Surgery / Cardiothoracic Surgery: Lung Cancer

What is the Washington University Advantage ?

Experience. Our physicians treat an average of 570 new lung cancer cases each year – far more than other facilities in the region. This means they have seen all forms of the disease and have at hand a large armory of technology, drugs, radiation and surgical treatment options and access to clinical trials if desireable.

Teamwork A multidisciplinary approach – combining the opinions of expert doctors in pulmonary medicine, surgery, and medical and radiation oncology – is important to our treatment management.

Our team also includes psychologists and social workers to help with the emotional and financial challenges facing people with a lung cancer diagnosis.

How are patients diagnosed ?

Patients are scheduled for a diagnostic work-up usually within two days of referral. If they have already had X-rays taken or laboratory tests done, they will be asked to bring along those x-rays and lab results. A surgical biopsy will be scheduled, if necessary.

A nurse coordinator will make the necessary appointments, then make sure all involved physicians are given the results. When possible, the nurse coordinator will schedule several tests on one day in order to cut down the number of trips the patient needs to make.

The diagnostic evaluation of a suspected cancer in the chest area is made using a mediastinoscopy to sample the lymph nodes below the neck.

Other tests may also be scheduled. Depending on where the tumor is, doctors may look into the chest, lungs or esophagus with a lighted instrument. The work-up may also include X-rays, CT scans or PET scans.

Washington University researchers are pioneers in the development of the newest machines to look for tumors. One of the newest scanning machines combines two often-used types of scanning – PET scans and CT scans – in one machine.

This machine provides high-quality images showing body structures, such as bones and organs, from a CT scanner, as well as images showing cancer activities in the cells from a PET scanner. The images are taken at the same time in a single scan, cutting the patient’s exam by about 15 minutes.

Because the scan reveals so much, it can find the smallest cancer that has spread to other parts of the body. Treatment can then target the cancer with the least amount of damage possible to the rest of the body.

How is Lung Cancer Treated ?

There are three major ways of treating cancer. Surgery, radiation and chemotheray. Surgery and radiation are used to treat localized tumors. Chemotherapy treats the whole body, aiming at cells that have broken away from the cancer source.

Surgery - Washington University has a dedicated thoracic surgery unit - a suite of hospital rooms designed for thoracic (chest) operations.

Each year, our surgeons perform about 400 lung removals. They may remove a lobe of the lung (lobectomy), an entire lung on one side of the chest (pneumonectomy), or just the part of the lung affected by the cancer (lobectomy), the most common procedure. Lobectomies have a lower risk of the cancer returning and a good survival rate.

Surgeons remove an entire lung – a pneumonectomy – only when absolutely necessary. Instead, they often perform a so-called “sleeve resection,” in which the cancer in the main bronchus is removed and the ends reconnected to keep the healthy part of the lung.

The “sleeve” surgery is more difficult than removing the entire lung, but it saves more healthy tissue so the lung can function better.

Medical Oncology - Chemotherapy plays many roles in cancer treatment. It may be used to cure a cancer, to control cancer growth, to shrink a tumor before surgery, to enhance radiation therapy, or to chase down cancer cells that have spread to other parts of the body. Our physicians are constantly investigating new chemotherapy drugs and looking for ways to make them more effective.

Many new treatments are available through clinical trials.

Radiation and Scanning Technology

The goal of radiation treatment is to eliminate or shrink a tumor, alone or in combination with surgery and chemotherapy. Radiation can be delivered from outside the body or from the inside, using radiation sources implanted in the tumor. Like surgery and chemotherapy, radiotherapy is sometimes used to control a tumor that can’t be cured, to improve a patient’s comfort.

Radiation techniques have been greatly improved in the past ten years. And radiation oncologists at the Mallinckrodt Institute are pioneers in this field, adopting and adapting new techniques at the earliest possible stages.

They continue their lead roles in the development of three-dimensional conformal radiation therapy (3D CRT), which will be the standard care of the future. This technology and software creates a model of the patient’s tumor, evaluates the effect of various radiation levels, and verifies dosage. By delivering multiple radiation beams from several angles, doctors can fit the radiation field as closely as possible to the outline of the cancer and limit side effects.

A large-bore CT scanning simulator, which scans patients in the positions in which they will receive radiation therapy, will mean further improvement of 3D CRT.

Regional/National Referrals

We treat many patients from outside the region and outside United States. For North American referrals, physicians may call the Barnes-Jewish Hospital Doctors Access Line at (800) 252-DOCS (3627).

Patients in the continental United States may refer to Family and Guest Services for assistance with lodging.

International Referrals

Physicians and patients from countries outside of the United States may view a complete list of our Centers of Excellence available for International Healthcare Referrals