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With an estimated 1 million new lung cancer cases per year among males and 400,000 cases per year among females, lung cancer is the most common cancer in the world, and the leading cause of cancer-related death, accounting for 1.18 million cancer deaths per year.
In the modern era of chest radiology exams, lung cancer and particularly indeterminate lung nodules are increasingly identified. Diagnosis is usually confirmed by obtaining tissue from either bronchoscopy, needle biopsy of a lung nodule, or other surgical techniques such as video-assisted thoracoscopy (VATS).
Chest x-ray, computed tomography (CT), and positron emisson tomography (PET) scans are the most common modalities to identify and stage lung cancer. PET is a whole body scan that takes 30-60 minutes, and uses a radio-labeled glucose, which tends to accumulate in tumor cells. Elevated glucose metabolism in cancer cells is the principle mechanism by which cancer is visualized with PET.
Diagnosis
The diagnosis of lung cancer is made after a chest X-ray or computed tomogram (CT) identifies an abnormality. The diagnosis is determined either by examination of the air tubes (bronchoscopy), from a biopsy taken from lymph nodes along the windpipe (mediastinoscopy and see graphic below), or from a needle passed with the help of CT (CT-guided needle biopsy).
Staging of Tumor
To determine the extent of tumor, a complete assessment called staging is performed. At MGH, a patient with lung cancer is first seen in a clinic attended by surgeons, oncologists, and radiation therapists, the Multidisciplinary Thoracic Oncology Clinic. A plan is made on the day of the visit to determine the best therapy for each patient. Appointments are usually scheduled within one week.
Thoracic Procedures
Thoracic surgery at Mass General Hospital has a long tradition in the treatment of lung cancer using both traditional and, more recently, minimally invasive techniques and VATS lobectomy for surgical removal. We also have a tumor ablation (removal) program where early stage lung cancer can be treated with radiofrequency ablation as an alternative to conventional treatment for patients who are not suited for surgical removal of the tumor.
The thoracic surgery department at MGH is one of the leading academic departments in the country and has one of the lowest rates of mortality (1.5%) with routine and complex lung surgery. Patient care is paramount.
Consultations
Consultations can also be obtained via the Center for Thoracic Cancers at the MGH Cancer Center. The lung cancer research program, supported by MGH thoracic surgery, is a multifaceted effort designed to understand thoracic cancer biology, discover novel agents, and improve treatment.
Surgery is advised for patients with non-small cell lung cancer that has not spread outside the lung. Some patients with more advanced lung cancer are treated with a combination of surgery, radiation and chemotherapy.
MGH thoracic surgeons perform the following resections for lung cancer:
- Lobectomy, pneumonectomy, segmentectomy, wedge resection
- Sleeve lobectomy
- Carinal resection, carinal pneumonectomy
- Tracheal resection
- Resection of superior sulcus tumors
- Chest wall resection
- Tumors involving the superior vena cava or the left atrium
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