Treatment: Lung Cancer

By the time lung cancer is detected, the disease is often dangerously advanced. So patients need treatment that offers every possible advantage. They need fast diagnosis and the opportunity to review all treatment options quickly. The Van Elslander Cancer Center offers screening, prevention and treatment in a single, convenient location, with a staff committed to providing the fastest and most comprehensive services available. Here’s how:

• A counselor is available immediately to consult with you on your symptoms and collect a comprehensive history to assess your risk for the disease.
• This counselor can also discuss ways to minimize your risk for lung cancer.
• A full range of screening options provides the potential for quick and accurate detection.
• Patients have access to all national clinical trials.
• Our multidisciplinary team of physicians work together closely to provide the optimal treatment regimen for every patient with lung cancer, providing important advantages for those who:
  • Have recently been diagnosed with lung cancer.
  • Have risk factors for lung cancer.
  • Have been referred by their family physician or another surgeon for a second opinion about their lung cancer.

Patients who have been diagnosed with lung cancer may come to the Van Elslander Cancer Center for a second opinion consultation. Second opinions are strongly recommended for all cancer diagnoses, so that you and your oncologist can choose the best treatment. Patients should ask their physicians to submit pathology materials for our review; each case receives a written evaluation.

If you are a Van Elslander Cancer Center patient and would like to obtain a second opinion, we can assist you as part of the University of Michigan Cancer Center Network. Because we are affiliated with their network, Van Elslander Cancer Center patients receive priority treatment.

Our multidisciplinary approach to cancer care ensures that in a single visit, each patient receives a complete team of nationally recognized experts, including:

• Pulmonologist
• Radiation Oncologist
• Medical Oncologist
• Thoraic Surgeon
• Oncology Nurse

• Lifestyle Counseling: Our staff counselor can work with you to create lifestyle and exercise guidelines to minimize your risk for lung cancer.

• Comprehensive history: Our counselors will work with you to obtain a complete history, including determining your exposure to risk factors. These may include smoking or second-hand smoke. Risk factors also include careers such as firefighting, chemical industry work and a history of work that involved inhalation of fumes from heavy metals, like early chrome plating techniques before environmental guidelines were established.
• Sputum cytology: Phlegm or spit is examined under a microscope for cancer cells.
• X-Ray: This simple photographic imaging test looks for lung cancer or to determine if the cancer has spread to other areas of the body.
• CT Scan: Also known as computed tomography, this painless imaging technique uses a special X-ray tube and detectors to produce detailed images of entire areas of the body (regular X-rays focus on just one part of the body). This helps to reveal cancer in the lungs as well as cancer that may have spread to other areas.
• MRI: Also known as magnetic resonance imaging, an image created by magnetic fields helps to reveal cancer in the lungs and other areas of the body. This service is offered at St. John Hospital.
• PET Scans: Also known as Positron Emission Tomography, this nuclear medicine exam views biochemical and physiological changes in tissues, as opposed to CT or MRI scans, which look for changes in anatomy. PET scans can examine the whole body with a single scan and can help determine if a nodule in the lungs is cancerous. This screening service is offered at UMCCC (The University of Michigan Cancer Care Center).
• Needle biopsy: A needle is used to remove a piece of tissue, which is then checked by the lab for cancer cells.

To determine how far the cancer has spread, your cancer care team uses a process of analysis known as staging. The stage of your cancer impacts your treatment and the prognosis for recovery. A number of different staging systems can be used to classify tumors. The TNM staging system assesses tumors in three ways: size of the primary tumor (T), whether it has spread to lymph nodes (N), and whether it has spread (metastasized) to other organs (M). Once the T, N, and M are determined, a number of I, II, III, or IV is assigned, with stage I being early stage and IV being advanced. In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV, denotes a more serious case. Your doctor will review your test results and tell you the stage of your cancer.

The three main treatments used to treat lung cancer are:

• Radiation Oncology: High-energy rays are used to kill or shrink cancer cells. For lung cancer, external radiation is most often used (as opposed to radiation implants). Radiation may be the main treatment for lung cancer, or it may be used after surgery to ensure all areas of cancer are killed. It can also be used to relieve uncomfortable symptoms such as pain, bleeding, and trouble swallowing. Side effects usually disappear after treatment ends and can include skin irritation, nausea, diarrhea and fatigue. Chest radiation can also cause lung damage and breathing difficulties.
• Chemotherapy: Depending on the type of lung cancer and the stage, chemotherapy may be the main treatment, or it may be used in addition to surgery. Anticancer drugs are injected or given by mouth. They enter the bloodstream and flow throughout your body, which helps to fight cancers that have spread. Side effects can include diarrhea, nausea, loss of hair, rashes on hands and feet, mouth sores and fatigue. Most of these side effects disappear once treatment ends.
• Surgery: Surgery is offered at St. John Hospital and Medical Center. A hospital stay of one to two weeks is usually needed. Surgery is followed by chemotherapy and radiation. Surgery may involve removing the tumor and some of the lung tissue around it or removing the entire lung. After the surgery, you will feel some pain, because in order to reach the lungs, the surgeon must cut through the ribs.

