Thoracic Oncology

Basis on the appearance of lung cancer cells under the lung, cancer is divided into two types

• Non-small cell lung cancer - Non- small lung cancer is also known as (NLCLC), this is a common term for several types of lung cancers that act in a similar way. This type of a cancer includes squamous cell carcinoma, adenocarcinoma and large cell carcinoma. It’s insensitive to chemotherapy as compared to small cell carcinoma (SCLC).
• Small cell lung cancer - Small cell lung cancer is also known as (SCLC), its most common in males and females and it spreads and grows faster than Non- small lung cancer (NLCLC), this makes it less likely to be cured with treatment but more likely to respond to chemotherapy

Symptoms of Non- small lung cancer and Small cell lung cancer are mostly similar, early symptoms may include

• Chest pain that gets worse when you take a deep breath, laugh, or cough
• Cough that doesn't go away
• Coughing up blood, in a very small amount or phlegm
• Fatigue
• Loss of appetite
• Shortness of breath
• Wheezing
• Bone pain
• Headache
• Weight loss without any reason

It might be possible that patient is suffering from recurrent respiratory infections such as pneumonia or bronchitis. When cancer spreads, additional symptoms depend on where the new cancer is formed. Tumors that are at the top of the lungs it can affect facial nerves, that leads to drooping of one eyelid, small pupil, or lack of perspiration on the one side of the face. All these symptoms are called Horner syndrome. This can also cause shoulder pain.

If a doctor has suspected the patient with lung cancer, then the doctor may ask for a screening procedure that includes imaging test (X- ray, CT Scan and PET scans), Sputum cytology, Tissue sample (biopsy)

• Imaging Test : An X-ray image of lungs may reveal an abnormal mass. CT scan can reveal small lesions in lungs that might not be seen on an X-ray; all these scans produce more detail and find smaller lesions.
• Sputum cytology : If patient is coughing up phlegm, microscopic examination can help in revealing if lung cancer cells are present.
• Tissue sample (biopsy): In this procedure a sample of abnormal cell is removed that is called biopsy. A doctor can perform biopsy in various ways that includes
  • Bronchoscopy in this doctor examines abnormal areas of the lungs using a lighted tube that is passed down through your mouth into your lungs
  • Mediastinoscopy in this procedure an incursion is made at the base of the neck and surgical tools are inserted behind the breastbone to take tissue samples from lymph nodes.
  • Needle biopsy in this procedure your doctor uses X-ray or CT images to guide a needle through chest wall and into the lung tissue to collect suspicious cells.

A biopsy sample can also be taken from lymph nodes or other areas where cancer has spread, such liver. There are some treatment options available for lung cancer like Surgery, Conventional Chemotherapy, Targeted agents and Immunotherapy and Radiation therapy.

If you are diagnosed with a lung cancer, patient’s care will likely be managed by the team of doctors that may include a surgeon who specializes in the chest and lungs, lung specialist, medical and radiation oncologist. Patient should discuss all the treatment option before making a decision. There are few treatment options such as Surgery, Conventional Chemotherapy, Immunotherapy and Radiation therapy.

Surgery

During the surgery the doctor works to remove the lung cancer and a margin of a healthy tissue. There are few procedures that are helpful in removing the lung cancer, those are as follows:

• Wedge resection is a form of a treatment that involves removal of a small section of the lung that contains the tumor along with a margin of healthy tissue. This surgical procedure may be an alternative option to a lobectomy.
• Segmental resection is also known as segmentectomy, it is a surgical procedure to remove a larger portion of lung, but not an entire lobe; it can also be used to remove normal tissue and tumor around it
• Lobectomy is a type of a lung cancer in which the surgeon removes the entire lobe of one lung; it’s done to remove the portion of the diseased lung. A lobectomy can also be performed occasionally for other conditions, such as fungal infection, emphysema tuberculosis, severe COPD, or trauma which interrupts major blood vessels near the lungs.
• Pneumonectomy is a surgical treatment that is done to remove an entire lung. This procedure can also be performed to treat conditions such as chronic obstructive pulmonary disease (COPD) and tuberculosis.
• If patient’s cancer is restricted to the lungs then surgery may be an option, if in case patient is suffering from a larger lung cancer, then doctor may recommend chemotherapy or radiation therapy before undergoing a surgery in order to shrink the cancer. If in case there's a risk that cancer cells were left behind after surgery or that patient’s cancer may recur, then doctor may recommend chemotherapy or radiation therapy after surgery.
• Now a days, advanced surgical techniques are introduced in the healthcare industry such as minimally invasive surgery and video-assisted thoracoscopic surgery (VATS) this helps in reducing the amount of time that patients need to spend in the hospital after lung cancer surgery and also may help them to return to the normal activities as soon as possible.

