms, lung cancer screening CT scans are performed on a yearly basis, for patients at high risk. Many times nodules or other findings are identified on the scans that do not indicate cancer. Based on the results of your scan, you may be referred to a lung specialist (pulmonologist) or thoracic surgeon, to help determine the significance of any abnormal findings. Current guidelines for eligibility for lung cancer screening include patients who are between 50 and 80 years of age, have a history of smoking the equivalent of a pack a day for 20 years, are current smokers or have quit in the last 15 years.

Once a lung tumor has been identified, your provider will consider using other diagnostic tests, such as PET scanning, to fully assess cancer extent and help determine next steps for diagnosis. The diagnosis of lung cancer includes determining the type of cancer and its stage (the extent of the disease – for example, whether it has spread to regional lymph nodes or other organs). There are multiple ways to diagnose lung cancer and the choice is based on each patient’s specific characteristics. Options for biopsy include:

• Image guided biopsy: performed in the radiology department, usually as an out-patient procedure, with a CT scan or ultrasound to perform a biopsy with a needle from the tumor in the lung, or another suspicious location in your body. Sedation may be necessary.
• Bronchoscopy/EBUS (endoscopic biopsy with ultrasound)/robotic bronchoscopy: performed in the operating room or the endoscopy area, usually as an out-patient procedure, where a scope is placed into the airway. Using specialized tools including ultrasounds or robotic guidance, biopsies from the tumor mass and any lymph nodes may be performed. Hartford HealthCare has access to the most cutting edge robotic bronchoscopy tools. These procedures usually require the use of a general anesthesia.
• Mediastinoscopy: performed in the operating room and involves inserting a scope into the chest through a small incision at the base of your neck. Biopsies of lymph nodes lead to larger samples which may help guide both your diagnosis and treatment options. This requires the use of a general anesthesia.

After the cancer has been diagnosed and staged, determining the best course of treatment is the next step. All members of the Hartford HealthCare cancer team regularly participate in multidisciplinary cancer conferences to discuss patients with new diagnoses of lung cancer to develop personalized and optimum treatment options for each patient. For early stage lung cancers, options are usually directed at treating and eradicating the tumor directly at its location. This often consists of surgical removal and is usually performed in a minimally invasive fashion. Hartford HealthCare surgeons are uniquely trained in the most modern minimally invasive approaches and regularly use the surgical robot or VATS (video assisted thoracoscopic surgery) approaches. A minimally invasive lung operation allows for decreased pain after surgery, shorter hospital stays and earlier return to normal activities.

For patients who are not considered candidates for surgery, the use of radiation is considered. Hartford HealthCare has skilled radiation oncologists with access to the most modern tools, including highly focused stereotactic techniques. If the tumor is more advanced or the cancer has spread to lymph nodes, medical oncologists work with you to determine your best options for chemotherapy, targeted molecular therapy or immunotherapy based treatments, sometimes in combination with radiation therapy. Through the Hartford HealthCare Cancer Institute and our partnership with Memorial Sloan Kettering, our medical oncologists have access to the latest research studies and medications to ensure you are receiving the best care for your cancer. Each patient will have a team of specialists who work collaboratively to provide a personalized care plan.

As a result of decreased prevalence of tobacco use and substantial improvements in therapy, we have witnessed a 30 to 40 percent decrease in lung cancer mortality over the past 10 years. This exciting trend means that many more people are surviving the disease than ever before.

After completion of the course of treatment, the next stage of survivorship consists of surveillance. Surveillance guidelines involve undergoing regular examination by your cancer doctors as well as CT scanning. The aim of this is to ensure that we are keeping a close eye on you and your body.

Throughout the period from diagnosis, treatment and surveillance, patients are surviving and living with their cancer. This may provide different challenges for each patient. Hartford HealthCare is well equipped with nurse navigators, social workers, nutritionists, physical therapists and many other support services throughout the entire health care system. This team can help patients deal with long term effects of cancer therapy and strive towards as much normalcy as possible. The diagnosis of any cancer, and especially lung cancer, is particularly scary. At Hartford HealthCare we look forward to partnering with you to ensure that all of your needs are met, you cancer is well cared for, and you are able to continue to thrive and survive despite this difficult diagnosis.