We designed the Van Elslander Cancer Center’s team and processes to help you assess your best treatment options and begin fighting your cancer quickly – usually within two weeks of your diagnosis:

• If a screening shows an abnormality, we will contact you to return within a week to consult with a pulmonologist.
• Often that same day a biopsy will be conducted, and our pathologists will determine whether the abnormality is cancer. You will generally get these results within two working days.
• The multidisciplinary team (see Who’s on your Team, above) meets every other week in a thoracic conference to review patients’ cases. This means that your case will be presented to this team at their next meeting, providing the input of all the team members at once and access to information on any clinical trials for which you may be eligible.
• Once you have met with your multidisciplinary team, you and your doctor will develop the best plan for your treatment.
• Within two weeks of your diagnosis, your action plan for care can be developed and treatment can begin.

Once you have received treatment, one member of your team will take the lead in your follow-up care. This is usually your pulmonologist (sometimes in conjunction with your primary care physician). These individuals will follow up with you to check your healing progress, conduct breathing assessments and address any concerns, and keep all other members of your team informed of your progress.

If follow-up visits determine your treatment was successful (usually after six months), you will receive annual checkups through your primary care physician.

Your follow-up care can also include other services offered through the Van Elslander Center, such as occupational therapy. At the Van Elslander Cancer Center, we treat your whole person, not just your cancer, for complete healing of body, mind and spirit. Patients whose breathing has been affected by surgery may have to re-learn tasks they once took for granted; our therapists will be there to help you maximize your quality of life.

We also offer many routes to spiritual strengthening at our special Healing Arts Center.

Here are a few of the ways the Van Elslander Cancer Center can help you prevent lung cancer:

Lifestyle Counseling (see Specialized Services, above):

The most important way to protect yourself against lung cancer is not to smoke and to avoid people who are smoking. Beware of environmental factors, too, such as asbestos, radon and formaldehyde (click here for more information).

Screening (see Specialized Services, above):

If you are concerned that you are at risk for lung cancer or may have lung cancer, quick action is your best ally. Prompt treatment could extend your life and relieve symptoms. If you experience any of these symptoms, contact your physician:

• Hoarseness or a cough that does not go away
• Pain in your chest
• Weight loss
• Loss of appetite
• Bloody spit or phlegm
• Shortness of breath
• Recurring infections such as bronchitis and pneumonia
• Unusual wheezing

The following symptoms can occur when lung cancer has spread:

• Painful or aching bones
• Numbness or weakness in the arms or legs
• Dizziness
• Jaundice
• Swellings that appear just beneath the skin

While these symptoms do not necessarily mean you have lung cancer, the Van Elslander Cancer Center will be ready with prompt screening services to put your mind at ease or to help you begin fighting the disease as early as possible.

Clinical Trials (see Clinical Trials, below): Ask your physician about participating in clinical trials, which offer access to promising new treatments.

The Van Elslander Center is one of only 13 facilities nationwide whose patients have access to all national clinical trials. In addition, qualified Van Elslander Cancer Center patients can participate in private trials sponsored by The University of Michigan Cancer Care Center Network.

Clinical trials are conducted to study promising new treatments that have shown potential value to patients. While there can be risks, these studies offer the most leading-edge treatment options and are often found to have great benefits to patients. Taking part in a clinical trial is up to you, and once you have joined the study, you are free to leave it at any time, for any reason.

A few examples of the many clinical trials for currently available to qualified lung cancer patients at the Van Elslander Cancer Center are:

• Study of response to gene therapy and radiation oncology in patients with non-small cell lung cancer
• Testing of a vaccine that may help lung cancer patients build an immune response and fight the tumor cells
• Evaluation of the effectiveness of chemotherapy combined with augmerosen in treating patients who have extensive-stage small cell lung cancer. Augmerosen may make tumor cells more sensitive to chemotherapy.
• A study of the effectiveness in inhaling the chemotherapy drug doxorubicin as opposed to injecting or taking it orally

For a list of current clinical trials, click here or call the National Cancer Institute at 1-800-4-CANCER.

At the Van Elslander Cancer Center, we believe the strength of your mind and spirit is essential to your body’s healing process. Our Healing Arts Center is available for you to use, providing services such as massage, reflexology, mediation, music and art therapies and holistic assessment.

You can find more information on lung cancer from these sources:

• The Van Elslander Cancer Center Lung Cancer Information Page
• The National Cancer Institute (NCI)