Chemotherapy

Chemotherapy treatment is often used to treat people who are suffering from lung cancer, it is combination of drugs that travels in the body to kill the cancer cell, it’s a primary treatment for small cell lung cancer This therapy depends on the type of the tumor; this option used if incase the cancer has spread outside lungs. One or more than one chemotherapy drugs can be given through a vein in arm (intravenously) or can be taken orally. Combination of these drugs is usually given in a series of treatments over a period of weeks or months, with breaks in between so that patient can recover. If there are remaining any cancer cells in the body after surgery, chemotherapy can be used to kill the cancer cells, It can also be used alone or with the combination of radiation therapy. Chemotherapy can also be used before surgery as it helps to shrink the cancer and also makes it easier to remove. Patient with advanced lung cancer, chemotherapy may be used to relieve pain.

Radiation Therapy

Radiation therapy is used as a main treatment for early stage cancer and is a promising modality; this procedure can be used for patients who are not considered for standard surgical resection. Radiation therapy has a high-powered energy beams from sources like X-rays and protons to kill cancer cells. During this radiation therapy procedure, Patient is asked to lie on a table while a machine moves around the body, directing radiation to precise points on his/her body.

Patients suffering from a locally advanced lung cancer, radiation can be used before surgery or after surgery; It is sometimes a combination with chemotherapy procedure. If in case surgery is not an option, combined chemotherapy and radiation therapy can be patient’s primary treatment.

If patient is suffering from an advanced lung cancer and if the cancer is spread to other areas of the body, radiation therapy can be helpful to relieve symptoms that include pain.

There are two types of radiation therapy

• External beam radiation therapy

External beam radiation therapy is also known as EBRT, it is one of the most common therapies that can be used to treat cancer. EBRT’s aim is to focus on radiation beam from outside the body on the cancer. It is a type of a therapy which is mostly used to treat Non- small lung cancer or it’s spread to other organs.

• Brachytherapy

Brachytherapy is also known as internal radiation therapy; it’s a form of radiotherapy; that is used to treat cancer. While the doing the procedure patient may feel pain during the placement of radioactive material, but he/she feel any discomfort once it's in place. It is frequently used to treat cancers like cervical, prostate, breast, and skin cancer and it can also be used as a treatment for tumors in many other body sites.

If it is compared with standard radiation therapy techniques, the upgraded and precisely targeted treatments can be more effective and cause less side effects

The paradigm of lung cancer is rapidly changing especially in the non curative cases where the details of the genetic and molecular abnormalities are derived from the patients cancer cells and treatments given to block the abnormal pathways that are the reason of cancer propagation in the first place.

These treatments are often oral and mostly not harsh like chemotherapy. Their tolerance and ease makes them god choice for long term usage and their excellent efficacy in addition is the reason why many lung cancer patients now talking about living with the disease rather than dying of it.

Immunotherapy

This field of oncology has significantly impacted the life of Lung cancer patients. In fact in the year 2018 Nobel Prize in Physiology or Medicine had been awarded jointly to two cancer immunotherapy researchers, James P. Allison, PhD, of The University of Texas MD Anderson Cancer Center, and Dr.TasukuHonjo of Kyoto University in Japan. This shows how immunotherapy will and is already changing the face of cancer treatment. To put simply a drug given over 30 min in halfa bottle of normal saline in day care once in 2 to 3 weeks can make some stage 4 cancers disaapear and keep it away for multiples of years. The warning is that it does not work in everyone and its side effcts are unique so only the experts, we reiterate, only the experts must decide who it is for, when is it best put to use and how to minter its effects.

• At Max Institute of Cancer Care we diagnose and treat at least 500 patients with primary and secondary thoracic cancers every year.
• Max Super-Speciality Hospital in Saket offers comprehensive cancer care delivered by trained/certified team of oncologists and physicians with a complete back-up of requisite speciality services.
• We provide treatment for all kinds of thoracic cancers, which include lung cancers, esophageal cancers, mesotheliomas, chest wall tumors and mediastinal tumors and pulmonary and pleural metastases.
• All our patients are discussed in dedicated thoracic tumour boards every week offering the benefit of multi-disciplinary input in their management. Most thoracic cancers are also discussed online with eminent oncologists across the nation at the National Cancer Grid Virtual Tumour Boards.
• Genetic and molecular information is routinely incorporated in the delivery of service to provide personalised and precise treatment.
• Patients are treated on contemporary North American and European protocols.
• Max Healthcare is at the forefront of participation in multicentre clinical trials and research related to thoracic cancers currently ongoing in India and internationally.
• We provide patient-centred care with dedicated staff to support the patient and families psychological and social needs